The 4 Hidden Costs of Delaying Remote Therapeutic Monitoring

For many outpatient rehab practices, remote therapeutic monitoring (RTM) often stays on a “someday” list. Leaders might see its potential, but full schedules and competing priorities make it easy to postpone. Meanwhile, clinicians keep answering questions between visits, checking on home exercise program adherence, and trying to understand why a patient’s progress has stalled.

The impacts of postponing RTM include missing out on potential reimbursement, but also go beyond that. They can show up in problems that go unnoticed between appointments, patients who leave before completing care, and less visibility into treatment results. In this article, we’ll take a closer look at these costs. 

Cost #1: Missed Revenue from Care Between Visits 

RTM creates an opportunity to receive per-patient reimbursement for care delivered outside the clinic, including initial setup and patient education, qualifying device supply, and monthly treatment management.

That opportunity can become substantial across a practice. Rehabilitation and Performance Institute (RPI), which operates 14 outpatient physical therapy clinics, reports more than $20,000 in incremental RTM revenue per month from its RTM program. While results will vary with patient enrollment and reimbursement, RPI’s experience shows how consistent care between visits can become a significant source of revenue.

This reimbursement opportunity is especially relevant because clinicians might already be doing parts of this work, such as checking home exercise adherence or responding when patients have questions between visits. RTM gives practices a way to organize, document, and bill for care that might otherwise go uncaptured, while making care more consistent for patients.

Cost #2: The Adherence Gap Between Appointments

A clinician can give clear instructions and demonstrate every exercise, yet still know little about what a patient manages to do at home. Someone might stop an exercise because it hurts, struggle to fit the routine around work, or become unsure whether the program is helping. If those difficulties don’t come up until the next visit, the clinician has lost time in which they might have adjusted the plan.

A recent survey by The Ohio State University Wexner Medical Center found that 76 percent of patients didn’t complete their assigned physical therapy homework. Forgetting or having no reminders was the most common reason, followed by a lack of time or scheduling conflicts. These findings highlight how everyday obstacles can interfere with a patient’s treatment plan, even when they intend to follow it.¹

RTM can help clinicians recognize difficulties sooner by giving patients a way to report their activity and response to treatment between visits. For example, a patient who repeatedly struggles with an exercise or puts it off might need a change in the exercise's difficulty, a conversation about pain, clearer instructions, or more information about how the exercise will help them. 

In a study of 80 people with muscle or joint conditions, those who received an app-based home exercise program with clinician support by phone and text reported better exercise adherence after four weeks than those given paper instructions. They also reported a better ability to engage in activities important to them, suggesting that connecting with patients between visits can help them put their treatment plans into practice.²

Without that connection, difficulties at home might go unnoticed until the next appointment, leaving patients with less support when they need it and clinicians spending valuable visit time addressing problems that could have been caught earlier.

Cost #3: Patients Who Leave Before Care Is Complete

When a patient misses a visit or stops scheduling, the reason isn’t always easy to determine. Maybe they’re struggling with their home program, unsure whether therapy is working, or finding treatment hard to fit into daily life. Research on outpatient physical therapy has identified pain, low confidence, and limited support among the factors associated with lower adherence to treatment.³

Contact between visits offers another opportunity to hear about these concerns and respond while the patient is still engaged. A clinician might adjust an exercise, answer a question, or help the patient reconnect their daily work to the goals they set at the start of care. 

When patients leave early, they might miss the chance to reach their treatment goals, while the practice loses visits that were planned but never delivered. The practice also has fewer completed episodes of care from which to understand and demonstrate results to referral partners.

Cost #4: Falling Behind on Value-Based Care

Payers are placing more weight on the quality and results of care. Programs such as the Merit-based Incentive Payment System (MIPS) and alternative payment models tie payment to performance measures, giving practices another reason to collect reliable information about what happens throughout a patient’s course of treatment. 

That bigger picture matters when practices are asked to demonstrate results in outcome-based contracts. Without information from the time between visits, a practice can report where a patient started and ended treatment, but has less evidence of the support provided along the way or the barriers clinicians helped patients overcome.

There’s also an important competitive consideration, as more patients grow accustomed to reaching their care teams through digital tools and come to prefer or even expect that connection during therapy. Practices that offer ways for patients to ask questions, share progress, and get support between visits might have an advantage when patients choose where to receive care. 

Adding It Up

Launching an RTM program requires technology, training, and clinician time, so it makes sense to consider the investment carefully. Looking at the potential impact across revenue, patient care, and the ability to demonstrate results can help practice leaders decide whether the time is right.

Where to Start

Begin by identifying patients who could benefit from monitoring between visits, then pilot RTM with one clinician or small group. As part of the pilot, review the work clinicians already do between appointments, such as checking home exercise activity and responding to patient questions, to see which services could meet RTM billing requirements.

A small pilot can help your practice assess patient engagement, clinician time, and reimbursement before expanding the program. For more guidance, see the Medbridge guide Remote Therapeutic Monitoring: An Operational Playbook.

References

1. https://wexnermedical.osu.edu/mediaroom/pressreleaselisting/3-in-4-skip-physical-therapy-homework-stunting-progress

2. https://pubmed.ncbi.nlm.nih.gov/28662834/

3. https://pmc.ncbi.nlm.nih.gov/articles/PMC2923776