Everything You Need to Know About Remote Patient Monitoring

“For chronic conditions like heart failure, atrial fibrillation and diabetes, the ability to monitor the patient’s condition remotely not only enhances the quality of care, it also improves clinical efficiency. And, it can substantially reduce healthcare costs.”
Robert Ford, Executive Vice President of Medical Devices, Abbott
Becker’s Hospital Review

Remote patient monitoring is a subset of telehealth that uses technology tools to track patient data outside the standard healthcare settings. Sometimes called RPM, this type of telehealth seeks to gather patient information from wherever they are; at home, school, or the office, and transmit it to clinicians or other healthcare providers.

Key to remote patient monitoring is the software, hardware, and digital connection that capture and transmit the data through the Internet. Today’s remote patient monitoring tools can be as sleek as an Apple Watch or Fitbit and can capture everything from exercise to heart rate, pulse, blood pressure, and more.

Remote monitoring devices can be patient-implanted as cardiac devices that sync to a transmitter in a hospital or can be a sleek, consumer-friendly wearable device. The goal of the technology is to reduce costs, provide proactive care, and simply allow patients to go on with their lives while tracking their healthcare outcomes.

Remote monitoring is a big player in the evolving world of healthcare delivery. Market Watch predicts the valuation of these products will top $1,502.9 million by 2024 in the U.S. How will these trends shift healthcare delivery in the future? How will reimbursement change? What should doctors, other healthcare providers, and patients expect as these new telehealth tools expand in the market?

“Medical technology is experiencing a major shift from expensive healthcare innovation to enhanced productivity solutions, improved outcomes and cost reduction. Remote monitoring is the major element in this shift.”
MarketWatch

There is an element of remote patient monitoring in apps like OrthoLive’s product; clinicians and patients are able to use their smartphones to show video of a physical characteristic or symptom instead of traveling to the office for an in-person visit. Therein lies one of the chief benefits of these tools. It is a more efficient way for patients and doctors to connect and share information without the travel and costs associated with an in-person visit.

There is increasing evidence that wait times associated with seeing a doctor are on the rise. Remote monitoring tools can eliminate these wait times and improve the speed in which care is given, ultimately improving outcomes and potentially saving lives.

But it is in the monitoring of chronic patient health conditions, which are now so prevalent in the United States, where remote patient monitoring may have its strongest benefit. Sending data directly from a patient to a healthcare professional in real-time has obvious benefits, including reducing the drain on hospital ERs. Care is more immediate because doctors can counsel patients without waiting for an appointment to roll around.

The numbers associated with the use of RPM tools is startling:

• The Veteran’s Administration (VA) reported a 25% reduction in bed days of care; a 19% reduction in hospital admissions; and 86% patient satisfaction scores when using RPM.
• Another study showed reduced mortality in chronic heart failure patients by using remote patient monitoring.

MHealth Intelligence says remote patient monitoring will increase in the future primarily because it reduces costs, improves access, and increases positive health outcomes, particularly in chronically ill patients. The American Society for Quality (ASQ) reports that remote patient monitoring has an overall positive impact on reducing organizational costs and providing healthcare providers with ROI.

While the benefits are clearly established and documented, how are doctors reimbursed for services that are generated from somewhere other than a clinical setting?

The government has been surprisingly supportive lately in their efforts to ensure provider payment for remote patient monitoring. In 2018, the Centers for Medicare & Medicaid Services (CMS) opened new doors for reimbursement for remote patient monitoring. The 2018 Medicare Physician Fee Schedule lists CPT Code 99091 as:

Collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time.

The Nixon Law Group shared the latest data on reimbursement for RPM in the U.S. Their findings revealed:

• As of January 1, 2018, CMS was paying $59 per patient per service period for RPM.
• Commercial payers are expected to follow suit, particularly in light of the studies that show RPM cuts costs and improves outcomes.
• Remote health monitoring services are not subject to the same geographic or “originating site” restrictions that govern general telehealth reimbursement.

Under the current rules for RPM reimbursement, doctors must:

• Document beneficiary consent before initiating remote patient monitoring.
• Have a face-to-face visit prior to RPM each year for new and existing patients.
• Use CPT Code 99091 only once per patient per contiguous thirty days for a 30-minute visit to review RPM data.
• Code 99091 can be used by a physician or other qualified healthcare professional.
• Use CPT Code 99091 only once per patient when billing other codes for Chronic Care Management (CPT 99487, 99489, 99490), Transitional Care Management (CPT 99495, 99496), or Behavioral Health Integration (CPT 99492, 99493, 99494, 99484).

CMS also loosened restrictions or added new rules for reimbursement under MACRA and MIPS and all signs point to more reimbursement changes for next year.

“Greater access to proven remote patient monitoring technologies can lead to safer, more effective monitoring of health and safety among older adults.”
Public Health Institute

The studies show that remote patient monitoring is increasing. Established and entrepreneurial ventures are increasing the number of applications that use the patient’s own digital devices to transmit data. Technology companies like IBM are testing new devices that will be used in the future for remote patient monitoring.

It’s clear that this subset of the telehealth field will continue to grow. There are clear benefits for both patients and clinicians at a time when healthcare costs are skyrocketing.

OrthoLive is pleased to be a part of the telehealth revolution in healthcare. Our telemedicine app is a subscription service that offers a low-cost way for orthopedic providers to immediately begin offering remote monitoring and virtual services to their patients. We also offer a nationwide network of clinicians standing by as virtual locum tenens. Contact us to find out more.