Remote patient monitoring today keeps the doctor away

Remote patient monitoring

Image credit: liveClinic Healthcare Blog

This is the first of a series of articles describing recent changes in reimbursement and the overall market opportunity for remote patient monitoring, which is considered one of the major healthcare trends of 2018.

Remote patient monitoring is a part of telemedicine that focuses on providing healthcare services to patients at home. Medical professionals use a remote interface to gather constant data, thus focusing on the constant monitoring of patients and their conditions rather than on occasional diagnosis.

The concept is promising; remotely monitored patients would not need to visit their doctors as often. At the same time, doctors could take decisions based on the health data received, usually far before symptoms would appear to the patient.

There are several different uses for remote patient monitoring devices in healthcare, some of the most prominent are for cardiac patients, asthma control, management of diabetes and hypertension, prevention of accidents or falls and clinical trials.

About three years ago, the biggest concern for remote patient monitoring was the return on investment for providers. More recently, reimbursement started to be perceived as the biggest challenge to the expansion of remote patient monitoring, holding the technology back. However, reimbursement barriers may be significantly lowered (if not eliminated) in 2018.

This first article of the remote patient monitoring series focuses on the United States’ Medicare and its upcoming changes, which will start to take effect in early 2018.

US Medicare

In October this year, a survey of US providers showed that limited reimbursement was the biggest hindrance to the expansion of telehealth.

Last month the Centers for Medicare and Medicaid Services (CMS) announced changes to Medicare reimbursement for remote patient monitoring and telemedicine will accelerate their adoption and use.

In fact, CMS has un-bundled CPT code 99091, meaning that as of the 1st of January 2018, doctors will receive separate reimbursement for time spent on collection and interpretation of health data that is generated by a patient remotely, digitally stored and transmitted to the provider. Payment will be $57 per patient per month for at least 30 minutes of monitoring.

CMS stated that this is the first step towards recognizing remote patient monitoring services for separate payment, and this will further refine and value the reimbursement codes for remote patient monitoring.

The Connected Health Initiative’s Executive director Morgan Reed stated: “We believe that the use of digital technologies that provide either one-way or two-way data between MIPS (Merit-based Incentive Payment System) eligible clinicians and patients is valuable, including for the purposes of promoting patient self-management, enabling remote monitoring, and detecting early indicators of treatment failure.”

One section of the new reimbursement rule specifically addresses payments for telehealth services and the expansion of existing codes to include new ones covering these services and remote patient monitoring. These codes include:

  • HCPCS code G0506 (Care Planning for Chronic Care Management)
  • HCPCS code G0296 (visit to determine low dose computed tomography (LDCT) eligibility)
  • CPT code 90785 (Interactive Complexity)
  • CPT codes 96160 and 96161 (Health Risk Assessment)
  • CPT codes 90839 and 90840 (Psychotherapy for Crisis)

Although small, the new Medicare benefit indicates a growing acceptance of remote patient monitoring as a viable – even desirable – means of providing health care services.

These policy updates signal that CMS is moving quickly to incentivize the integration of innovative technologies as it pushes for the transition towards value-based care. Medical companies can use this opportunity to help hospitals and doctors to meet their payment incentives by ensuring that digital health products conform to the requirements set out in these codes/laws.

For detailed information about the changes in US Medicare reimbursement related to remote patient monitoring, and how they might impact your strategy, email us at [email protected].