When the Centers for Medicare & Medicaid Services started reimbursing suppliers for distant affected person monitoring (RPM) companies in 2018, the well being care neighborhood’s response on the outset was lower than underwhelming. Then got here the boon in telehealth utilization prompted by the COVID-19 pandemic, which—after the preliminary spike in Q2 2020—stabilized in early 2021 at a degree 38 times higher than it was before the pandemic, with 13 to 17 percent of office and outpatient visits happening by way of telehealth.
But “despite the broad adoption of telehealth,” in accordance with a report by the Medical Group Management Association (MGMA), “RPM is one component of telehealth that has lagged.” Even although RPM’s use will increase steadily annually, MGMA’s Stat ballot of 586 healthcare leaders taken in June nonetheless discovered that 75% of medical practices have yet to offer it. And the RPM adoption price appears to be equally sluggish in large healthcare facilities, of which only 20% acknowledge having any sort of RPM, in accordance with a separate 2021 survey.
The advantages of offering distant affected person monitoring companies are substantial, extensively acknowledged, and lengthen throughout the healthcare panorama. In mild of that, why are many U.S. healthcare suppliers nonetheless not providing RPM? That’s a query we’ll discover right here with an intention towards illuminating options which may provide help to in your technique to integrating RPM into your apply.
The Benefits of RPM
RPM makes use of info know-how to transmit patient-generated well being knowledge gathered exterior the medical setting to the affected person’s well being care group to allow them to make assessments concerning the affected person’s progress, and if essential, intervene to make therapy changes aimed toward bettering outcomes. Used most successfully, RPM has the potential to assist well being care professionals (HCPs) take care of thousands and thousands of Americans with manageable continual illnesses, comparable to diabetes, weight problems, and hypertension. In truth, it’s a win-win care technique that’s useful for sufferers, HCPs, payors, and healthcare techniques.
For sufferers, RPM helps maintain them related to their care groups, which it appears they admire. According to a examine of 300 shoppers launched in June 2021 by MSI International, 80 percent of Americans view RPM favorably, with 36% to 43% saying it gives a spread of advantages, like peace of thoughts, comfort, effectivity, accuracy, and management over their private well being.
For HCPs, the connectedness of RPM provides them ongoing visibility into the well being progress of sufferers between commonplace workplace visits, which—particularly within the administration of continual illness—helps care groups maintain sufferers on observe. In a 2022 survey of 100 U.S. medical apply leaders, 66% indicated RPM improves patient outcomes, an assertion well-supported by medical analysis. For instance, one examine offered in 2021 of 424 middle-aged sufferers whose kind 2 diabetes was managed by way of RPM on our firm’s platform at 11 U.S. facilities demonstrated significant immediate (3 months from baseline) and sustained (6 and 12 months) glycemic improvement. That included decreases in common glucose and the common proportion of excessive glucose readings in addition to a rise within the common proportion of in-range readings.
As for payors, in addition they admire RPM’s worth. Many acknowledge it’s higher to pay on the order of $50 to $200 a month to handle continual illness by way of RPM and maintain a affected person in vary and wholesome than to should cope with the emergent and dear adversarial well being occasions that may develop when sufferers go unchecked within the months between routine workplace visits.
Finally, with regards to suppliers, comparable to well being care techniques and medical practices, it’s the creating reimbursement panorama that’s proving to be probably the most welcome advantage of RPM. In truth, continual care suppliers are witnessing the evolution of their id from price middle to income generator, because of 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 organising a affected person—e.g., syncing a diabetes affected person’s glucose meter to an RPM platform—a supplier can submit a one-time declare for ~$19 (CPT code 99453)
- For every affected person that syncs their knowledge in a month, the supplier can submit a declare for ~$56 (99454)
- If a supplier analyzes that knowledge, they’ll submit one other month-to-month declare for ~$56 (99091)
- If they seek the advice of with the affected person for 20 minutes, they’ll submit a month-to-month declare for ~$50 (99457), and
- If they seek the advice of for a second 20-minute session, they’ll submit yet another for ~$41 (99458)
Barriers to RPM Adoption
With the all-around advantages of utilizing RPM to handle sufferers with continual situations, together with such a provider-friendly reimbursement construction, why are solely 20% to 25% of well being care suppliers presently offering RPM companies?
Unbelievably, one factor we’ve discovered pretty repeatedly among the many suppliers we communicate with annually is that the details about RPM reimbursement merely hasn’t reached them but. For them, it’s merely a matter of consciousness, so we proceed to teach our supplier companions on the most recent info within the evolving RPM area.
Another problem we’ve discovered amongst some suppliers is the misunderstanding that solely Medicare reimburses for RPM companies. The actuality is that there’s a rising throng of personal payors overlaying RPM, which, finally rely, was as much as 74, and a few of them reimburse for RPM at a fair greater degree than Medicare.
Probably the largest impediment we encounter amongst some suppliers is the misunderstanding that they should do every part directly and aren’t fairly positive the place to start out. For instance, some imagine after they submit a declare that they need to embrace each one of many RPM companies described above. But that’s not true, and—in truth—it’s why CMS has assigned a novel CPT code for every discrete a part of RPM care.
For instance, many care groups might want, at minimal, to rearrange for his or her continual care sufferers to sync their knowledge month-to-month. At the identical time, they’ll arrange their RPM platform so it flags solely sufferers whose well being knowledge signifies that one thing is “out of bounds.” At that time, the care group can look into whether or not some form of intervention is warranted. But no matter whether or not it’s a single service, like a knowledge sync, or a number of companies, it’s necessary to know that every part of RPM care could be submitted by itself for month-to-month reimbursement.
Probably probably the most useful step a supplier can take in the event that they’re undecided the place to start out is to discover a dependable companion that focuses on RPM planning and implementation. But even that may really feel burdensome, which is why it’s encouraging to have sources just like the 12-step RPM Playbook the AMA printed earlier this yr, overlaying every part from figuring out the necessity and forming your group to partnering with the affected person, implementing a program and evaluating its success. The Playbook even gives steering on evaluating potential RPM distributors “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 various suppliers who’ve but to enterprise into RPM, there are likewise many who’re dipping their toe within the water with a pilot program and nonetheless others simply diving proper in. Either manner, contemplating RPM’s substantial advantages, it’s in all probability price it to easily get began at some degree, particularly in case your group focuses on treating sufferers with continual situations. It will likely be a transfer to help not solely the well being of your sufferers but in addition the long-term well being and competitiveness of your group.
Zach Henderson is the chief industrial officer at Glooko Inc.