Work to improve reimbursement for Remote patient monitoring programs have stalled, and that may cause health systems and hospitals to think twice about launching or expanding their platforms.
The barrier came from 21 members of the American Medical Association The CPT Editorial Board, has not been able to agree on revisions to the CPT code to include RPM services. The panel indefinitely suspended the changes proposed at its meeting last month.
RPM was first recognized by the Centers for Medicare and Medicaid Services in 2019 through a small set of codes for remote physiological monitoring services, allowing clinicians to claim reimbursement for collection data from patients through several medical devices outside the hospital.
Since then, CMS has gradually revised and expanded those rules, adding rules for telemedicine monitoring.
This problem has hindered the development of new RPM programs, as health systems and hospitals often rely on Medicare reimbursement to maintain such programs. Without that financial support, some organizations may decide not to launch or expand their platforms.
Oren Nissim is CEO and co-founder of Brook Health, a remote patient monitoring company and an expert in RPM reimbursement. We sat down with Nissim to discuss the problem this is causing RPM providers, caregivers, and patients and the pace of innovation are finally coming together, but these debates are slowing progress for everyone.
Ask. Please describe what was considered at the May CPT Editorial Board meeting and what happened.
ONE. At the CPT Editorial Board meeting in May, proposed changes to CPT code language to include services such as remote patient monitoring were considered. The proposed changes aim to align reimbursement requirements, such as the number of data points that need to be collected from patients each month and the amount of time providers must spend on the data to qualify for reimbursement. to return.
The panel discussed whether these requirements are warranted or whether reimbursement could be provided with fewer constraints on patients and providers.
However, during the meeting, the council failed to reach any agreement or resolution. Many market stakeholders expressed that the current requirements appear to be too high and that more flexibility and reasonableness need to be introduced. The panel has not yet concluded whether this is indeed the case.
The main problem appears to be the lack of a clear definition of the type of participation required to be provided Efficient RPM service. RPM is not designed simply as a means of payment for devices placed in the patient’s home; Although these devices are necessary to provide the service, they are not the service themselves.
The panel may need more data and a better description or determination of what constitutes a good form of participation to make informed decisions about proposed changes to the CPT code language to fully Pay RPM.
Ask. The CPT Editorial Board meeting in May may make hospitals and health systems think twice before implementing or expanding RPM. Please explain more clearly how you feel about the meeting results.
ONE. The results of the May CPT Editorial Board meeting should not necessarily prompt hospitals and health systems to reconsider implementing or expanding RPM programs. Instead, it should pressure those involved to focus on the type of engagement that drives results and understand that providing devices and connectivity in the home is just a cost of creating a interaction model.
RPM is designed to save money, through both patient and provider engagement, that will deliver consistent health outcomes.
The panel may be hesitant to make changes because they believe the feedback they receive is not entirely accurate. The language in CPT codes is designed to define the form of interaction, and while some flexibility may be needed, significantly lowering the bar is not the right answer.
Lowering the bar too much will not create a good form of engagement and will instead make returns easier without providing the desired value.
The focus should be on drafting a better form of participation and working together to achieve this goal, rather than promoting restrictions on the current form of participation. The current form is intended to start a discussion, which is currently ongoing.
However, the discussion should not be one-sided, but stakeholders should simply push for more flexibility. Instead, the focus should be on the original RPM’s goal: achieve better results and save costs. If programs cannot demonstrate support for these goals, they should not participate in RPM.
Q. What are some real-life examples of how reimbursement issues affect patients and clinicians?
ONE. Reimbursement issues are affecting patients and clinicians in a variety of ways, especially regarding copayments for RPM services. While the May CPT review did not directly advance this issue, a proposed bill in Congress to eliminate copays from RPM has brought the issue to the forefront.
Patients, especially those with Medicare, may have difficulty paying the monthly copay for RPM services, which are provided to help manage their chronic condition at home. In the past, these patients would have been placed in nursing homes or had costly and labor-intensive home visits by nurses.
While Using technology for RPM is the right approach, penalizing patients with co-pays can be detrimental, especially for those living on a pension or on a limited income.
Although copays for RPM are relatively low, ranging from $10 to $30, they are still a barrier, especially considering these are recurring monthly costs. The perception of being taxed for these services may discourage patients from participating, ultimately reducing the success of RPM programs.
Ask. You also think the pace of innovation with RPM is finally here. Let’s discuss the state of the technology and where it’s headed.
ONE. The pace of innovation in RPM is accelerating, with technology playing a key role in expanding and broadening the human engagement model. In particular, AI has the potential to enhance conversations between care providers and patients, allowing for more efficient information gathering without the need for face-to-face meetings.
By using AI correctly, healthcare providers can glean more signal and less noise from patient data, yielding better insights and improving services. care service.
The adoption of RPM technology is accelerating and is expected to reach mass market scale within the next 5 years. As technology becomes more accessible and affordable, obstacles to implementing RPM solutions will be eliminated. The focus now turns to ensuring the correct and responsible deployment of these technologies. AI is an accelerator, allowing healthcare providers to deliver care more efficiently and effectively.
It is important to realize that while AI can automate certain tasks, human involvement is still needed to monitor home care processes as well as address concerns about healthcare and medical response. AI can assist in gathering information and asking common questions, but although we see promising evolution, AI cannot completely replace the human touch.
As RPM technology becomes more widely available, it has the potential to change care for patients with chronic diseases, much in the same way GPS technology has changed navigation. The right use of AI and other RPM technologies will be key to harnessing this potential and improving patient outcomes while reducing healthcare costs.
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