With Remote Patient Monitoring, Picking Tools Is Easier Than Change Management

Tracking patients between visits to the oncologist is not a new idea. There’s ample evidence that prompting patients to report symptoms can allow practices to get ahead of events before they become crises, preventing emergency department visits and improving outcomes.1-3

Today, the need for care between visits carries new urgency. The rise of chimeric antigen receptor (CAR) T-cell and bispecific therapies has prompted community practices to explore how they can safely administer these game-changing treatments—typically at a much lower cost than a hospital or academic center. Use of patient monitoring technology alongside systems for care management could offer a path forward, according to members of the panel, “Is Remote Therapeutic Monitoring Delivering Value?”

Susan Sabo-Wagner, RN, BSN, OCN, NEA-BC | Image: AON

Debra Patt, MD, PhD, MBA | Image: Texas Oncology

Jeff Hunnicutt | Image: LinkedIn

Annette Fontaine, MD | Image: NMCC

Tuesday’s discussion at the Community Oncology Alliance (COA) Payer Exchange Summit in Reston, Virginia, featured Susan Sabo-Wagner, RN, BSN, OCN, NEA-BC, vice president of clinical innovation, American Oncology Network, as moderator; panelists were Annette Fontaine, MD, chief medical officer, New Mexico Cancer Center; COA President Debra Patt, MD, PhD, MBA, executive vice president, Texas Oncology; and Jeff Hunnicutt, CEO of Highlands Oncology in Bentonville, Arkansas.

At Texas Oncology, “We have a long experience using electronic patient-reported outcomes [ePROs], which is remote therapy monitoring, but we've not been doing that billing component until just recently,” Patt said. “Over the last 7 years, we've implemented ePROs in patients that are newly on active therapy for 100,000 patients; we've been doing for a long time.”

“Just recently, we started doing patient monitoring around bispecific therapy in one of our regions,” Patt said, explaining this effort will serve as a pilot. “This is an emerging need, and we need to solve for this.”

As early adopters of remote patient monitoring, both Texas Oncology and Highlands Oncology made significant investments that haven’t always paid for themselves, even when the practices could demonstrate improved outcomes and savings to payers.

Patt has published results on the effectiveness of ePROS,2,3 while Hunnicutt has worked to get commercial payers to see the value in patient monitoring. Sometimes they will be intrigued by the data, but getting reimbursement is a different story. Medicare has come around in recent years with a series of programs for specific services.4,5

The panelists offered examples of how remote monitoring contributes to better patient care, as well as instances where Medicare rules limit uptake in programs that would benefit patients—and ultimately payers.

“Being a breast cancer specialist, I give a lot of CDK4/6 inhibitors,” Patt said, noting that this drug class can cause gastrointestinal (GI) toxicity. Her triage nurse lets her know when a patient reports GI toxicity through ePROs, and on many occasions Patt has been able to hold a dose and manage a dose reduction based on this information.

Fontaine uses remote monitoring in 2 ways: a nutritional service allows patients to interact with dietitians remotely, and a different service evaluates a patient’s functional status.

The challenge isn’t getting patients to sign up, she said. The roadblock occurs when patients who don’t have supplemental coverage must pay cost-sharing for remote monitoring. Many of Fontaine’s patients can’t afford supplemental coverage, much less a co-pay.

“They get excited because they're getting a Fitbit and a fancy scale in the bathroom, but then when they have to pay that bill every month, they very quickly drop out. So that's an issue,” she said.

In addition, Fontaine and her fellow panelists said internet connections are uneven. “A lot of our patients are in rural New Mexico, and a lot of you serve patients in rural areas as well,” she said. “We are in the United States, but internet connection is not the same across America.”

Hunnicutt distinguished between remote patient monitoring (RPM), which he called “the physiological side” that includes heart rate, blood pressure, etc, and remote therapeutic monitoring (RTM). He discussed how these pieces can be aligned with specific reimbursement programs now offered by CMS. RTM is a specific reimbursement stream that started in 2022 for “non-physiological data,”4 while programs such as chronic care management (CCM) and principal care management (PCM) offer funds for RPM-type monitoring.5

For Highlands, Hunnicutt said, adoption of these revenue streams has allowed the practice to replace revenue lost when the Oncology Care Model (OCM) ended in June 2022. The practice opted not to take part in the Enhancing Oncology Model, but it had seen great success under the OCM and was not going to reverse course. “We had transformed,” Hunnicutt said. “You can’t untransform. This is the way we care for patients now.”

The practice kept staff members who allowed Highlands to provide the added services, but it had to figure out how to pay for them. CCM allowed Highlands to recapture about 25% of the revenue, and RTM made the practice whole, Hunnicutt said. For practices that never started transformation or had to let staff go after the OCM, “RTM allows them to be able to bring those people back into the practice, just do a better job caring for patients.”

“So that, to me, that’s the ROI thing,” he said. “I didn't mean to make a whole lot of money on RTM, but if you can make us whole and allow us to be able to do that for our patients, then that's all it is.”

Sabo-Wagner asked the group about their biggest challenges, and Patt explained that selecting tools is comparatively easy—implementation is where the big changes occur. She encouraged practices to learn from others, and she shared how she has visited Highlands Oncology to observe their patient education process. Hunnicutt, in turn, said it’s important to gain staff buy-in from the outset of a new process and not present it as a fait accompli.

“I always thought it would be hard to figure out what tools you can use,” Patt said. “And not that that's an easy part, but I do think implementation and change management is probably the hardest.”

If practices have made the right investments and have selected the right partner, Patt said, they must ensure they have the infrastructure to respond. “The 3 categorical things I would say are: having a doctor write the order, having the patient enroll and consent, and then managing the revenue cycle—I think that's where a lot of the technologic innovation can really help us get where we need to be to make the lift much easier. Then those infrastructure investments and change management—that’s really going to be the work of the practice.”

References

1. Basch E, Deal AM, Dueck AC, et al. Overall survival results of a trial assessing patient-reported outcomes for symptom monitoring during routine cancer treatment. JAMA. 2017;318(2):197-198. doi:10.1001/ jama.2017.7156
2. Patt D, Wilfong L, Hudson KE, et al. Implementation of electronic patient-reported outcomes for symptom monitoring in a large multisite community oncology practice: dancing the Texas two-step through a pandemic. JCO Clin Cancer Inform. 2021;5:615-621. doi:10.1200/ CCI.21.00063
3. Patt D, Patel AM, Bhardwaj A, et al. Impact of remote symptom monitoring (RSM) with electronic patient-reported outcomes (ePRO) on hospitalization, survival, and cost in community oncology practice: The Texas Two-Step study. JCO Oncol Pract. 2023;19(suppl 11):abstr 569. DOI:10.1200/OP.2023.19.11_suppl.569
4. Telehealth and remote patient monitoring. HHS. Updated January 17, 2025. Accessed September 14, 2025. https://telehealth.hhs.gov/providers/best-practice-guides/telehealth-and-remote-patient-monitoring/billing-remote-patient
5. Frequently asked questions about practitioner billing for Chronic Care Management Services. CMS. Updated August 16, 2022. Accessed September 14, 2025. https://www.cms.gov/files/document/chronic-care-management-faqs.pdf