RPM reimbursement codes clear the way for expanding RPM programs, such as glucose monitoring for diabetes patients

RPM Reimbursement Paves the Way for Expansion in 2020

With the ongoing shift in healthcare towards a value-based care model, the concept of remote patient monitoring (RPM) for chronically ill patients certainly grabbed attention throughout 2019. By introducing new reimbursement codes for RPM in late 2019, the Centers for Medicare & Medicaid Services (CMS) is clearly inviting the increased use of RPM, presumably made possible with telemedicine, in 2020. Some experts view 2019 as the trial run for RPM reimbursement; now that the CMS has officially endorsed RPM, albeit in limited capacities, 2020 is expected to see a significant rise in the adoption of RPM programs. However, current limitations in technology and software could curb growth, warn industry watchdogs.

Having been under pressure from the American Medical Association since 2018, the CMS recently added new CPT codes for reimbursement of services performed under general supervision of a qualified healthcare provider; with these codes, RPM is classified as a “designated care management service” that can be provided in the patient’s home under the general supervision of a physician or other health care professional. The codes are designed to give providers more time with their patients in virtual care, but some critics feel that the codes are too narrowly defined to make a notable difference in the general use of RPM; for instance, federally qualified health centers (FQHCs) and rural health centers (RHCs) are not eligible for RPM reimbursement. Additionally, several key questions remain unanswered, such as whether RPM may be utilized for non-chronic care cases or whether an established provider-patient relationship is a prerequisite for RPM reimbursement.

Meanwhile, hospitals and health systems have expressed huge interest in implementing RPM as part of their transition to a value-based care model; 88 percent have already invested in or plan to invest in RPM technologies, as noted by the 2019 Spyglass Consulting report. Early adopters have already run pilot programs last year and, with the adoption of the new CPT codes, are ready to expand their programs in 2020. Thus far, the most popular mobile technologies consist of smartphones and tablets used in conjunction with telemedicine video conferencing software platforms and wearable devices. Electronic health record (EHR) patient portals are expected to play a large role as well for providing patient access.

However, software and technology advancements may not yet be able to provide the level of care needed for RPM. The overall goals of RPM include better patient outcomes and lower costs, but a focused smartphone app that only connects to a limited number of devices has been shown to fall short of providing such results on a larger scale. Furthermore, the devices and apps must be able to filter the incoming data and flag only noteworthy events for a provider’s attention; otherwise, overwhelmed health care professionals may fall victim to alert fatigue.

To compound matters, the structure of RPM may not be fully capable of supporting the cybersecurity required to comply with HIPAA and HL7 for keeping health data confidential and secure. Traditionally, patient monitoring systems have been deployed in healthcare facilities, where the environment and users remain carefully controlled. However, moving the monitoring systems into patients’ homes introduces vulnerabilities in the architecture. In addition, patients must be trained on the proper use and regard for private health data, and optimal outcomes will depend partly on the levels of patient engagement and compliance in using the devices as instructed. If the RPM devices and apps are as simple and accurate as wearable activity trackers have proven to be, thus encouraging a high rate of usage, then careful analyses can identify trends that may require medical intervention.

Many physicians welcome RPM reimbursement and the expansion of RPM into patients’ homes. A reliable telemedicine system with user-friendly digital health devices will be able to capture patients’ health data and medication usage in their day-to-day activities. By offering an authentic picture of the state of patients’ health conditions, rather than requiring patients to (sometimes inaccurately) describe symptoms and concerns during periodic office visits, RPM enables health care providers to closely observe patients’ health and behaviors and, thus, better assess the effectiveness of treatment plans. At the same time, the availability of measurable health data feedback may encourage patients to take a more active role in handling their health issues. And as we all know, an engaged patient is generally a healthier patient.

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  1. […] engagement among providers doubled—from 14% of physicians to 28% over the three-year period—and remote patient monitoring (RPM) usage jumped from 13% of physician participation in 2016 to 22% in 2019. Overall, the results of […]

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