https://www.techtarget.com/virtualhealthcare/feature/Why-assessing-remote-care-quality-matters-for-RPMs-future
The digital healthcare boom has spurred the adoption of virtual care models, including at-home care models supported by remote care tools. Though remote patient monitoring is not especially new, the COVID-19 pandemic gave the model new life, prompting several health systems to adopt it.
Michigan Medicine was one of those health systems. Launched in April 2020 amid in-person care restrictions, Michigan Medicine's Patient Monitoring at Home program provides care for hospital-discharged patients, outpatient chronic disease and post-rehabilitation patients, Ghazwan Toma, M.D., the program's medical director, told Virtual Healthcare.
Patients receive a kit with various Bluetooth-connected devices, including a tablet, blood pressure scale, blood pressure cuff, pulse oximeter and thermometer. A clinical care team tracks the vital signs daily, noting positive and negative trends. If the patient's data shows troubling trends, a clinician triages the patient, and the health system's post-acute care team intervenes.
The program aims to enhance patient outcomes, which can be measured by fewer unnecessary emergency room visits and hospital admissions. And now, thanks to a new study, Michigan Medicine knows that the RPM program is operating as intended and achieving its goal of reduced hospitalizations.
Toma, who is also a clinical assistant professor in the Department of Family Medicine at the University of Michigan Medical School, has wanted to study the Patient Monitoring at Home program for years.
Proving RPM's efficacy is "hugely important, because it's not a traditional healthcare [service] we're providing," he said.
Though the RPM as we know it today has its roots in a 2005 Johns Hopkins study, followed by sporadic implementation among some prominent health systems, the scale of adoption post-pandemic necessitates solid clinical evidence.
"This type of RPM is still in its infancy; therefore, having data that shows that it works or not is critical," Toma said. "And it's not just for patient care. [It's also] so that the providers know that, okay, there's this service and I have this vulnerable patient. I can be more at peace when I discharge the patient."
Further, health system administrators need this data to determine how best to implement RPM programs. Toma explained that gathering data is not enough. Health systems need clinicians who can track and interpret the data and the resources to intervene when necessary. So, in addition to the technology implementation aspect, RPM programs often require workflow changes and strategic resource allocation.
The growing body of clinical evidence is also essential for healthcare payers. Payers must assess whether reimbursing RPM is worth the cost, and data from health systems can help them make informed decisions.
Toma underscored that the question of reimbursement for RPM is complicated by the fact that no two RPM programs are exactly the same.
"I know there's a lot of RPM, and RPM could be as simple as an AI system that comes to your phone with a text message and then hopefully [the patient's care can] get escalated to somewhere in the clinic, but there's no device, nothing involved in it as long as the patient have their own smart device," he said. "So, it could be as simple as that, and it could be as complicated as our program."
Thus, clinical evidence can help payers determine the appropriate reimbursement rates for different levels of RPM.
At Michigan Medicine, researchers conducted a case series study to determine the impact of the Patient Monitoring at Home program on hospitalizations. They examined six-month outcomes for 1,139 patient encounters from November 2020 to August 2022.
According to Toma, the researchers decided to examine six months of outcomes data because a longer study period would provide a more comprehensive view of efficacy. The duration of enrollment in the program varied, ranging from seven to 386 days, with a median of 38 days.
The study found that the average number of hospital admissions dropped by 59% in the six months after program enrollment. Additionally, the researchers broke down the data by diagnoses, finding that the program was associated with hospitalization reductions across the top diagnoses at the time: COVID-19, congestive heart failure and hypertension.
Researchers further determined that COVID-19 did not drive the reduction in hospital admissions. On excluding COVID-19 patient data from the study sample, researchers observed a 49% relative reduction in the risk of hospitalization from the six months before program enrollment to six months after.
However, the most interesting finding was that a shorter duration of at-home remote care monitoring was associated with a greater reduction in hospitalizations. The sweet spot was 60 days of at-home RPM. Patients who stayed longer experienced fewer benefits.
"My interpretation is that some of these patients who end up staying in the program too long -- over 100 days, over 90 days -- these are the ones that medically and socially are especially complex," Toma explained. "Where there's always a need for services and admissions and ER visits…and an RPM program, this is not alone enough to cut significantly on their admissions."
While the research team concluded that RPM effectively reduces hospital admissions for various conditions, they underscored the need for further research.
Toma hopes to conduct research on which types of patients are best suited for at-home monitoring and a larger observational case-control study in which RPM patient data can be compared with those of others who did not receive RPM.
"I would want to look at this from a 360-degree angle," he said. " You want to look at it from different ways. I'm hoping we can build on this study and publish something else to look at other factors that play into this."
In addition to research, Toma and his team hope to expand the program, adding that it has the potential to help mitigate healthcare worker burnout. Busy ERs and increased hospitalizations add to healthcare workers' clinical and administrative burden, exacerbating burnout. RPM offers a pathway to care for patients at home, reducing the load on the workers.
Michigan Medicine plans to increase the number of patients enrolled in the RPM program by adding new kits and expanding the types of conditions that can be treated. Today, the program enrolls patients with other cardiac conditions, liver cirrhosis, sepsis and diabetes, and program leaders hope to expand enrollment to post-surgical patients following prostatectomy and some urological procedures.
Research and clinical assessments will be critical to that expansion and the broader adoption of RPM nationwide.
"I do hope to see more publications, since there's an explosion of RPM in the last five years, whether it's from our program or others, to study and maybe structure the RPM in general -- maybe subcategorize it to more sophisticated services such as ours versus more straightforward or simpler services, and who can be a good fit for what, and where they're coming from, whether that’s inpatient or outpatient," Toma said. "So again, we do need more data and more support from healthcare systems, payers and legislators."
Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.
27 May 2025