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Cited by 30Telemedicine and Telehealth ImplementationBlood Pressure and Hypertension StudiesMobile Health and mHealth Applications

Effects of Remote Patient Monitoring Use on Care Outcomes Among Medicare Patients With Hypertension: An Observational Study

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Tang, Mitchell, Nakamoto, Carter H., Stern, Ariel D., Zubizarreta, Jose R., Marcondes, Felippe O., Uscher-Pines, Lori, Schwamm, Lee H., Mehrotra, Ateev·2023·Annals of Internal Medicine
DOI 10.7326/m23-1182
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Abstract

BACKGROUND: Remote patient monitoring (RPM) is a promising tool for improving chronic disease management. Use of RPM for hypertension monitoring is growing rapidly, raising concerns about increased spending. However, the effects of RPM are still unclear. OBJECTIVE: To estimate RPM's effect on hypertension care and spending. DESIGN: Matched observational study emulating a longitudinal, cluster randomized trial. After matching, effect estimates were derived from a regression analysis comparing changes in outcomes from 2019 to 2021 for patients with hypertension at high-RPM practices versus those at matched control practices with little RPM use. SETTING: Traditional Medicare. PATIENTS: Patients with hypertension. INTERVENTION: Receipt of care at a high-RPM practice. MEASUREMENTS: Primary outcomes included hypertension medication use (medication fills, adherence, and unique medications received), outpatient visit use, testing and imaging use, hypertension-related acute care use, and total hypertension-related spending. RESULTS: 192 high-RPM practices (with 19 978 patients with hypertension) were matched to 942 low-RPM control practices (with 95 029 patients with hypertension). Compared with patients with hypertension at matched low-RPM practices, patients with hypertension at high-RPM practices had a 3.3% (95% CI, 1.9% to 4.8%) relative increase in hypertension medication fills, a 1.6% (CI, 0.7% to 2.5%) increase in days' supply, and a 1.3% (CI, 0.2% to 2.4%) increase in unique medications received. Patients at high-RPM practices also had fewer hypertension-related acute care encounters (-9.3% [CI, -20.6% to 2.1%]) and reduced testing use (-5.9% [CI, -11.9% to 0.0%]). However, these patients also saw increases in primary care physician outpatient visits (7.2% [CI, -0.1% to 14.6%]) and a $274 [CI, $165 to $384]) increase in total hypertension-related spending. LIMITATION: Lacked blood pressure data; residual confounding. CONCLUSION: Patients in high-RPM practices had improved hypertension care outcomes but increased spending. PRIMARY FUNDING SOURCE: National Institute of Neurological Disorders and Stroke.

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  1. [1]1. Centers for Medicare & Medicaid Services. Medicare Program; Revisions to Payment Policies Under the Physician Fee Schedule and Other Revisions to Part B for CY 2019; Medicare Shared Savings Program Requirements; Quality Payment Program; Medicaid Promoting Interoperability Program; Quality Payment Program-Extreme and Uncontrollable Circumstance Policy for the 2019 MIPS Payment Year; Provisions From the Medicare Shared Savings Program-Accountable Care Organizations-Pathways to Success; and Expanding the Use of Telehealth Services for the Treatment of Opioid Use Disorder Under the Substance Use-Disorder Prevention That Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act. Fed Regist. 2018;83:59452-60303. 42 CFR Parts 405, 410, 411, 414, 415, 425, and 495.
  2. [2]2. Centers for Medicare & Medicaid Services. Medicare Program; CY 2020 Revisions to Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment Policies; Medicare Shared Savings Program Requirements; Medicaid Promoting Interoperability Program Requirements for Eligible Professionals; Establishment of an Ambulance Data Collection System; Updates to the Quality Payment Program; Medicare Enrollment of Opioid Treatment Programs and Enhancements to Provider Enrollment Regulations Concerning Improper Prescribing and Patient Harm; and Amendments to Physician Self-Referral Law Advisory Opinion Regulations Final Rule; and Coding and Payment for Evaluation and Management, Observation and Provision of Self-Administered Esketamine Interim Final Rule. Fed Regist. 2019;84:62568-63563. 42 CFR Parts 403, 409, 410, 411, 414, 415, 416, 418, 424, 425, 489, and 498.

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Authors
Tang, M., Nakamoto, C. H., Stern, A. D., Zubizarreta, J. R., Marcondes, F. O., Uscher-Pines, L., Schwamm, L. H., & Mehrotra, A.
Affiliations
  • Harvard University (US)
  • Department of Health Care Policy, Harvard Medical School, Boston; Department of Biostatistics, Harvard School of Public Health, Boston; and Department of Statistics, Harvard University, Cambridge, Massachusetts (J.R.Z.)
  • Massachusetts General Hospital (US)
  • RAND Corporation, Arlington, Virginia (L.U.)
  • Beth Israel Deaconess Medical Center (US)
ORCID
Venue
Annals of Internal Medicine
Publisher
American College of Physicians
Published
2023-11
Volume
176
Issue
11
Pages
1465-1475
ISSN
  • 0003-4819 (ISSN-L)
  • 1539-3704
DOI
10.7326/m23-1182
OpenAlex
W4388406339
Cited by
30
References
22
Citations by year
2026: 9 · 2025: 16 · 2024: 5
FWCI
7.64
Type
journal article
Language
en
Open access
Locations
  • Annals of Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (submittedVersion)
Funders
National Institute of Neurological Disorders and Stroke (R01NS111952)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
Keywords
remote patient monitoring, hypertension, Medicare, acute care use, health care spending, outpatient visits, chronic disease management, primary care practices
MeSH terms
Aged, Blood Pressure, Medicare, Humans, Hypertension, Monitoring, Physiologic, United States

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