Effectiveness of RPM technology in doubt

More than half of the nation's accountable care organizations are using or looking into remote patient monitoring technology to manage chronic care populations, a new survey indicates, but questions remain as to whether that technology will be effective.

"Trends in Remote Patient Monitoring 2013," released by the Spyglass Consulting Group, indicates RPM technology "has been shown to reduce the risk of hospital readmissions, control healthcare delivery costs and increase access to care," but those successes have been found in small pilot projects focused on a specific population.

[See also: Remote patient monitoring technology market sees big growth]

Gregg Malkary, founder and managing director of the Menlo Park, Calif.-based consulting firm, said it might take years for an ACO to find an RPM platform that works. "It's a complicated field with a lot of confusion," he said. "We're in a huge state of experimentation now."

According to the Spyglass study, 55 percent of ACOs have deployed or are evaluating RPM technology. However, the report found:

• 71 percent are concerned about the integration of RPM technology with existing clinical care processes and systems, such as the electronic medical record;
• 58 percent are concerned that the platform doesn't have the necessary support for business analytics or decision support tools, leaving them with raw data but no means of using it to enforce evidence-based medicine; and
• more than 50 percent are questioning whether RPM technology is effective and can produce an adequate return on investment.

Malkary said many ACOs are still trying to figure out their own structure, and are only slowly developing a care coordination network that pulls in all the relevant parties, from the hospital to the home care agency. As a result, they're dealing with health information exchanges and EMRs that aren't integrated.

As they face penalties from the Centers for Medicare & Medicaid Services for Medicare patients who are re-admitted to a hospital, Malkary said, some ACOs are offering free post-discharge services, while others are wondering if it would be less expensive to accept the penalties than to invest in the technology needed for follow-up care.

Others – such as Scripps Healthcare in San Diego and Geisinger in Pennsylvania – are conducting RPM pilots with small populations, such as those with congestive heart failure.

"They're finding success (with RPM) as an early symptom management tool," he said. "That's good, but it isn't a solution."

Malkary said many payers aren't reimbursing for RPM technology yet because the data isn't available to prove its effectiveness. The small pilot projects have shown success, he said, but they haven't yet led to larger pilots. In addition, remote patient monitoring data isn't yet synching in to the EMR, so that data can't be fed into clinical decision support tools.

"The question is, how can you do chronic disease management, and how can you do it cost effectively?" he said.