This is a generalized list of the decisions and execution items required to establish a program for remote patient monitoring. It is intended to provide guidance to office managers and practice owners contemplating such a program.
If you have questions, please feel free to call BlueStar and ask for free consulting help. We’re happy to help you as you plan out your program—no obligation on your part.
PROGRAM PLAN and GOALS
a. Decide: what are the goals of the program? Is it to better care for patients? To generate additional revenue? To meet an existing clinical requirement for care? To create additional work for healthcare providers who are not fully loaded?
b. Specify the reasons for having the RPM program.
c. Estimate the potential number of patients that might ultimately be in the program. (A program for 10 patients will be built differently than a program for 100,000 patients.)
d. Research RPM: read a few of the ten industry documents provided on the BlueStar TeleHealth home page.
2. FINANCIAL PLAN
a. Determine the reimbursements that might be available for the program:
iii. Medicare Advantage
v. Identify patient co-pays and deductibles, and the probability of collection thereof
b. Determine the costs for delivery of the program
i. Hardware, including inventory, shipping, refurb, etc
ii. Software, including training and tech support
iii. Monitoring of data and connection to EMR
iv. Other, including staff time
c. Calculate the resultant positive cash flow, and determine if that cash flow is sufficient to justify the program
3. ENROLLING PATIENTS
a. Specify: what disease state or condition will you focus on?
b. Specify: who will decide on what patients to enroll?
c. Specify: how will the patients be enrolled?
i. Face to face, or via phone?
1. Who does it—doctor, staff, third party?
ii. How will the clinical provider enroll the patient to initiate activation?
1. Via e-mail
2. Via an EMR entry
3. Via a web-form
4. Via a written note (prescription pad)
a. Pick the peripherals needed to monitor the disease states and chronic conditions
b. Decide on communications protocols: wifi or cellular?
c. Decide on how to transmit the data from the peripherals to the web-based platform:
i. Patient-owned smart phone?
ii. Standalone hub?
iii. Patient owned television set?
iv. Direct cellular from peripheral?
d. Identify sources of equipment and hubs, and get prices and availabilities
e. Verify FDA approval
f. Get sample equipment; use it, test for suitability
a. Pick a software from among the dozen or so in use nationally.
b. Identify license fees and per-user costs
c. Decide on the level of EMR integration required
iii. Automated (limited)
iv. Automated (full)
d. Sample the software for suitability
e. Build the training gameplan—who will need training, and how will they get it?
f. Identify source of customer support for patients who need it
g. Identify source of technical support for staff
a. Specify: who will do the monitoring?
b. Establish a written protocol for monitoring, signed by the chief clinician
c. Specify: when will alerts be generated?
d. Specify: who will receive alerts?
e. Specify: what non-alert communications will be required, and to whom will they be sent?
f. Specify: what EMR entries will be required?
i. When will they be posted?
ii. Who will post them?
g. Specify: what means will the monitoring team use to ensure patient engagement?
a. Specify: who will bill for reimbursement?
b. Specify what data will be needed to provide to the billing office, and how that data will be generated, and by whom
c. What requirements must be met to bill for CPT codes 99453, 99454, 99457, and 99458?
d. Establish an in-house policy for the use of 99458—are you willing to bill for it? And if so, how many times per month?
e. Specify the documentation required to provide auditability.
8. CLINICAL FOLLOWUP?
a. When the monitoring team determines that a patient needs attention
i. How will they transmit that need?
ii. To whom/
b. Will clinical followup occur via a telehealth event with the patient?
i. If so, who makes the appointment with the patient?
ii. What hardware will the patient and clinical team use for the video interaction?
9. PATIENT TURNOVER
a. Specify: at what level of non-compliance will a patient be asked to leave the program?
b. Specify: how will a non-compliant patient be notified of being removed?
c. Specify: Will you require the equipment to be returned, and if so, how?
d. Determine a gameplan for how to store, refurbish, retest, re-pair, and re-issue the previously-used equipment.
10. METRICS AND MEASUREMENTS
a. Determine what to measure, and how to determine success
b. Engagement and compliance:
i. Total patients enrolled
ii. Patients participating
iii. Patients who are non-compliant more than 30 days
i. Theoretical revenues based on CPT code accomplishment
ii. Amount submitted for reimbursement
iii. Net difference between reimbursements and costs
i. Patient satisfaction scores
ii. Trends in chronic conditions