When the Centers for Medicare & Medicaid Services began reimbursing providers for remote patient monitoring (RPM) services in 2018, the health care community’s response at the outset was less than underwhelming. Then came the boon in telehealth utilization prompted by the COVID-19 pandemic, which—after the initial spike in Q2 2020—stabilized in early 2021 at a level 38 times higher than it was before the pandemic, with 13 to 17 percent of office and outpatient visits taking place via telehealth.
But “despite the broad adoption of telehealth,” according to a report by the Medical Group Management Association (MGMA), “RPM is one component of telehealth that has lagged.” Even though RPM’s use increases steadily each year, MGMA’s Stat poll of 586 healthcare leaders taken in June still found that 75% of medical practices have yet to offer it. And the RPM adoption rate seems to be similarly slow in large healthcare facilities, of which only 20% acknowledge having any sort of RPM, according to a separate 2021 survey.
The benefits of providing remote patient monitoring services are substantial, widely acknowledged, and extend across the healthcare landscape. In light of that, why are many U.S. healthcare providers still not offering RPM? That’s a question we’ll explore here with an aim toward illuminating solutions that might help you on your way to integrating RPM into your practice.
The Benefits of RPM
RPM uses information technology to transmit patient-generated health data gathered outside the clinical setting to the patient’s health care team so they can make assessments about the patient’s progress, and if necessary, intervene to make treatment adjustments aimed at improving outcomes. Used most effectively, RPM has the potential to help health care professionals (HCPs) care for millions of Americans with manageable chronic diseases, such as diabetes, obesity, and hypertension. In fact, it’s a win-win care strategy that’s beneficial for patients, HCPs, payors, and healthcare systems.
For patients, RPM helps keep them connected to their care teams, which it seems they appreciate. According to a study of 300 consumers released in June 2021 by MSI International, 80 percent of Americans view RPM favorably, with 36% to 43% saying it provides a range of benefits, like peace of mind, convenience, efficiency, accuracy, and control over their personal health.
For HCPs, the connectedness of RPM gives them ongoing visibility into the health progress of patients between standard office visits, which—especially in the management of chronic disease—helps care teams keep patients on track. In a 2022 survey of 100 U.S. medical practice leaders, 66% indicated RPM improves patient outcomes, an assertion well-supported by clinical research. For example, one study presented in 2021 of 424 middle-aged patients whose type 2 diabetes was managed via RPM on our company’s platform at 11 U.S. centers demonstrated significant immediate (3 months from baseline) and sustained (6 and 12 months) glycemic improvement. That included decreases in average glucose and the average proportion of high glucose readings as well as an increase in the average proportion of in-range readings.
As for payors, they also appreciate RPM’s value. Many recognize it’s better to pay on the order of $50 to $200 a month to manage chronic disease via RPM and keep a patient in range and healthy than to have to deal with the emergent and costly adverse health events that can develop when patients go unchecked in the months between routine office visits.
Finally, when it comes to providers, such as health care systems and medical practices, it’s the developing reimbursement landscape that’s proving to be the most welcome benefit of RPM. In fact, chronic care providers are witnessing the evolution of their identity from cost center to revenue generator, thanks to how payors are structuring RPM reimbursement. CMS has assigned a unique CPT code for payors to use for each discrete RPM action. According to the 2022 CMS schedule:
- For setting up a patient—e.g., syncing a diabetes patient’s glucose meter to an RPM platform—a provider can submit a one-time claim for ~$19 (CPT code 99453)
- For each patient that syncs their data in a month, the provider can submit a claim for ~$56 (99454)
- If a provider analyzes that data, they can submit another monthly claim for ~$56 (99091)
- If they consult with the patient for 20 minutes, they can submit a monthly claim for ~$50 (99457), and
- If they consult for a second 20-minute session, they can submit one more for ~$41 (99458)
Barriers to RPM Adoption
With the all-around benefits of using RPM to manage patients with chronic conditions, including such a provider-friendly reimbursement structure, why are only 20% to 25% of health care providers currently providing RPM services?
Unbelievably, one thing we’ve found fairly regularly among the providers we speak with each year is that the information about RPM reimbursement simply hasn’t reached them yet. For them, it’s simply a matter of awareness, so we continue to educate our provider partners on the latest information in the evolving RPM space.
Another challenge we’ve found among some providers is the misconception that only Medicare reimburses for RPM services. The reality is that there’s a growing throng of private payors covering RPM, which, at last count, was up to 74, and some of them reimburse for RPM at an even higher level than Medicare.
Probably the biggest obstacle we encounter among some providers is the misconception that they have to do everything at once and aren’t quite sure where to start. For example, some believe when they submit a claim that they must include every one of the RPM services described above. But that’s not true, and—in fact—it’s why CMS has assigned a unique CPT code for each discrete part of RPM care.
For example, many care teams may want, at minimum, to arrange for their chronic care patients to sync their data monthly. At the same time, they can set up their RPM platform so it flags only patients whose health data indicates that something is “out of bounds.” At that point, the care team can look into whether some kind of intervention is warranted. But regardless of whether it’s a single service, like a data sync, or multiple services, it’s important to know that each component of RPM care can be submitted on its own for monthly reimbursement.
Probably the most helpful step a provider can take if they’re not sure where to start is to find a reliable partner that specializes in RPM planning and implementation. But even that can feel burdensome, which is why it’s encouraging to have resources like the 12-step RPM Playbook the AMA published earlier this year, covering everything from identifying the need and forming your team to partnering with the patient, implementing a program and evaluating its success. The Playbook even provides guidance on evaluating potential RPM vendors “with the intent of finding someone who will be a long-term partner and not just someone to execute a transaction.”
Making the Leap to RPM
While there are many providers who have yet to venture into RPM, there are likewise many who are dipping their toe in the water with a pilot program and still others just diving right in. Either way, considering RPM’s substantial benefits, it’s probably worth it to simply get started at some level, especially if your organization focuses on treating patients with chronic conditions. It will be a move to support not only the health of your patients but also the long-term health and competitiveness of your organization.
Zach Henderson is the chief commercial officer at Glooko Inc.