The Business Case for Remote Monitoring

Things to Consider

When evaluating the business case (financial) for remote patient monitoring, there are two issue to consider. The first issue is to determine the program appropriate for the patient group that you want to provide treatment for. That is relevant because there are two basic choices. The first program is titled Remote Patient Monitoring (RPM). That program was created in August of 2022 when CMS created five new CPT codes which cover the entire program. In this program, remote monitoring devices are given to patients by the provider organization. Devices are expected to be taken home to collect daily readings which are to be digitally transmitted to the patient who, for CMS reimbursement, are required to generate a minimum of 16 daily device reading each month. Except for an initial device set-up and orientation CPT code, this code can be billed only once per month regardless of the number of devices. Except for a $20 initial setup CPT code, the other codes reimburse approximately $56 for device usage and an additional $52 for clinical staff non-face-to-face time for daily monitoring, phone calls, referrals, prescription refills, etc. That reimbursement is for clinical staff time. There is an add-on code that takes into account 20-minute increments over the initial 20 minutes. That code can be billed as often as is required paying approximately $20 each add-on over the $52. When considering the total potential billable amount and factoring in the cost of the device and the costs associated with delivering the service, this is not a program than should be considered if your organization's primary goal is to increase revenue. If the same patient group are responsible for excessive ED visits and frequent hospital readmissions, organizational savings associated with those reductions could be compelling financial reasons to remotely monitor and manage them. Also, it is important to keep in mind, that patient services in this program are only for monitoring; not treatment.

The second program is titled Chronic Care Management (CCM). There are three versions of CDM: They are Non-complex staff; Complex staff; and Physician driven. They vary by the time spent on care management, who provides the service and complexity. To qualify, the non-complex plan requires patients to have two chronic diseases. Complex CCM requires a minimum of three chronic diseases. Each of those programs specify medical staff as the service provider. Physician driven CCM means just what it states. All monitoring and other activities are delivered by a physician. The Physician and Non-complex care CPT codes have restrictions on how much time can be billed which is around $200 monthly. The Complex CCM plan is open-ended as to the time allowed. The amount of time needed to manage someone with three, four, five or more chronic illnesses can be substantial and the program allows for that.

Organizations are free to utilize a range of different programs but can only bill a given patient during any calendar month on a single plan. All CCM plans require that you monitor and manage patients with at least two chronic diseases. A more complete description of the CCM program each can be found at CPT Codes and Associated Revenues.

In 2018, according to the CDC, 51.8% of patients had multiple chronic conditions. It is highly probable that patients with diabetes have hypertension, and could very likely be obese, and have a respiratory disease as well. Patients with this profile are the financial low-hanging fruit in this scenario. These are also the patients likely to have a high frequency of ED visits and frequent hospital readmissions. Their billable time in the Complex staff program could be 150 minutes per month or more. The savings from a reduction in ED visits and hospital readmissions could dwarf that amount.

Unlike most competitive remote patient monitoring systems, Intersect on FHIR has the capability to integrate with multiple medical devices and the capability to monitor conditions applicable to the patients' diagnosis. The intent here is not to say this patient group is the only one worthy of managing, but rather baring some unknow consideration, it should rank highly on the group to consider.

Another consideration regarding the CCM program is that unlike the RPM program, medical devices can be prescribed as a durable medical supply and are not an expense of the provider organization. Also, as with the RPM program, the services are not for treatment; only monitoring. Intersect invites you to engage with us for a discussion about what a CCM initiative might look like in your organization.

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