Five significant updates concerning remote patient monitoring that will help you determine whether to add the service to your practice.
Heading into 2020, adoption of telehealth services was already on the rise. Then the health crisis hit. Now it appears that COVID-19 has not only cemented telehealth's place in the healthcare landscape but done so in a very big way.
McKinsey & Co. is projecting that virtual visits could potentially account for $250 billion, or 20%, of what federal and commercial payers spend on outpatient, office, and home health visits in 2020. Before the pandemic, telehealth accounted for an estimated $3 billion in spending.
Remote patient monitoring, or RPM, is one such telehealth service experiencing a surge in adoption during the crisis. Generally speaking, RPM is the use of digital technologies to monitor and capture medical/health data from patients and electronically transmit the information to their providers for assessment, recommendations, and instructions. Providers use RPM to collect a wide range of patient data, including blood pressure, weight, heart rate, and blood sugar levels.
Remote patient monitoring is a service that was positioned for significant growth leading into 2020; the pandemic has only accelerated it. Here are five of the most significant updates concerning RPM that will help you determine whether now is the right time to add the service to your practice.
Thanks to an overhaul of remote patient monitoring CPT codes for 2020, RPM became one of the more lucrative Medicare care management programs. The vast majority of RPM services are now billed under four CPT codes: 99453, 99454, 99457, and 99458. There is a small payment for initial patient enrollment into an RPM program, and then a monthly base payment for management of the device and patient readings. Finally, there is an optional service for each 20 minutes of care management — which can be provided by clinical staff — up to 60 minutes total. When added together, each RPM patient can earn a practice up to around $210 per month.
The average practice furnishes about 20 minutes of RPM care management, which brings the total monthly reimbursement to around $120 per Medicare beneficiary. If 50 patients are enrolled in an RPM program and each receives the care management services minimum, that will yield an estimated $72,000 annually. Even after covering expenses associated with running a program, which will vary based on several factors (e.g., use of cellular vs. Bluetooth devices), RPM can generate significant and consistent revenue.
Before the pandemic, Medicare announced in its final rule on chronic care remote physiologic monitoring services that it was expanding its guidelines to include the provision of RPM services when conducted by auxiliary clinical staff under general supervision of a medical provider. As opposed to the “direct supervision” standard, “general supervision” allows for much more flexibility in structuring an RPM program.
In addition, remote patient monitoring and chronic care management (CCM) services can now be billed separately within the same month for a single patient. The only caveat is that each of the two services must meet the minimum time threshold requirement independently.
Remote patient monitoring is not only payable by Medicare, but also 23 state Medicaid programs (as of June 2020, according to the Center for Connected Health Policy). In addition, numerous commercial payers cover remote patient monitoring within their telehealth coverage policies (with some caveats).
While some of this coverage was spurred by COVID-19 (more on this below), many private insurers were already embracing — or being legally forced to embrace — remote patient monitoring. As of December 2019, Foley & Lardner reported that 13 states require commercial health plans to cover RPM services. They are often following Medicare's lead on not only covering the service but reimbursing it generously.
We briefly touched on the profound effect of COVID-19 on telehealth in the beginning of this column. Let us dive a bit further into some of the ways the pandemic is helping drive adoption of remote patient monitoring.
Remote patient monitoring technology is an effective solution for keeping patients with chronic and acute health conditions home and safe (e.g., maintaining social distancing) while permitting practices to continue effectively monitoring disease progression and responding to any developments. Recognizing this value, CMS issued guidance in late March concerning RPM in its "Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency" interim final rule. This included several changes to how CMS covers RPM. Some changes announced were permanent while others were indicated for the duration of the pandemic.
Perhaps the most significant permanent change included in the rule is that remote patient monitoring can now be used for Medicare patients with acute conditions. This expands coverage from only patients with chronic conditions and allows for remote monitoring of COVID-19 patients.Medicare also clarified that, unlike chronic care management, RPM can be provided for patients with only one disease. Perhaps the most significant temporary change is that CMS stated RPM could be provided to new as well as established Medicare patients. This change eliminated a barrier to streamlining the provision of RPM services to new beneficiaries without having to require a possibly risky in-person office visit.
CMS has also issued multiple telehealth waivers which provided flexibility (e.g., geographic location, type of health site) during the pandemic and granted payment parity between telehealth and in-person clinical care for Medicare. Many commercial payers followed these new Medicare guidelines for remote patient monitoring, while numerous states included RPM in their telehealth parity laws.
Furthermore, the COVID-19 Telehealth Program established by the Federal Communications Commission (FCC) includes remote patient monitoring. Through the program, the FCC is distributing $200 million appropriated by Congress under the Coronavirus Aid, Relief, and Economic Security (CARES) Act to help qualifying providers deliver telehealth services. RPM platforms and services are eligible for this program funding.
Such federal, state, and commercial initiatives have served to greatly incentivize providers to launch or expand remote patient monitoring programs. While there are few statistics available specifically concerning RPM growth during the pandemic, there are plenty that speak to telehealth broadly. The McKinsey report noted earlier states that healthcare providers are reporting 50-175x the number of telehealth visits pre-COVID-19. Meanwhile, FAIR Health is reporting that telehealth claim lines increased more than 4,000% nationally from March 2019 to March 2020. Another way of looking at this: Telehealth claim lines represented just 0.17% of all medical claim lines in March 2019. One year later, telehealth comprised close to 8%.
Remote patient monitoring is a care delivery service that depends greatly on patient engagement. RPM programs are successful when patients understand and appreciate the value of the service and commit to playing their part, which largely depends upon their RPM device and how data is transmitted from patient to provider.
As practices offering remote patient monitoring — and other telehealth services — are finding, patients are increasingly on board with participating in programs, with many compelled to embrace the solution at least in part due to the pandemic. For example, McKinsey notes that 11% of consumers used telehealth in 2019. Now, more than 3 in 4 consumers are interested in receiving virtual services going forward. Forrester projected in April that virtual care visits will soar to more than 1 billion this year.
In addition to regulatory efforts, the federal government is issuing guidance to help providers deliver virtual care during and following the pandemic, which includes strategies to increase telehealth uptake. Practices will play a significant role in getting patients to buy into the concept of remote patient monitoring and then stay engaged in programs once enlisted.
While little good has come out of COVID-19, a possible silver lining is the subsequent rise in the adoption of telehealth. It represents a technological trend that is likely to redefine the delivery of care. Practices must embrace the solutions that will help them meet the evolving needs and demands of patients. Remote patient monitoring is one such service proving to be advantageous for patients, lucrative for practices, and a boon for the healthcare system.
There has been a growing effort to further expand federal telehealth guidelines in the industry and by lawmakers. As information on the value of the expanded RPM and CCM guidelines during the crisis becomes public, one can safely assume that at least some of the temporary guideline expansions will become permanent.
The landscape of healthcare in America is changing rapidly. Remote patient monitoring can help practices keep pace and ensure they not only survive this crisis but thrive when we can finally put it behind us.
Daniel Tashnek, JD, is the co-founder and vice president of Prevounce Health, a healthcare software company that simplifies the provision of clinical preventive services, chronic care management, and remote patient management. Daniel is also a practicing healthcare attorney specializing in regulatory compliance, reimbursement, scope of practice, and patient care issues.