PMD Healthcare Blog

PMD Healthcare Blog

CMS Backs RPM-Why Stakeholders should pay attention

For years, telehealth and telemedicine adoption rates have been stalled by uncertain payer support. In fact, 67% of physicians cite federal support as the primary barrier for telemedicine.

This year, those barriers are starting to crumble, and the future of remote patient monitoring (RPM) is looking increasingly confident. The Centers for Medicare and Medicaid Services (CMS) has opened up payment pathways for physicians that utilize RPM in a variety of scenarios. In particular, the avenue of RPM to care for patients with chronic conditions has become less restrictive and more profitable for both hospitals and physicians.

Let's look at how these new CMS codes are opening-up RPM as a successful care channel, and some supporting evidence as to the effectiveness of RPM for patients who have chronic conditions, recovering from a post-acute-care event or requiring home healthcare support.

CMS Enables Remote Patient Monitoring

Last year (2018) was the first time that CMS enabled RPM by providing critical payment pathways. Before 2018, CPT code 99091 was bundled with telehealth, which meant doctors reviewing patient monitoring devices weren't being separately reimbursed. Instead, all "management services" were bundled together and restricted to only telehealth eligible services. In 2018, 9901 was unbundled from telehealth opening up avenues for physicians to receive reimbursement for RPM.

While that initial step was critical towards embracing RPM as an emerging technology the $59 per patient per service period (varied by geographic location) was just the beginning of more robust changes. This year CMS has continued to unravel the barriers of RPM adoption for patients and hospitals.

Three new codes related to RPM have been added to CMS this year.

  1. 99454: Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on the use of equipment.
  2. 99457: Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days
  3. 99453: Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month

What Do These Translate To?

Between these three codes, there is $69 per patient per month reimbursement on equipment costs, a $54 reimbursement for spending 20 minutes reviewing patient monitoring data, and a $21 reimbursement per patient for the initial set up and patient education on devices. The total reimbursement is $123 per patient, per month plus and extra $21 for each new patient set up.

The Value of RPM for Patients With Chronic Conditions

Beyond the obvious reimbursement benefits to providers, RPM is a hyper-effective method of monitoring patients at high risk for hospital readmission, emergency use or sudden changes in healthcare status.

A 2008 study by the Veterans Health Administration (VHA) highlighted the benefits of RPM for 17,025 active patients. This was the first study of its kind, especially given the scope of participants.

Here's what the study found:

  1. RPM resulted in a 25% reduction in bed days for patients.
  2. There was a 20-25% reduction in hospital CHF readmissions.
  3. There was a 20% reduction in hospital COPD readmissions.
  4. The mean patient satisfaction score was 86%.

On top of this, the annual cost to deploy RPM was only $1,600 per patient. In comparison, the cost for home-care was $13,000, and the cost for nursing home care was over $77,000.

As a result of this study, the VHA grew their RPM program from 20,000 patients in 2008 to 150,000 patients in 2012.

More recently, in 2015 Banner Health deployed a telehealth pilot program within its most complex, chronically ill patient population.  Participants were provided with remote patient monitoring tools such as blue-tooth enabled glucometers, weight scales, and heart monitors. In 2017 Banner released an analysis of patient results over the first full year of their telehealth program revealing:

  • 75% reduction in readmissions
  • 50% reduction in the number of hospital days
  • 49.5% reduction in hospital admissions
  • 34.5% reduction in overall costs

Of course, RPM's value extends to patients (care,) hospitals (ROI,) and physicians time. While some hospitals may assume that chronic patients represent a small minority of the overall patient index, a Rand study highlights that over 60% of Americans have at least one chronic condition and 42% of Americans had more than one. Furthermore, 2/3rd of Medicare-eligible patients have 2 or more chronic conditions.

The Value of RPM for Hospitals (ROI)

An eHI report found that many hospitals are finding more accurate results from RPM data than data derived in the hospital setting. The care avenues that RPM opens are profound. There's a reason that EY's survey of digital technologies in the health ecosystem revealed that hospitals who are taking steps to "self-disrupt" their practices with modern technology are benefiting — technology is changing patient treatment.

But, like any new looming technology, adaptation is hinged to profitability. So, let's talk ROI.

Here are some of the ways that RPM can immediately impact operational return on investment.

RPM:

  1. Naturally increases the patient-to-physician ratio. A single physician can monitor a great number of patients and capture reimbursement benefits by doing so.
  2. Improves physician workflow by giving physicians more time to focus on immediate care patients while remotely watching those at risk.
  3. Frees up critical bed space for high-profile and high-revenue cases for hospitals.
  4. Reduces unnecessary emergency room visits and hospital readmissions.
  5. Provides hospitals greater access to data across the patient lifecycle and the ability to garner insightful health data across the entire patient population.

Not only is remote monitoring reimbursable, but it can also have a positive impact financially for hospitals by eliminating unnecessary penalties, improving quality and freeing up resources that enable their systems to provide more care to those in most need.

The Value of RPM for Physicians

Finally, let's address the value of RPM for physicians. While the reimbursement figures are obvious motivators for physicians, reduced workloads, is probably the most significant benefit.

Rising levels of physician burnout is a serious threat to the entire medical ecosystem and finding ways to curb rising rates of doctor decline in an age where physicians are already in a massive shortage is critical for both doctors, hospitals, and patients.  Advances in technology that can improve provider efficiency and care for patients, while at the same time make solid financial sense should be part of a physicians’ arsenal.

Final Thoughts

The new CMS reimbursement codes will help break some of the barriers surrounding RPM adoption. As it stands, RPM is a fantastic way for hospitals to reduce unnecessary emergency room utilization, reduce hospital readmissions, improve the quality of care and patient satisfaction.

Key stakeholders and hospital administrators should be eyeing RPM as one of the most significant emerging technologies in the telemedical space.

If you're looking for more information on this subject or our RPM products, contact us.