Technology has proven beneficial for treating chronic conditions and generating data. But changes in reimbursement could be coming in 2024.
Federally qualified health centers (FQHCs) are an important safety net for individuals who often do not have easy access to primary and preventive care. With a mission to ensure the delivery of high-quality, comprehensive health care services to these underserved communities, many FQHCs are now choosing to leverage technology – like remote patient monitoring (RPM) – to reach more individuals and take a proactive approach to their care that results in better outcomes and minimizes health care overall costs.
Since the COVID-19 pandemic, incorporating RPM into a patient’s care has proven extremely effective for FQHCs. Services can be extended beyond traditional in-person visits, which is particularly important when monitoring patients for high blood pressure, diabetes, heart failure, asthma and other chronic conditions. The patient-generated data also enhances continuity of care, allowing clinicians to identify potential red flags before they escalate into more complicated problems. By having a holistic view of the patient and taking proactive measures, FQHCs can ultimately reduce overall health care costs for both the patients and payers.
Yet, despite the early successes with RPM deployments and the obvious benefits from the initial grant funding FQHCs received for RPM projects and specific disease management initiatives during the pandemic, FQHCs still face significant uncertainty about how to pay for these beneficial programs long term, as those grants are limited in scope and duration.
As the reimbursement currently stands, Medicare does not reimburse FQHCs or rural health centers (RHCs) for RPM activity. Additionally, Medicaid coverage varies greatly by state. Currently, 34 state Medicaid programs provide RPM reimbursements, but this coverage often does not include FQHCs. Many Medicaid programs also have restrictions – such as limiting the types of clinical conditions for which symptoms can be monitored, the devices used and the information that can be collected.
To keep RPM programs running, and potentially consider expanding their use, FQHCs have needed to find creative ways to pay for them. Among the approaches are:
While these efforts may help sustain existing programs, there are indications that changes are on the horizon to make RPM reimbursements more impactful. Changes to current reimbursement presented in the 2024 Proposed Physician Fee Schedule (PFS) would allow for reimbursements to FQHCs for RPM services for Medicare beneficiaries. While this does not dictate coverage for Medicaid beneficiaries, and there is some concern that billing for RPM under the same G0511 code as CCM will not provide enough sustainability for RPM activities, it's a starting point. If Medicare does expand eligibility for RPM reimbursement to FQHCs, it is anticipated that many Medicaid plans may follow suit. This would create a sustainable model for RPM programs at FQHCs and provide needed support to many individuals who receive their care through these community health clinics. Many stakeholders provided robust feedback to CMS’s proposed PFS and anxiously await the 2024 PFS Final Rule in early November.
Lucienne Marie Ide, MD, PhD, is founder and CEO of Rimidi, a leading clinical management platform designed to optimize clinical workflows, enhance patient experiences, and achieve quality objectives for chronic disease management.