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Telehealth Research Uncovers Challenges in Launching an RPM Program

A report in Health Affairs indicates remote patient monitoring programs for cardiac care patients do reduce mortality in the short term, but they haven't been sustainable and also lead to increased ED visits.

Source: ThinkStock

By Eric Wicklund

- Remote patient monitoring programs for cardiac care patients have helped reduce mortality over six months – but the telemedicine platform has proven less effective in the long run, and has even led to an increase in hospital visits.

The good news-bad news results of a study led by Columbia University and Northwell Health researchers and published in this month’s issue of Health Affairs point to the complexities of connected care. Programs that aim to connect patients at home with their care teams may result in improved outcomes over the short term, but they also offer more opportunities for intervention – which can boost costs – and they still have problems with sustainability.

The research team, led by Renee Pekmezaris, PhD, a professor at Northwell Health’s Feinstein Institute for Medical Research, analyzed 26 RPM programs covering more than 2,500 patients and compared their outcomes to a similar number of patients receiving traditional in-person care.

According to their analysis, mortality rates among those using a connected care platform dropped 40 percent within the first six months, but that rate was statistically comparable to in-person care after one year.

“There may be several reasons for this,” Pekmazaris said in a press release accompanying the study. “Patients may become less adherent to monitoring their vital signs, like weight and blood pressure, over time. Whether they are too sick to adhere, or they just don't make it as much of a priority as they did right after their hospitalization, we don't know.”

“These findings are important because, as scientists and providers, we need to understand when to rely on telemedicine, and how to create a program that most benefits patients,” she added.

That’s especially evident in the next set of data points.

The study found little difference in the rate of all-cause or cardiac-specific hospitalizations between the RPM group and the control group. However, at six months, those receiving RPM care were 50 percent more likely to visit the Emergency Department.

Pekmazaris and her colleagues speculated this increase in ED visits could be a result of the heightened level of scrutiny afforded by an RPM platform. In other words, the technology enables caregivers to spot health concerns early, necessitating the ER visit, while a traditional platform might not notice anything until the health issue is serious enough for a hospital stay.

That bump in ED visits can create an impediment to the adoption of RPM programs. Healthcare providers could attribute that spike to a long-standing argument that some telehealth programs create more healthcare services. RPM proponents, meanwhile, will point out that the ED visits are, in the long run, less costly than hospitalizations, and would likely improve outcomes.

These conversations will likely become more prevalent in the coming year, thanks in part to the Bipartisan Act of 2018 and recent initiatives by the Centers for Medicare & Medicaid Services to promote (and reimburse for) more telehealth and RPM programs.

“Recent regulatory changes that relaxed Medicare restrictions on telehealth reimbursement make it imperative that studies fully describe outcomes (for example, heart failure–related versus all-cause hospitalizations) and deliberately test all essential intervention elements, such as intervention duration,” the study noted.

“As HTM (home telemonitoring) transitions to common use, a value framework should be considered,” the study concluded. “Specifically, the balance between the cost of HTM implementation and improvements in length and quality of life, decreases in travel time for patients and providers, and increases in provider efficiency must be constantly assessed.”

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