JMIR Publications

ABSTRACT

Background:

Chronic conditions such as diabetes and hypertension pose major public health challenges, including high burdens, high costs, and high rates of comorbidities. Despite effective treatments, over half of patients fail to achieve blood sugar or blood pressure control. Innovative tools, including remote patient monitoring (RPM), aim to address barriers to care by digitally transmitting health data to providers.

Objective:

To assess the impact of RPM on healthcare resource utilization in Medicare beneficiaries with diabetes or hypertension.

Methods:

This study used a longitudinal panel from 2016-2020 based on Louisiana Medicare Fee-for- Service claims. The outcomes included monthly outpatient, emergency room, and inpatient visits. Patients were included if they were diagnosed with diabetes or hypertension before 2016. RPM treatment was defined as at least one CPT code 99453 or 99454, with the corresponding month considered the treatment month. Control beneficiaries were randomly assigned treatment months matching the treatment group. An inverse probability treatment- weighted, controlled interrupted time series analysis with two-way fixed effects was conducted. Regressions were clustered at the primary physician level.

Results:

The study included 5,488 beneficiaries in the treatment group and 341,226 in the control group. RPM increased the level of outpatient visits in the treatment group by 2,284.01 visits per month per 1000 people (P<.001) after initiation and decreased the trend of outpatient visits by 37.61 visits per month per 1000 people compared to the control group (P<.001). Similarly, the level of emergency room visits increased in the treatment compared to the control by 84.60 visits per month per 1000 people initially after RPM initiation (p<0.01) and decreased the trend by 1.40 visits per month per 1000 people (P<.001). The level of inpatient visits increased by 32.64 visits per month per 1000 beneficiaries in the treatment group compared to the control immediately after RPM prescription (P=0.002) but the trend decreased by 0.54 visits per 1000 people each month (P<.001).

Conclusions:

RPM is associated with a modest but statistically significant increase in healthcare utilization among Louisiana Medicare beneficiaries with diabetes or hypertension. Although utilization trends downward, the rate of decline does not offset the initial increase. This population may have unique characteristics contributing to the opposite effect observed in other studies. Strategies to maximize the benefits of RPMs should include educating older adults on digital health applications, ensuring appropriate population targeting, and equipping physicians to integrate RPMs effectively.