5 Reasons Why RPM Programs Fail

Over the past years, RPM (Remote Physiological Monitoring), has garnered a lot of interest over the years, but so have reports by many healthcare organizations that RPM programs are not producing the expected results. In this first part of our series on achieving RPM success, this article covers the 5 reasons why many programs fail.

Based on our experience implementing RPM programs for the management of chronic diseases or for the prevention of readmission in a post-acute setting, here are the top 5 reasons why RPM services fail

• #5 Negative Financial ROI
• #4 Lack of Clinician Buy In
• #3 Cumbersome Technology
• #2 Insufficient Monitoring Support
• #1 Lack of Patient Engagement

Definitions of Failure

One aspect that is important to define first is, what failure actually means. 

In my experience, it can mean three things:

(1) The service is financially not sustainable based on the cost to run the RPM service and the (fee-for-service) reimbursement.

(2) Lack of patient participation, i.e., (a) patients don’t stay long enough on the service, (b) after a few weeks patients are no longer submitting vital signs, (c) patients are not interested in signing up for the service.

(3) Insufficient positive patient outcomes, such an improvement of disease-specific vital signs (e.g., blood pressure for hypertensive patients or A1C levels for diabetics) or a reduction in urgent and emergent care utilization (e.g., a visit to the ER or a hospital admission).

The five reasons I listed above are, of course, closely correlated with each of these three definitions of failure. E.g., reason #5 (negative financial ROI) is directly correlated with the first definition of failure; reason #1 (lack of patient engagement) is a root cause of definition (2).

Before I dive into the definition of the 5 reasons, I want to acknowledge that obviously the five reasons are all interrelated with each other: Insufficient Monitoring Support (#2), Cumbersome Technology (#3), and Lack of Clinician Buy-In (#2) all result in or contribute to a Lack of Patient Engagement (#1) that ultimately leads to a negative ROI (#5).

#5 Negative Financial ROI

What ultimately gives RPM programs the “kiss of death” is the lack of financial viability: the inability for the RPM program to generate sufficient revenue that offsets the cost.

Mathematically speaking, this is either because the cost is too high or because the revenue is not high enough.

For RPM, the total cost is mostly made up of the cost of RPM equipment, the per patient per month cost of the monitoring dashboard, and the cost of staff to support and monitor the patient.

On the revenue side, most RPM programs rely on direct fee-for-service billing for RPM, though it can include other fee-for-service charges and other financial benefits as well.

In my next article I’ll offer some solutions on how to increase revenue (ethically!) and to lower cost (responsibly!).

#4 Lack of Clinician Buy In

Clinician buy-in is key for a number of reasons. 

First and foremost, it’s the clinicians’ decision to offer a patient RPM monitoring as a way to take better care of the patient’s health. 

Secondly, to effectively impact the patient’s health outcomes — whether it’s the management of a patient’s chronic conditions or to prevent a readmission post discharge — the clinician needs to trust the quality and reliability of the data and use it in the management of the patient’s care.

Thirdly, it is optimally the clinician’s job to invite the patients into playing a more active role in their care - by regularly taking and thereby transmitting their vital signs (see reason #1).

In the second part, I’ll lay out a number of ways to increase clinician buy-in and how to overcome overt and hidden objections.

#3 Cumbersome Technology

Many people would have probably listed this as the main reason, but is amazing how much cumbersome technology people are willing to put up with if they are just sufficiently motivated. 

The main aspect of “cumbersome” technology in the world of RPM has to do with the connectivity of the devices that capture the vital signs. Over the past decade or two, most devices have been wirelessly connected by Bluetooth, and if you’ve ever had to fight connecting your earbuds or speaker to your phone, you know how tricky Bluetooth connections can be.

Another flavor of “cumbersome” are the user interfaces used by the monitoring nurse and by the clinician. While many “RPM dashboard” interfaces are decent, many of them show idiosyncrasies that don’t match the thinking or preferred workflow of a nurse or of a clinician. A bad user interface can lead to a frustrating experience when the clinician cannot easily and expediently review the patient’s data. In some cases, it could even lead to important data being missed.

Next week, I’ll lay out some pragmatic recommendations to avoid the accidental investment in cumbersome RPM solutions.

#2 Insufficient Monitoring Support

A key aspect of RPM is a designated monitoring staff that reviews the data from all patients on a daily basis and follows up with patients that either haven’t taken their measurements or who’s vital signs are outside the acceptable range.

This level of daily monitoring is key to keep the patients engaged in their participation and to generate meaningful historical data that is of clinical 

In the second part of this series I will lay out some staffing models (it doesn’t always have to be an RN) and some real-life anecdotal monitoring staff-to-patient ratios.

#1 Lack of Patient Engagement

Ultimately, though, your RPM program will fail when you your patients are not engaged, when they are not participating.

You can have the best equipment and user experience, sufficient reimbursement codes, a well-trained monitoring team and a physician who is excited about integrating RPM into their practice. But if the patient is not engaged, if the patient is not taking their vital signs; or if the patient is not taking their medication as prescribed and not following the other elements of the care plan — ultimately your program will fail.

Which, in my opinion, is the #1 reason why many RPM programs are failing - with root causes for the lack of patient engagement being multifold itself.

Designing a Successful RPM Program

To design a successful RPM program, the comprehensive solution must address all the reason of failure:

• A trusted ROI model that keeps cost well below the revenue.
• Clinicians that are excited about integrating RPM into their practice
• Technology that connects easily and is intuitive to use.
• A well-trained, adequately staffed monitoring team
• A multi-pronged approach to ensuring initial and continued patient engagement.

With those 5 elements in place, your RPM program is very likely to succeed with demonstrably improved health outcomes and a highly positive bottom line.

How to do that will be the topic of next week’s article.

Is your RPM program succeeding? Or is your RPM program failing? If so, why do you think that is? Is it reason #5 or reason #1? I’d love to know, so reach out if you’re willing to share.

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Christian Milaster and his team launch, expand, and grow Telehealth Programs for rural health centers, behavioral health agencies, health systems, schools, and libraries. Christian is the Founder and CEO of Ingenium Digital Health Advisors where his team and consortium of experts partner with healthcare leaders to enable the delivery of extraordinary care by accelerating the adoption of digital health innovation.

To explore how we can help your organization solve your challenges, contact Christian by phone or text at 657-464-3648, via email, or video chat.