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RPM vs Telehealth - What is the difference?

RPM vs Telehealth - whats are the differences?

RPM and telehealth are terms often used interchangeably as modern and convenient ways to improve access to healthcare services and provide cost-effective and scalable opportunities for medical professionals and clinical service providers. But is there a difference?

There are also nuances and differences related to the reimbursement conditions for service claims submitted to Medicare and other payers, the nature of the service from a patient perspective, and the care management requirements for the provider.

In this article, we look at RPM Vs Telehealth and clarify how they’re both similar and contrasting to ensure your healthcare organization selects the most appropriate and sustainable solutions for your patient cohort and demographics.

Why Should Healthcare Providers Examine the Contrasts Between RPM and Telehealth?

Where two types of patient service delivery seem similar, many organizations may wish to define the benefit of differentiation.

The answer is key – even if you consider RPM and telehealth as related patient care services, the Centers for Medicare and Medicaid Services (CMS) regard them as very different categories.

Therefore, the reimbursement rates, reporting requirements, and eligibility conditions will depend on the type of patient care you offer and impact the revenues and profitability of your healthcare organization, depending on which solutions you believe are most suitable.

RPM vs Telehealth: The Main Differences

Telehealth as a term has been used in the medical community for some time. It is a broad-scope category that refers to several patient communication strategies without necessarily conferring the detail about how practitioners liaise with patient groups or how they monitor their welfare and vital signs.

Remote patient monitoring solutions are primarily based on the use of advanced technology to extract, log, and examine patient data, using that information to inform care protocols, emergency care interventions, medication prescriptions, and lifestyle recommendations.

As a result, a telecare service might incorporate RPM programs but could also involve multiple other services without this level of specificity or patient engagement. Telehealth could refer to any methodology or service technology that collects and shares data between healthcare providers.

Contrasts Between RPM and Telehealth Services

Both RPM and telehealth require a degree of interaction between the physician and the patient. However, RPM services and claimable reimbursements do not mandate the specific amount of time a clinician should spend engaging with their patient.

Instead, they must conform to minimum criteria, such as providing at least 20 minutes of patient care management per 30-day billing cycle, including at least one live dialogue with the patient – of an unspecified duration.

Physicians can allocate their time depending on patient needs, the outcomes of patient measurements, and the importance of clinical data reviews or peer consultations before entering into a confidential discussion with the patient.

The ideology behind telehealth is to replace in-person appointments and to facilitate live communications between patient and practitioner via audio or video calls, with reimbursement values equivalent to face-to-face meetings.

RPM, however, is also designed to augment and supplement in-person visits. It provides real-time data tracking and patient oversight to ensure physicians can make immediate judgment calls when worsening symptoms or measurements indicate the potential or emerging signs of a medical emergency.

This immediacy of information prevents avoidable hospitalizations and fatalities, reduces rates of readmissions, and means healthcare professionals can supervise and monitor patients in at-risk groups without necessarily transitioning their long-term care to a solely remote basis.

Unlike telehealth reimbursements, RPM providers can file claims for every 20 minutes of care management delivered per month – whether once or multiple times for patients with numerous conditions.

Read more about RPM billing requirements here.

Why Does the Location of a Healthcare Service Affect Claimable Reimbursements?

The CMS requires a telehealth service provider to verify an 'originating site'. That means the patient's location at the point at which they receive a service. Patients are expected to attend the designated site to receive telehealth medical services – that might be:

  • A hospital or emergency treatment clinic.

  • A federal health center.

  • A physician’s office.

  • A rural health clinic.

  • A mental health facility.

  • A nursing center.

RPM has no such location requirement, and a patient can receive support, care management, and assistance from a suitably qualified practitioner or clinician from any location. The key objective is to remove barriers to care and ensure a patient with a condition, acute illness, or long-term risk indicator is monitored in a way that is convenient and accessible.

The vast majority of RPM patients record readings through FDA-approved medical devices from their homes, transmitting measurements to their physicians through secure cellular communication networks.

Which Medical Professionals or Organizations Can Offer RPM and Telehealth Services?

A further distinction defined by the CMS relates to the eligibility of the healthcare service provider. RPM can be delivered by a clinician, physician, or another suitably qualified healthcare professional. They can then delegate responsibility for some aspects of the service to other colleagues, such as nursing staff or outsourced RPM providers, maintaining supervision and oversight.

The direct outcome is that one physician can support a greater number of patients and assist larger geographical patient regions without stretching resources or putting unmanageable stress on their time capacities.

Telehealth works differently since eligible providers, per the CMS criteria, are limited to:

  • Physicians and physician assistants.

  • Nurse practitioners and midwives.

  • Clinical nursing specialists.

  • Clinical social workers and psychologists.

  • Registered nutrition professionals and dieticians.

The issue with this more defined list of approved providers means organizations have fewer opportunities for scalability and service expansion and remain exposed to the considerable cost of missed appointments.

Choosing Between the Roll Out of RPM and Telehealth Services

The final point is that Medicare lists claimable telehealth services but excludes RPM from this category. Therefore, physicians and healthcare providers can introduce flexibility and provide both telehealth and RPM depending on patient needs and the resources available within the organization.

RPM is widely seen as the most advanced, patient-centric, and preventative solution to multiple prevalent health conditions. It is ideal for services supporting growing patient numbers with chronic conditions, patients with mobility or travel limitations, or within rural or larger-scope regions where remote care delivery is more efficient.

However, the right services may depend on the medical proficiency of the workforce, the priorities of the service, and the cost-efficiencies of each comparable solution.

For more information about RPM, telehealth, and the similarities and differences, please contact the Wanda Health team at any time.


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