Hospitals are struggling with how to get a return on their investments for remote patient monitoring, particularly in rural communities.
Adoption of remote patient monitoring, which can use smartphone applications, connected devices and telehealth to treat conditions such as heart disease, has lagged in hospitals due to reimbursement uncertainty from commercial payers and the Centers for Medicare and Medicaid Services. Reimbursement is especially challenging in rural and underserved areas where providers say the technology has the potential to extend care and significantly improve patient outcomes.
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"CMS modifies payments to providers based on the cost of living, so providers in rural areas with lower cost of living tend to be reimbursed at lower rates than providers in areas with a higher cost of living,” said Maya Sandalow, associate director of the Bipartisan Policy Center’s health program. “It's important that CMS and other payers ensure that the reimbursement levels are really adequate to pay for high quality programs.”
There is hope among vendors selling the technology that the Trump administration and Congress will take steps to make virtual care more accessible to rural providers.
In the absence of any changes to reimbursement, providers will have to look elsewhere for cost savings. Montage Medical Group, a multispecialty practice based in Monterey, California, said remote patient monitoring allows it to offer more care without having to hire doctors.
“Primary care doctors are at an absolute premium,” said CEO Dr. Mark Carvalho. “We bring one in, and they almost immediately fill up with new patients because there's such a gap. So, any of the tools that we use, such as [remote patient monitoring], are offsetting office visits and creating capacity because we are never going to get there from a hiring perspective.”
On average, Montage Medical's monitoring program has reduced in-person patients by 500 to 1,000 visits per year, Carvalho said. It particularly has been helpful in the parts of Monterey County where there are significant transportation barriers. Many patients would forgo receiving care if there was not remote monitoring, he said.
A study of 23,000 patients being treated for hypertension and part of a remote patient monitoring program, more than half of whom were in rural and underserved communities, demonstrated the technology's promise.
There was a 70% increase in the percentage of all patients achieving their blood pressure goal and a 27% reduction in hospital admissions, according to the study, published in November by researchers from Boston-based Massachusetts General Hospital and Durham, North Carolina-based Duke Health.
The findings, presented at the American Heart Association’s scientific meeting, show the importance of constant care for hypertension patients, said Dr. David Feldman, cardiovascular medicine fellow at Massachusetts General Hospital and one of the researchers.
“They need a resource to reach out to when things aren't going well and when we identify that things aren't going well, we need to act on it,” Feldman said. “Whether you’re in a rural or urban area, hypertension looks the same. The difference is someone in an urban area has accessibility to act on it while those in a rural area do not.”
The study's authors said cost savings were driven by a reduction in hospital admissions. Researchers analyzed CMS claims data and compared patients in monitoring programs against those who utilized the system without the remote care. They estimated providers saved $1,308 annually per patient for those in the remote patient monitoring program.I
Even with savings, lower Medicare reimbursement has made it hard for hospitals to sustain the programs, said Dr. Marat Fudim, another researcher on the study and an advanced heart failure and cardiology specialist at Duke Health.
Reimbursement isn’t the only challenge facing rural adoption of the technology programs.
Many areas lack the broadband internet coverage required for the programs and patients may not use the devices consistently. Around 25% of rural Americans lack broadband internet coverage, according to a 2022 report from The Pew Charitable Trusts’ broadband access initiative.
“In order for these programs to work well, a lot of elements have to align right,” Sandalow said. “The patient needs to actually use the technology as prescribed. The data has to transmit well to the providers and then providers need to be able to detect abnormal readings and respond quickly … and that requires significant financial investment. Rural providers are already overburdened.”
