Remote Patient Monitoring2024-01-09T17:53:48-04:00

Alliance for Connected Care’s Advocacy:

  • The Alliance for Connected Care joined a letter, led by the Connected Health Initiative (CHI).
  • The Alliance for Connected Care and the American Telemedicine Association sent a letter on February 21, 2023.
  • The Alliance for Connected Care called for data around RPM/RTM outcomes. Below is a list of those data.

Background

Remote patient monitoring is a set of services involving the collection, analysis, and interpretation of digitally collected physiologic data, followed by the development of a treatment plan, and the managing of a patient under the treatment plan.

The Centers for Medicare and Medicaid Services (CMS) proposed and created RPM codes in the Calendar Year (CY) 2019 Medicare Physician Fee Schedule. The codes provided reimbursement for using technology to monitor patients between visits. Additionally, CMS noted that these services would not be subject to Medicare telehealth restrictions in section 1834(m) of the Act, and the valuation would reflect the resource costs associated with furnishing services utilizing communication technology.

In 2022, CMS further expanded remote monitoring for certain medical specialties, called remote therapeutic monitoring (RTM), to collect non-physiological data.

Please find our RPM priorities here

Featured RPM Data

Please see below a deck highlighting major RPM findings that was shared with the Alliance.  Citations for the studies referenced are included here.

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Multi-Jurisdictional Contractor Advisory Committee (CAC)

In February 2023, the majority of the MACs, led by Novitas Solutions, met in a Multi-Jurisdictional Contractor Advisory Committee (CAC) to jointly consider a new local coverage determination (LCD) for RPM and RTM for Non-Implantable Devices. Neither of these services have a National Coverage Decision (NCD) by CMS but CMS has included these services in Medicare Physician Fee Schedules since its creation in 2018. In the absence of a national coverage policy, an item or service may be covered at the discretion of the Medicare contractors based on a local coverage determination (LCD).

The MAC meeting resulted from concerns that the RPM codes were being used more broadly than originally intended, and that utilization was rising faster than expected (RPM grew six times since the creation of the codes). There were concerns from the RPM stakeholder community about potential payment cuts to RPM and the LCD process, which didn’t offer enough specificity for stakeholders to understand the implications of a potential LCD.

The Alliance was a leader in the process. The Alliance led a call for data and convened stakeholders advocating for continued RPM/RTM coverage. Due to these efforts and pressure from CMS, the MACs determined not to move forward with an LCD.

During the MAC meeting, the majority of the medical specialty societies present expressed strong support for RPM. Particularly notable were cardiologists and primary care doctors from at least a dozen leading academic medical centers testifying about how their RPM programs were crucial to improving patient outcomes.

Data

Upcoming Federal Study
The Department of Health and Human Services (HHS) Office of Inspector General (OIG) announced it is working on a study: The Use of Remote Patient Monitoring Services in Medicare (OEI-02-23-00260). 

The review will be based on Medicare fee-for-service claims and Medicare Advantage (MA) encounter data for remote patient monitoring services. It will look at the extent to which the use of remote patient monitoring services has changed, the nature of remote patient monitoring services being used by Medicare enrollees, and the characteristics of enrollees using remote patient monitoring services. The review will also determine the extent to which provider billing for remote patient monitoring services may indicate fraud, waste, or abuse.

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