Increase in remote patient monitoring driven by small number of PCPs

Key takeaways

• There was a rapid rise in remote patient monitoring during the COVID-19 pandemic, with 19,762 claims across 15,862 unique patients in March 2021, up from 4,355 claims across 3,653 patients in February 2020.
• Out of 336,113 primary care providers, only 342 accounted for 69% of remote patient monitoring claims in 2020.
• Remote patient monitoring could help improve early disease detection, patient engagement and treatment effectiveness, but barriers to implementation include costs as well as the need for education among patients and practices.

Billing for remote patient monitoring increased more than four times during the first year of the COVID-19 pandemic, with much of the rapid growth driven by a small number of primary care providers, a new study in Health Affairs found.

In 2020, early in the pandemic, “Medicare and commercial payers made further changes to encourage the use of remote patient monitoring, including waiving cost sharing and relaxing requirements for billing, such as minimum measurement days and the need for established patient-provider relationships,” Mitchell Tang, a doctoral student at Harvard University, and colleagues wrote.

The researchers examined deidentified claims data from the data asset center OptumLabs Data Warehouse, which were filed from January 2019 to March 2021. Overall, they found there were 19,762 general remote patient monitoring claims across 15,862 unique patients in March 2021, up from 4,355 claims across 3,653 patients in February 2020. Continuous glucose monitoring “showed a more modest increase,” according to the researchers, rising 51% from February 2020 to March 2021.

Of the 336,113 eligible primary care providers in the study, just 342 accounted for 69% (n = 34,406) of the insurance claims for remote patient monitoring in 2020, while 3,019 accounted for 31.1% (n = 15,493).

“In contrast, the top 0.1% of primary care providers by outpatient telemedicine claims volume accounted for only 6.1% of telemedicine claims,” the researchers wrote.

The researchers did not observe targeted use of remote patient monitoring. Of the 8,481 patients with diabetes or hypertension who were treated by high-volume providers in 2019, 21.5% had a remote patient monitoring claim in 2020.

Speaking to Healio, Tang highlighted several barriers that primary care providers face in successfully implementing remote patient monitoring, which not only include upfront costs in acquiring devices, but “the organizational costs related to learning how to effectively operate the program.”

“PCPs and their staff must learn how to educate patients on appropriate use, including how to overcome patient digital literacy barriers or digital infrastructure limitations,” he said. “They must also establish new processes to handle this new stream of data, for example, determining who will actually monitor the data and how and when it will be relayed to physicians.”

Despite the small number of primary care providers that utilize it, remote patient monitoring could enhance patient care. Presenting a scenario where a patient with hypertension is given a connected blood pressure cuff for daily readings, Tang detailed three key outcomes.

“The data could help the provider assess the effectiveness of the current treatment plan, and adjust accordingly; the data could improve patient engagement in their own condition management; [and] the data could enable early detection of complications,” he said.

Tang and colleagues recommended further research be conducted on potential benefits of remote patient monitoring — which was not assessed in the current study — while “payers and policy makers should closely monitor its use and be prepared to establish appropriate controls as informed by new evidence.”