How to Determine ROI For Remote Patient Management

The COVID-19 pandemic changed how we live today. Many societal norms and systems were impacted by...

The COVID-19 pandemic changed how we live today. Many societal norms and systems were impacted by this pandemic, including healthcare. The unusual conditions surrounding the pandemic gave remote patient management the ultimate push –  it became the new norm.

Some insurance providers and healthcare organizations decided to invest in remote patient monitoring, a cutting-edge technology, to address health-related issues and provide high-quality care to patients in their own homes on a much smaller budget. It was a game changer and one we’re only getting used to right now. Constantly evolving, constantly incorporating new innovations and tech.

In this article, we’re going to take a look at RPM and more importantly its ROI. 

Benefits of Remote Patient Monitoring for healthcare organizations and payers

Utilizing technological advancements to collect patient data outside of conventional healthcare venues has become the new norm. Remote patient management offers patients, healthcare organizations, and practitioners incredible benefits. Here are a few to take into account:

Fewer Visits to the Doctor

Remote patient monitoring greatly decreases patient visits to the doctor or the hospital.* This not only improves patient daily care but saves insurance companies a lot of money in the end.*  Another benefit is that by having patients interact less with other patients, or staff members in a hospital, doctors can mitigate the spread of diseases. Hospitals can be a breeding ground for pathogens. 

Lower healthcare costs for payers and providers

Remote patient management systems aid healthcare providers in monitoring and managing high-risk patient care, while reducing unnecessary hospital admissions and readmissions. Extended hospital stays and expensive care can be significantly decreased. 

Enhance Patient-provider Communication

Thanks to remote patient management systems, patient-doctor interactions have improved. Not only do patients feel more in control of their conditions, but RPM tools have also helped them to build a better relationship with their healthcare professionals.

rpm enhances patient-provider communication

This has led to various insurance companies offering financial incentives for medical institutions to use RPM systems, as they are increasing patient satisfaction ratings around the world. 

Competitive Market 

In the last few years, especially with the COVID-19 pandemic, the use of remote patient management has grown at an incredible rate. Companies and startups are investing a lot in platforms and RPM tools. It is an incredibly competitive market and most practitioners are discovering that in order to survive in it, they need to embrace and adapt to its paradigm-shifting solutions. 

High return on investment

Implementing a remote health monitoring system enables a high return on investment - ROI -  for patients, medical professionals, and insurance companies alike. Everyone engaged stands to earn significantly - not only income but peace of mind -  and lose very little in the process. 

ROI & RPM programs 

It is important to have realistic goals and ROI targets when it comes to RPM programs. This will help you measure the success of your program and ensure that you are not wasting time, or money,  on a project that is not working. There are some tips you can implement to set realistic expectations. The main tip is: Healthcare providers must understand and analyze the current state of their RPM programs, what's working, what isn’t, and why. This will provide a clear picture of what to expect in the long run.

A flexible baseline metric must be set as a starting point to create your goals. RPM programs should start small and work their way up. Start with small investments and slowly incorporate more and more technology. Some might take time to adjust depending on your directional outcomes. Acknowledging that your metrics aren't headed how you wanted to go is not a failure, it's being objective.

It’s important to create an action plan with specific steps and deadlines. It is better to consider a long-term plan as cash flow can become an issue. Remote patient monitoring ROI targets focus on increasing clinical capacity as a means for growth. A proper strategy, when it comes to RPM, allows you to buy time in order to reach your goals with value buildup.

How to determine ROI for remote patient management? 

Each health organization has unique operational procedures, geographical characteristics, and population density when it comes to patients and caregivers. Your staff members are different, as well as your patients. As such ROI will be different. It’s important to understand that a health organization's method of calculating its return on investment differs completely from those used by insurance companies. 

ROI refers to the actual current value of an investment minus the overall cost of that investment, divided by the initial cost of the investment. It takes into account not only what money you put up front, but what you ended up investing in overtime – for example in maintenance and staff training. 

rpm roi

It’s a bit technical — With this in mind, follow these simple steps in order to determine your ROI for remote patient management:

Know the Remote Patient Monitoring Reimbursements Codes 

The billing period for remote patient monitoring CPT codes is 30 days or at the end of every month, except for CPT 993453 which is billed 16 days after monitoring. 

There are 4 remote patient monitoring reimbursement codes:

  • CPT 99453 deals with device set-up and patient education costs. The standard reimbursement rate is $18.77.
  • CPT 99454 pays for supplying the device for routine alert messages or a daily recording. The patient must use the RPM device for at least 16 days/month to bill this code. The standard reimbursement rate for this code is $62.44.
  • CPT 99457 covers the first 20 minutes of data analysis. The standard reimbursement rate for this code is $32.84 (for the facility) and $51.61 (for non-facility).
  • CPT 99458 covers every additional 20 minutes of data analysis. The standard reimbursement rates for this code are $32.84 (for the facility) and $42.22 (for non-facility).

Determine the expected amount of reimbursement

If you bill each code once every month, the estimated yearly revenue for a non-facility can be determined using the following equation:

[(62.44 + 51.61 + 42.22) (12) + 18.77] x (# of enrolled patients)

For example: 

  • 20 patients = $37,880.20
  • 100 patients = $189,401.00
  • 300 patients = $568,203.00

Subtract the cost of remote patient monitoring systems to obtain ROI

RPM companies differ in pricing models depending on the amount of technology the clinic or practitioner wants to proceed with. 

Forms of ROI from remote patient monitoring

Clinical ROI

Using remote patient management systems helps healthcare providers to analyze and monitor data and quickly identify patterns and outliers. This supercharges early diagnosis, and allows for more efficient actions, and treatments. RPM also increases patient engagement, and adherence to plans and minimizes disease complications. 

Financial ROI

As medical costs continue to increase, financial savings are more important than ever. With remote patient monitoring, clinics and healthcare organizations save money by reducing emergency room visits, in-person doctor visits, hospital admissions, and the overall use of expensive resources.

Operational ROI

Hospitals and healthcare providers can improve their ROI due to the benefits of remote patient monitoring, such as: 

  • Improved patient health results.
  • Lowering operational costs.
  • Relieve overburdened physicians.
  • Perform time-consuming and manual tasks, such as data entry.
  • Ensure doctors focus on high-risk patients. 
  • Reducing potential liabilities for providers.

Why is remote patient monitoring worth the investment? 

The use of remote patient monitoring is a game changer – it is a cost-effective solution that can help improve the quality of care. RPM not only reduces costs for the healthcare sector but also enhances patient outcomes by encouraging prompt treatment. It also reduces hospital readmissions, which saves time and money for patients.


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