Automation, Analytics, and AI- the next for RPM program that can result in 6 figure additional revenue for HCPs!

RPM Program- the New Normal for Chronic Disease Management and a Potential to generate an additional 6 figures revenue for HCPs! 

Post COVID-19, the need for Remote Patient Monitoring (RPM) has increased exponentially in the US and the RPM program has been adopted by both patients and providers. With the growing sophistication of the RPM solutions and greater clarity from CMS on RPM reimbursements, it is evident Remote Patient Monitoring will become the new normal of managing chronic conditions.  

Along with its clinical decision-making, continuous monitoring, and remote telemedicine capabilities, the program also brings the potential to generate 6 figures additional revenue to the HCPs! 

Here are some significant statistics and predictions about the RPM program and its adaptation: 

• 43% of hospitals and clinics are using RPM or plan to do so in the next 12 months 

• It is estimated that 30 million US patients, or 11.2% of the population, will use RPM tools by 2024 

• 75% of diabetes care participants said they would adopt RPM in diabetes care if it is effective in improving health outcomes (Source) 

The benefits of RPM are also evident! For instance, RPM in Cardiac Care management has been a major adaptation, especially for post-diagnosis care and chronic management!  

A recent RPM study found that there was a 65% reduction in hospital admissions and an 85% decrease in inpatient services for patients enrolled in a Virginia medical network's nursing and RPM program. This decline in admissions and services also resulted in $615,127 in inpatient claims cost savings! (Source)  

But, with increasing popularity also comes governance to avoid abuse and wastage of CMS reimbursement benefits! Here are the latest rules in brief that are updated by the CMS in their final bill of 2023! 

CMS RPM Reimbursement Rules 2024: 

• One Device reimbursement bill per month 

• One practitioner reimbursement per month 

• Patients with Established patient relationship status eligible for RPM programs 

• Minimum 16 days of data records essential using RPM devices and platform 

If you RPM program adheres to the above rules, below are the latest reimbursement rates with its CPT code: 

• 99453: Initial setup and education, with an average reimbursement rate of $19.65 

• 99454: Data transmission, with an average reimbursement rate of $46.50 

• 99457: Management services for the initial 20 minutes, with an average reimbursement rate of $48.14 

• 99458: Management services for each additional 20 minutes, with an average reimbursement rate of $38.64 

• 99091: Collecting and analyzing physiologic data, with an average reimbursement rate of $52.71 

RPM and 6 Figures Additional Revenue Generation: 

There are majorly 3 different parties involved in the RPM program that can benefit from RPM reimbursements that are RPM device manufacturers, RPM solution providers and Physicians/Hospitals. 

If we roughly calculate the reimbursement amount considering the 16-day rule, each RPM patient who gets enrolled in the program can generate an additional reimbursement revenue of $1374.5 per annum!  

If a hospital manages to enroll 100 patients in the RPM program, it can effectively generate 6 figures of additional revenue per annum from the program. 

Also, these are not just hypothetical scenarios. Many such Hospitals and RPM solutions providers have a successful RPM program. But to generate this additional revenue with stability, there are certain essential functionalities and digital experiences that RPM solution providers must integrate into their platform to make it successful and future proof.

Techno-functional essentials to ensure the success of the RPM program and RPM solutions: 

Integration and Interoperability:  

The MedTech industry is heading towards a new scale of data interoperability and right from data ingestion to data processing and sharing, RPM platforms will need a certain standardization of the data to ensure hassle-free and seamless data interoperability.  

Consumer-Driven User Experience and Accessibility: 

While the use case of RPM is purely medicinal, patients or users that are enrolling to the platform will also have to generate the data for 16 days at least for RPM platforms and providers to claim the reimbursements.  

 This requires a certain level of experience design because while patients value the health benefits and outcomes of the RPM program, they might refrain from using it if the workflows and system navigation becomes a hassle for them.  

Automation, Analytics, and AI: 

 One of the major reasons why Physicians or Providers shy away from RPM programs is because of the manual operational burdens of the platform and the lack of ease for providers to access the required information.  

 While RPM program brings the additional revenue, RPM platform will have to bring the required automation for seamless onboarding, deliver the required outcome analytics to help with the clinical decision making, and use AI to deliver clinical intelligence and operational excellence to the providers. 

We engineer the next for RPM platforms! Bring the best of integrations, intelligence, and interoperability to your RPM program with AIMdek’s Innovation Engineering: 

 To ensure RPM has the essential data intelligence, seamless device and health systems integrations, AIMDek offers Data-as-a-Service accelerator to the RPM and Medical Device Manufacturers!  

 From standardized data ingestion to Change Data Capture based data processing automation, we have designed a perfect Interoperability solution for RPM platforms and RPM devices. Our integration solution can make customer onboarding seamless and data transmissions automated for various purposes and business models.  

 To understand more about our Integration and Innovation engineering solutions, send us an email at marketing@aimdek.com and talk to our SMEs today!