Reimbursement for remote patient monitoring is accelerating adoption

Remote patient monitoring (RPM) does precisely what it says, allowing providers to monitor patients while patients are at home or otherwise outside of the hospital or clinical care setting. It’s an innovative concept and one that cuts down on costs and catches complications before they escalate. Business Insider describes the RPM industry as “emphasizing illness prevention over ‘sick care.’” By empowering patients to take healthcare into their own hands (or smartphones, or other devices), providers can truly help stave off illness or emerging complications rather than treat what’s already there.

The need for RPM

RPM technologies are becoming increasingly necessary as large swaths of the American population age, and rural areas face a medical staff shortage. Digital technology solutions like GetWell Loop can help bridge the gap between patients and providers and ease geographic limitations.

The potential for RPM technologies is staggering — and the numbers prove out its value. GetWell Loop hospital clients, for example, have published research validating a 45% reduction in readmissions and 54% fewer complications compared to national benchmarks. However, the reimbursement rate for providers utilizing RPM has been lacking until this year. In 2016, for example, Medicare reimbursement for these technologies totaled just $28.75 million out of a $990 billion overall Centers for Medicare & Medicaid Services (CMS) budget.

Fortunately, as providers and CMS have seen the clear evidence that RPMs improve quality and cost, they have adapted mechanisms to reimburse providers for their use with smart providers already getting paid.

The introduction of new RPM codes

In late 2018, CMS released the final Medicare Physician Fee Schedule for 2019, which included several new billing codes addressing RPM technologies.

Now, providers can be reimbursed for the “collection and interpretation of physiologic data” (CPT code 99091), meaning more specifically that they can claim reimbursement for time spent collecting and analyzing the health data generated by various RPM technologies.

Other new codes include:

  • HCPCS Code G2012 Brief communication technology-based service: Reimbursement of around $10 per event is available for providers who answer patient questions or concerns via virtual check-in (to assess whether an office visit is necessary)
  • HCPCS Code G2010 Remote evaluation of recorded video and/or images submitted by an established patient: Physicians receive reimbursement for time spent evaluating video or photos of symptoms submitted by established patients
  • CPT Code 99453 Remote monitoring of physiologic parameter(s) (e.g, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment: This code covers reimbursement for onboarding and educating new patients about an RPM service, as well as time spent setting up equipment
  • CPT Code 99457 Chronic care remote physiologic monitoring treatment management services, 20 minutes or more: Clinical staff are allowed 20 minute increments per patient, per month in which to take advantage of RPM capabilities to monitor their patients

CMS justified these changes by citing the elderly, isolated and disabled populations who will benefit, saying that, “under this proposal, Medicare will start paying for virtual check-ins, meaning patients can connect with their doctor by phone or video chat,” said Seema Verma, CMS Administrator.

“Many times this type of check-in will resolve patient concerns in a convenient manner that gets them the care that they need and avoids unnecessary cost to the system. This is a big issue for our elderly and disabled populations where transportation can be a burden to care as well as to caregivers. We’re not intending to replace office visits but rather to augment them and provide new access points for patients.”

The benefits of RPM

Expanded reimbursement for providers is crucial because it will allow for the advancement of RPM into mainstream American healthcare, enabling monitoring care and guidance in the home setting. These “new access points” represent a dramatic alteration from the way medicine is practiced, but also one that’s proven to work.

RPM is successful because it works in conjunction with providers, rather than replacing them. The technologies help care teams:

  1. Reach more patients than phone- or clinic-based approaches allow
  2. Identify at-risk patients in real time
  3. Improve outcomes through better patient compliance and early intervention
  4. Become more efficient by focusing care teams on the right patient at the right time

Using RPM, providers can detect problems earlier, while patients can be more actively engaged in their own healthcare (and all from the comfort of their own homes). It’s a win-win situation for both parties. These RPM reimbursement codes are also helping care management teams move from a cost center to a revenue center in their health systems, demonstrating the potential to expand programs beyond only high- or rising-risk patients.

The growth of digital health innovations

By improving outcomes and reducing costs, RPM provides a space for digital health innovations to grow, and appropriate reimbursements incentivize the integration of these innovative technologies. This is a boon to providers and consumers alike, as reflected in patient satisfaction ratings; 92% of GetWell Loop patients stating that they are “Extremely Likely to Recommend” their provider to a friend or colleague.

The expansion of reimbursement for providers who use digital technologies (including virtual check-ins) and RPM is one way that the Centers for Medicare & Medicaid Services has signaled growing recognition of the importance of these services. It’s my hope that commercial payers will soon follow CMS’ lead, expanding the reach of RPM innovations to patients across the country.