Remote patient monitoring can help providers extend care for patients in underserved areas and improve outcomes, but only if it’s a reimbursable service.
During the COVID-19 pandemic, use of remote patient monitoring soared among Medicare beneficiaries, according to an August 2022 study in JAMA Internal Medicine. From February 2020 to September 2021, usage of remote patient monitoring increased from 91 claims per 100,000 enrollees to 594 claims per 100,000 enrollees, according to the study.
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But as adoption has increased, reimbursement of the technology faces an uncertain future. The Centers for Medicare & Medicaid Services has expanded payment for remote patient monitoring since 2018 by adding billing codes that cover some of the services under Medicare fee-for-service health plans. But reimbursement value for some of those codes decreased in the 2023 Medicare Physician Fee Schedule by more than 10% and could again in 2024.
In February, six of the seven Medicare Administrative Contractors, which administer Medicare reimbursement on behalf of CMS, met to discuss the future of remote patient monitoring reimbursement.
The May 11 end of the public health emergency will remove some temporary flexibilities for remote patient monitoring, such as not enforcing sanctions under the Anti-Kickback Statute for waiving co-payments for these services. The flexibilities made it more cost effective for providers to implement remote patient monitoring.
"It will put remote patient monitoring companies in a tight spot and force them to start immediately, at the end of the public health emergency, to start discharging patients and living with the potential consequences of falling patient adherence rates," said Thomas Ferrante, a healthcare lawyer at Foley and Lardner.
Advocates for remote patient monitoring say a growing body of clinical evidence favors more widespread permanent coverage.
“This is not the right time for Medicare to slow down [reimbursement for remote patient monitoring],” said Chris Altchek, CEO of remote patient monitoring tech company Cadence. “It's really getting started. It's really having an impact. It's really increasing health equity. If they slowed it down now, it's going to send a really bad signal to the other payers that will follow Medicare's lead.”
Provider organizations like University Medical Center use remote patient monitoring to extend care for chronic care patients who have a hard time regularly traveling to see a doctor. University Medical Center utilizes devices from Boston-based startup Ceras Health to monitor the vital signs of patients with diabetes, high blood pressure and other chronic conditions.
“The more opportunities that payers give us to interface with patients and can be reimbursed, the more opportunities exist for us to make a difference in patient care,” said Dr. Richard Friend, dean of the University of Alabama’s College of Community Health Sciences, which operates University of Alabama’s University Medical Center. The medical center has clinics servicing rural patients across Alabama.
In a state like Alabama, where 80% of counties are in rural locations and some don’t have one critical-access hospital, remote patient monitoring can make a big difference. But to make the program work, reimbursement is needed to offset the cost of supplying and managing the devices. Friend said the cost savings potential speaks for itself.
“A device that may cost $100 is going to end up saving the healthcare system thousands of dollars,” Friend said. “We have to be forward-thinking and continue to put the patient at the center to achieve the goals that everybody across the country wants to achieve, which is better care with the right resources in a way that's cost effective.”
Southwest Community Health Center in Bridgeport, Connecticut, uses remote patient monitoring technology from Chicago-based TimeDoc Health to track the blood pressure and other vital signs of its hypertension patients. The program has been able to enroll around 1,000 hypertension patients and has seen a more than a 30% improvement in blood pressure control, said Dr. Dara Richards, chief medical officer. More than 60% of patients have achieved control of their blood pressure.
“Patients are very happy and very engaged,” Richards said. “We can see with the remote monitoring where we've asked them to check their blood pressures daily, preferably twice per day, and we can see from the portal that they're doing that. We monitor adherence rates and those have been very high.”
Despite this success, the program's future is somewhat uncertain. The remote monitoring aspect of the program was funded in part by a grant from the Health Resources & Services Administration. Richards said the federally qualified health center is looking for additional funding opportunities to keep the program going; otherwise, it won’t be able to monitor and receive alerts when someone’s blood pressure is critically high.
Industry stakeholders remain optimistic.
“The big hurdles are going to be with co-pay cost sharing but there are other revenue opportunities and strategies such as Medicare Advantage,” Ferrante said. “The rule is if Medicare fee-for-service covers it, Medicare Advantage plans must cover it.”
