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The Value of RPM Reimbursement

The Value of RPM Reimbursement

How fee-for-service and value-based care organizations benefit in 2022

By Tom Spalla, VP Sales

Years ago, did you (or someone you know) buy a watch or other device that counted steps walked in a day? Unbeknownst to us at the time, that technology was much more than a pedometer. It was a first step in the path to what has become known as Remote Patient Monitoring (RPM), a growing body of technology that monitors patient health data between provider visits.

Today, RPM goes far beyond keeping track of steps. In addition to wearable devices that record and report data, smartphone applications have become a front-line resource to help patients and providers manage chronic conditions. Providers can use them to prompt patient feedback to get a deeper picture of symptoms, assess pain severity according to standardized rubrics, increase adherence to health plans with medication reminders, or educate patients about their condition at opportune times. And, the list of RPM functionalities continues to develop.

CMS-approved RPM care is expanding

In addition to remotely monitoring physiological symptoms to track wellness and manage chronic conditions, 2022 brings an expanded code set for Remote Therapeutic Monitoring/Treatment Management (RTM). The 2022 CPT reimbursement codes for RTM are 98975, 98976, 98977, 98980, +98981. With RTM, providers are reimbursed for collecting and interpreting non-physiological data of respiratory system status, musculoskeletal system status, therapy adherence, and therapy response.

Capturing the patient’s voice on a day-in, day-out basis has the potential to individualize care on a previously unobtainable level, leading to a greater quality of life through optimized, targeted treatments.

Patients and providers are ready for RPM

Studies show that patients and providers alike are eager to embrace new RPM technologies that foster continuous, proactive health management. MSI International found 80% of Americans are in favor of using RPM, and almost 50% are very favorable to its incorporation into medical care.

A recent Insider Intelligence survey estimates thirty million US patients will use remote care tools by 2024, which is not a surprising statistic given that today’s remote patient monitoring technology monitors multiple health conditions such as COVID, diabetes, and IBD symptoms management.

The many benefits of RPM

Today, RPM is transforming patient care. It provides precise patient health information between in-person visits to improve patient outcomes, increase patient engagement, streamline clinical and administrative efficiency, lower costs, and provide an additional revenue stream for healthcare organizations.

Improve patient outcomes

Health information gathered between visits is at the provider’s fingertips during face-to-face encounters. Accurate data saves time, improves documentation accuracy, and can lead to more effective health management.

Increase patient engagement

Automated triage empowers patients to alleviate symptoms, encourages care plan compliance, and alerts staff when intervention is needed.

Enhance medication compliance

Failure to adhere to medication plans not only impacts patients’ health, but also costs the US health care system. One study published on PharmacyTimes.com estimated $528.4 million was wasted on nonoptimized drug therapies in a single year, resulting in approximately 275,689 deaths.

Expand CCM and telehealth

RPM and RTM services are easily inserted into existing Chronic Care Management (CCM) and telehealth workflows, giving providers a more comprehensive view of patient health.

Boost team capacity

RPM can automate many non-critical care-related tasks, allowing organizations to focus resources where they are needed most.

Lower costs

Hospital readmissions are a significant source of uncompensated care. A recent study at Mount Sinai Hospital noted that its 30-day readmission rates for heart failure patients decreased to 10% with the aid of RPM. There are numerous other studies that support the same findings.

Create additional revenue

Built-in CPT code reporting tracks claim codes relating to RPM, RTM, CCM, and telehealth, simplifying billing processes.

Multi-specialty RPM made easy

Clinical and administrative labor are driving factors of the high cost of health care in the US. Datos Health streamlines workflows with its capability to merge all remote care plans for chronic conditions onto a single platform, focusing clinical and administrative labor in one place and simplifying technology infrastructure. Easy drag-and-drop functionality creates programmable responses that target care when and where needed, allowing clinicians to broaden their reach while conserving resources.

Example #1: Oncology Care Management

The side effects of cancer treatments often go unreported, impacting the patient’s quality of life and adherence to care plans. Proactive outreach to patients between visits creates a significant workload that may overlook symptoms, side effects, and trends that lead to adverse events. Through rules set by the care team, the Datos Health system prompts patients to report symptoms, which triggers automated responses to help alleviate discomfort or unwanted side effects. Automated self-care management is part of a larger rules-based triage construct used to identify patients requiring intervention or other appropriate action based on established workflows, best practices, and validated questionnaires- such as CCTAE.

Example #2: Cardiac rehab and heart failure monitoring

Unlike other RPM platforms that require a specific tool, Datos Health works with care teams to determine the best device to monitor their patients. For example, a heart failure patient could be monitored using a smart device, blood pressure monitor, or pulse oximeter. Post-walk, patients are automatically sent the appropriate standardized survey and prompted to report symptoms via the Datos Health user-friendly app. Any symptoms or results outside of standard thresholds are reported to the care team, prompting treatment plan changes and potentially mitigating adverse events. Not only is clinical information streamlined, but built-in reporting also optimizes coding and billing activities.

The Datos Health revenue opportunity

There are 5 CMS-reimbursable CPTs available for RPM and 5 for RTM

RPM CPT Description* RTM CPT
99453 Initial set-up, patient education 98975
99454 Remote monitoring, monthly 98976 (respiratory system)
98977 (musculoskeletal system)
99457 Treatment management, first 20 min 98980
+99458 Treatment management, add’l 20 min +98981
99091 Collection and interpretation of data transmitted by patient N/A

*Please consult AMA or CMS resources for specific descriptions

Datos Health ROI

Providers that enroll patients into a Datos Health RPM program will be reimbursed approximately $22 for 99453 (initial set-up) and $49 for 99454 (monthly transmission), based on Medicare rates. In the first year, reimbursement for 50 patients (CPTs 99453 and 99454) amounts to approximately $62,400, with an ROI of roughly $49,900. ROI can vary depending on the number of patients in a program, FTE costs, and other factors such as the complexity of the condition monitored. Providers are reimbursed via 99457 and 99458 for additional time managing monitored patient when medically necessary, with approximate payments of $52 and $41, respectively.

Smooth the path to value-based care

More challenging to quantify but equally as relevant to the financial future of healthcare organizations is the potential effect of RPM on value-based care. Payment model evolution will continue to stress better health management, positive health outcomes, and reward for performance. RPM not only helps patients monitor their health, but also creates a record of progress toward achieving the critical thresholds of reportable health measures that unlock enhanced reimbursement.

RPM is a win-win for patients and their providers. Patients are more engaged with their care plan, receive timely information about their symptoms, and enjoy better health outcomes. Providers can boost clinical efficiency and effectiveness while creating additional revenue that allows them to continue serving their communities. RPM is poised to be a catalyst in successfully pursuing healthcare’s Triple Aim of optimizing performance.

If you haven’t done so already, I strongly urge you to investigate everything RPM has to offer. We are on an exciting trajectory that can improve wellness, positively impact chronic condition management, and lower the cost of care. Contact us to learn how Datos Health can improve patient outcomes as well as your organization’s bottom line.