What’s new in remote patient monitoring-and how it can benefit you

May 24, 2019

Emerging growth and quality opportunities accompany CMS’s growing enthusiasm for RPM.

For years, CMS balked at reimbursing physicians for remote patient monitoring (RPM) and other types of non-face-to-facecare, but it seems those days are over. During the past two years, the agency has built on its existing coverage of chronic care management-related RPM services by adding new codes for RPM reimbursement.

Physicians who haven’t yet taken advantage of these new reimbursement codes because of concerns about staffing or implementation may want to consider leveraging mobile-enabled remote patient monitoring (mRPM). This technology is much more efficient and cost-effective than past approaches such as telephonic RPM. Easy to implement, it can provide nearly immediate clinical and financial value for large group practices or solo practices with minimal clinical support staff. 

Reimbursement leading the way

On January 1, 2018, physicians were permitted to start billing separately for 99091, a code that is separate from, and can be billed concurrently with, CMS’s Chronic Care Management (CCM) program that reimburses for time spent on patient-generated data collection and interpretation. 

As of 2019, CMS also added a new level of CCM management, CPT 99491, and increased the weighting of RPM as a practice improvement option under the Merit-based Incentive Payment System (MIPS).

In September 2018, CMS approved three of the new codes for RPM, 99453, 99454 and 99457. In the 2019 Medicare fee schedule, these codes are for general physiological remote monitoring of chronic conditions. These new reimbursements were long-overdue, because they finally allow practices to bill “incident to” for any clinical staff that implement and manage RPM, instead of just physicians.  The new codes also do not make restrictions about where the patient needs to be located, such as a rural area or in a medical facility, for the monitoring.

The new codes followed a two-year study (published in November 2017), of the CCM program that showed millions in cost savings and an increase in patients’ awareness of their chronic conditions. The report’s findings have likely been a major driver of the new RPM codes for CCM, since they are a less costly way for physicians to manage their patients’ chronic conditions when compared with more frequent face-to-face visits.

Adding RPM without the overhead

Physicians who aren’t yet participating in CMS’s CCM program (with RPM as a chronic care management tool) may have shied away because of the expansive requirements of CCM. In addition, reservations may surround a perceived need-and the related costs-to hire additional care team members or outside services to perform the care management interactions.

That’s where mRPM comes in. An automated schedule uses push notifications to prompt patients to enter requested biometric, objective and subjective data (including social determinants of health); patients can then respond at a time and place convenient for them. Once the data has been received, a clinician assesses the information and can decide if there is any need for a face-to-face visit or phone conversation. With a dashboard for the physician practice and a patient-friendly mobile app for check-ins between appointments, mRPM can greatly enhance communication between providers and patients. In addition, patients become more aware and engaged in their own care without overburdening care teams.

From the viewpoint of RPM and CCM coding requirements, mRPM is more cost-effectiveand more likely to meet patients’ needs than other remote communication methods such as telephonic RPM. Most patients already have mobile devices integrated into their daily lives, so checking in with their physicians via a mobile app fits easily into their lifestyles. In addition, traditional telephone-based interactions with patients means calls that occur only during certain hours, patients needing to be available during those times, and games of “phone tag”-all of which are inconvenient and inefficient for patients as well as clinical and office staff. In addition, mRPM’s efficient and consistent collection of health data helps solve the revenue-versus-cost problem of paying a staff member to talk with one patient at a time to gather “one-off” data, that may or may not be complete. 

Avoiding the data deluge

Because it can control the quantity and quality of patient-reported data captured at the practice, mRPM is more cost-effective. With the right platform, a patient is enrolled in an mRPM“care journey” specific to their health needs. The patients’ questionnaire responses via the app are automatically forwarded to clinicians and reviewed by the practice, health system and/or health plan to assess risk and possibly follow up with an intervention when needed.

Patient-reported data shared in this way is surrounded in context at a pre-determined frequency appropriate for each patient’s clinical condition/s and care plan. This process is much more efficient and relevant than receiving a flood of non-actionable biometric data multiple times a day, or whenever the patient decides to share it with the doctor-which could be not frequently enough, or too frequently.

Moreover, mRPM doesn’t require the patient to acquire or learn a new device or specialized equipment because smartphones and mobile devices are already so widely adopted. Pew Research Center reported in 2018 that 46 percent of seniors own a smartphone, with 73 percent of adults aged 50 to 64 and 89 percent of adults aged 30 to 49 years owning such a device. This familiarity, and preexisting lifestyle integration,offer positive adherence momentum for physicians in launching an mRPMprogram for their patients.

Engaging the patient

While relevant patient-reported data capture and revenue enhancement are the primary goals of an mRPM program, an ancillary benefit of an appropriatelystructured mRPM program is stronger patient engagement. That’s because the simple act of being reminded, or “nudged,” to capture and report outcomes on a consistent, unobtrusive basis can elicit positive health behaviors that providers did not anticipate, or even explicitly recommend.

The phenomenon of improving patient adherence to a care plan through gentle reminders is based on the Nudge Theory, a Nobel Prize-winning behavioral economics theory contending, in part, that indirect suggestions and positive reinforcement can influence people’s actions. That means physicians and organizations need to make it easy for patients to create and follow new healthy habits.

In the coming years, nothing will be easier or more habitual for patients than to communicate and share data using their personal mobile device. The alignment of mRPM with this trend-along with CMS’s newfound enthusiasm for RPM-makes non-face-to-face care tasks more efficient and beneficial for patients. Given the opportunities to improve patient outcomes while also bringing in new revenue streams, mRPM is certainly worth your while.

Harry Soza is president and CEO of CAREMINDr, a Silicon Valley tech company that partners with providers and health plans to advance population health management by enabling physicians to leverage the power of mobile-enabled remote patient monitoring that engages patients and leads to improved outcomes and lower costs. He can be reached at hsoza@caremindr.com.