3 Areas to focus to succeed in the RTM world

Technology-enabled remote care delivery in healthcare has driven significant improvements in patient care and outcomes. Remote Patient Monitoring (RPM) and Remote Therapeutic Monitoring (RTM) have emerged as key innovation opportunities to engage with patients beyond the clinic's walls.

RPM claims have increased nearly 1300% from January 2019 to November 2022. The number of clinicians using an RPM technology by August 2023 to manage their patients is up to 84% compared to 20% in 2021. This was not the case pre-COVID era; many companies looking to provide insights on physiologic data of patients outside of the clinic for review to clinicians ended up in the graveyard for nearly a decade before the COVID pandemic of 2019.

The recent adoption of RPM in 2018 and later and with the global medical crisis that occurred, led to the discussion and proposal of the codes for RTM based on peer-reviewed evidence collected by a few companies in the Musculoskeletal (Reflexion Health) and Respiratory (Propellor Health) space.

Both provide invaluable data outside traditional clinical settings by using medical devices (hardware and software). It is important to know and understand the subtle differences between RPM and RTM summarized in the chart below

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Over the past decade and a half, RPM has gained traction with clinicians and the reimbursement communities. It is now RTM’s turn for the uphill battle of adoption. Having worked with a many organizations implementing RTM, we observed a few critical challenges that entrepreneurs need to address head-on:

Know thy customer

1. Is your solution assistive or disruptive?: Healthcare providers often operate within deeply ingrained protocols and workflows optimized over the years to deliver patient care efficiently. Introducing RTM into these established practices requires changes not only in technology but also in the behavior and routines of healthcare professionals. This disruption can lead to staff resistance, slowing adoption and limiting RTM solutions' scalability. It important to recognize the success RPM has had on improving patient outcomes across healthcare sectors by facilitating timely interventions, enhancing chronic condition management and reducing hospital readmissions by integrating into the workflow of the providers.
2. Understand how practices operate i.e. Time Management, Cash flow & Clinical Workflow: Healthcare professionals already face considerable demands on their time. The integration of Remote Treatment Monitoring (RTM) into these established routines introduces additional responsibilities, such as monitoring patient data, tailoring treatment plans from afar, and communicating more frequently with patients. These responsibilities, often extending beyond the bounds of billable hours, can compound the workload if not seamlessly incorporated. It is critical to understand that small to medium practices operate on very low net margins thanks to the administrative load from billing and claims. Recognizing how RPM has demonstrated its the value for cost effectiveness success, particularly in managing chronic conditions like hypertension is essential. By reducing the need for hospital stays and emergency visits, RPM has been shown to significantly lower healthcare costs. In fact, its implementation has been associated with a dramatic 85% reduction in hospital readmissions translating to substantial cost savings of about $5.5 million. Thus, while RTM may initially seem to add to the burden, with thoughtful integration and the use of automated systems, it promises considerable long-term financial benefits, alleviating some of the financial pressures from the administrative aspects of care.‍
3. Technical Integration with Existing Systems: Effective RTM implementation requires seamless technical integration with healthcare IT systems, such as electronic health records (EHRs) and practice management software. Achieving this integration can be technically challenging and costly, creating another barrier to the widespread adoption of RTM. Without smooth integration, the benefits of RTM, such as improved patient monitoring and data-driven decision-making, can be outweighed by the inefficiencies and frustrations of disjointed systems.

Regulatory and Reimbursement Uncertainties:

The ambiguous nature of regulatory requirements for Remote Treatment Monitoring (RTM) adds a layer of complexity to its integration within healthcare practices. As definitions and guidelines for medical device classification continue to evolve – with the FDA distinguishing between devices that require registration and those subject to enforcement discretion – healthcare payers and providers face a landscape riddled with ambiguity from commercial payers being able to determine an appropriate reimbursement rate for RTM services. This ambiguity plays a critical role in the hesitancy surrounding RTM adoption due to exposure of risk related to the use of the “medical device”.

Clarity and consistency in these areas would not only encourage broader adoption of RTM but also streamline clinical operations, leading to improved patient outcomes and a more efficient healthcare delivery system as seen with RPM.

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Patient Engagement Difficulties:  

RTM's effectiveness, like RPM, heavily relies on patient participation where the patient needs to engage and provide reviewable data at least 50% of the days within a 30-day period of time. With non-physiological data collection being the core data collection component of RTM, it implies that significant data collected will be subjectively collected data such as Patient Reported Outcome Measures (PROMs) making patient engagement even more important.

Engaging patients, particularly those not tech-savvy or without access to necessary devices, remains a significant hurdle. Additionally, many traditionalists (clinicians and patients) interpret remote monitoring as impersonal, which may affect their attitude towards delivery, which affects the motivational dynamics crucial in physical therapy.

Over the years RPM has shown to empower patients to actively participate in their healthcare, leading to higher satisfaction and a better understanding of their conditions. Clinicians are delivering higher touch points of care by enhancing the therapeutic alliance between patient and clinician. One hospital showed patient satisfaction over 90% for those in their RPM program.RPM has demonstrated that for patients in remote locations or for those who may not have the ability to access quality healthcare, it can break down geographical barriers, urban transportation complexities and while optimizing resource allocation. In urban & rural areas, 75% of doctors have adopted Remote patient monitoring to manage chronic disorders, 65% adopted RPM for medical management, & 60% for care coordination.

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Looking Ahead: The Future of Remote Monitoring

The juxtaposition of RTM's challenges with RPM's benefits underscores a critical path for the future of healthcare technology. To unlock RTM's full potential, a collaborative effort among healthcare providers, technology developers, regulators, and insurers is necessary. Addressing RTM's obstacles requires clear regulatory guidelines from the FDA and across insurance, interoperable technology solutions, effective patient engagement strategies, and robust privacy and security measures.Integrating RTM and RPM into patient care models promises to revolutionize the sector as healthcare evolves. By leveraging technology, healthcare providers can offer more personalized, efficient, and effective care, improving health outcomes for patients globally. The journey of RTM may be fraught with challenges, but its potential to enhance physical therapy and broader healthcare practices remains vast and untapped. With concerted efforts to overcome current hurdles, the future of remote therapeutic monitoring in healthcare looks bright, promising a new era of patient-centered, technology-driven care.

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