Remote patient monitoring: Building a virtual practice

Jon Regis, MD, explains how he set up a virtual office using remote patient monitoring to help his practice thrive during the COVID-19 pandemic and into the future.

The following transcript has been edited for length and clarity.

Medical Economics: Remote patient monitoring. What is it?

Jon Regis, MD: what it means to me in our organization is a way to better engage the patient their biometric data, their physiologic data, using either technology outside of traditional medical office. So I think the key is being able to monitor the patient, give the patient better access, get the patient better engagement using a technology — I call them “gizmos sometimes —to make sure they were in better contact.

Medical Economics: How has the pandemic changed the way that you use remote patient monitoring?

Regis: It's interesting because the pandemic, I think, forced the country in various sectors into uncharted territory. And I think that the changes you're going to see in healthcare are going to last forever, and some of the changes are going to be good.

The remote monitoring and telemedicine grew out of the fact that patients, of course, were uncomfortable coming into the office to see their physician and we needed to make sure that we were engaged and in contact with our providers. And so out of that grew the concept — which was already there — about how we can monitor some of the disease processes at the patient's home or wherever. For the patient didn't wouldn't have to come into our office.

The pandemic has decimated the hospitality industry, but it has also devastated the primary care industry. In fact, I'm concerned that in certain areas of the country, you're going to have primary care docs who really might go out of business or be forced to not remain independent any longer. Sometimes the option was going to be employed by the hospital, and hospitals are having such problems, that option may go away. So I'm afraid you might have primary care doctors actually going out of business.

I'm part of a committee that's trying to save primary care. I was on the phone listening to some physicians in Alabama and Mississippi and sure that other kind of more rural areas and they didn't even have the internet, ir wasn't even available for them. So there was a five-man physician group that were actually working for free, and they have 30,000 patients, and this will get them to close the door. Now, that to me is a medical emergency.

But I think, for us, the concept of being able to monitor our patients, especially those with multiple comorbidities, from their home, I think that technology's here, and it's just going to grow. And I suspect we'll be able to monitor other conditions in the next five to 10 years, I think the whole concept of the medical office is going to change.

Medical Economics: How are you actually using remote patient monitoring? Can you provide some some examples of how you've treated some patients using it?

Regis: We did two things. First, Reliance Medical Group is a multi-specialty primary care group. We have about 21 offices. We have about 70,000 individual patients and I always wanted to be able to be in contact with all my patients. So we developed an app that could go on an iPhone or whatever smartphone. And I wanted every one of our patients to have access to that app to push information, appointments, that kind of thing. Well, from out of that concept, I thought that maybe I can use the app as the connectivity piece for my patients.

So what we did was looked at hypertension and diabetes, which was very easy to pull those patients from our EHR, you put into certain codes and get a list, which we had about 6,000 to 7,000 patients.

But let me back up a little bit and explain how this whole remote monitoring thing and app were started. It came out of the concept of the annual wellness visit. I'm sure you're familiar with that. Well, before the pandemic actually even hit, we were having difficulty getting our patients in to get their annual office. And we were relying on our regular office staff to schedule and make calls amongst the other thousand things they were doing. I decided to make an investment and decided to hire a person whose primary responsibility is to call patients and to get them to come in for the annual wellness visit. We went from doing maybe 12 or 13 or 14 per week to 60 or 70 a week. I said that’s some real ROI! It made a lot of sense.

So we decided to develop a concept called the virtual medical office. And we had that one employee, and now we’re up to 12. And what they do is a number of things: First of all, they're responsible for working with our partner, putting patients on the app, especially if they have high blood pressure, hypertension or diabetes. We're calling these patients. We're loading them onto the app. We ctually give them a Reliance-logoed blood pressure machine. And we had the patients come in or we meet them, and they got their blood pressure cuff, information about their particular condition, and to let them know that this red bag is part of their prescription, we tell them ‘you're no longer going to be able to come in here and just get a scrip and go home. You're going to have to participate in your care.’

We have a list of standards and guidelines that we follow and tell us what the guardrails are. And when patients fall off the guardrails, they get red lighted and our staff calls them to check up on them and get them back on course if they’ve fallen off if they're not following the guidelines.

The virtual office staff has grown to the fact that this staff is not only doing remote monitoring and AWVs. They're looking at our agency scoring, and charts. They're doing quality analysis to help us close gaps. We're doing behavioral health assessments, even over the phone before the patient comes in. I think it will generate as much revenue as the traditional office, eventually.

Medical Economics: How should physicians getting started on their own journeys in terms of using virtual care and remote patient monitoring technologies to help them treat their patients? What advice would you give them on where to start?

Regis: I would start small. I think that you, first of all, find a technology partner that that can work with you. Sometimes, you have to make the investment, if you're large enough to do that. Or cut out some time from your existing staff to make this happen. They can start with 100 patients. 100 patient may generate $16,000 to $17,000 a month if they're remote monitoring. This is new revenue, Okay? And it's not revenue that depends upon Congress to pass a stimulus package. It’s revenue that’s already there. so I'm tapping into codes that already exists.

Look, healthcare is a business. It's a very special business. I'm trying to use the tools that are there to make sure I can pay my staff and providers commensurate with what they're doing. And for primary care, we've always been on the low end, our margins have always been very small. So I'm saying, ‘Look, we’ve got to revolutionize this thing’ and the pandemic is going to hasten this and help all of us look at other ways that we can engage our patients, generate additional revenue and reduce costs to to whole system. We've already shown that we've prevented several hospitalizations

Medical Economics: Have you have you run into any challenges with payers in terms of getting paid for any of this?

Regis: Let me say first of all, we have some payer partners that are working with us on this on the concept. We know that every payer in New Jersey pays remote monitoring codes. But you have the same snafus that you have in any multi-payer system: sometimes they pay it, sometimes they don't pay it. Sometimes it's inappropriate denials. You just got to go through the process as you normally do. When we first got started, for example we found out our virtual team wasn't checking eligibility. So our virtual teams started focusing on denials.

Medical Economics: Is there anything else about this topic that you think it's important for physicians to know about?

Regis: I would say, again, start small. Don't get discouraged. Make sure you do the financial analysis. If you start out with 100 patients, become very familiar with what remote monitoring and other avenues of revenue are out there besides that patient visit in your office. You'd be surprised.