As telemedicine became mainstreamed as a result of the COVID-19 pandemic, the practice of remotely monitoring patients has concomitantly been elevated in terms of both importance and use. The applications here are numerous, but currently primarily concentrate on post-hospital-discharge of high- risk patients and chronic disease management. The former is largely employed to prevent hospital readmissions by identifying emerging complications early when they can be easily addressed. The latter is similarly directed toward keeping patients healthy, but on a longer-term basis through frequent monitoring of their health status, customized treatment protocols, and frequent communication/intervention.
Examples of prevalent chronic diseases whose course could be improved through the use of a monitoring program include:
- Asthma
- Congestive heart failure
- Chronic obstructive pulmonary disease (COPD)
- Cancer
- Diabetes
- Hypertension
- Obesity
Typical remote physiologic measurements today come from home-based devices measuring blood pressure, blood glucose, blood oxygen content, weight, respiration flow, and medication adherence, all of which communicate their data (through either Bluetooth/Wi-Fi or cellular transmission) to an Internet- or cloud-based platform that is monitored by a medical provider, and increasingly intermediated by artificial intelligence. But given the success and future potential of remote patient monitoring (RPM), innovation is advancing at an impressive rate. Newly introduced technologies include wall-mounted non-contact measurements of respiration, heart rate, and activity/movement using ultra-wideband radar, leveraging smartphone cameras to measure blood pressure, heart rate, respiration and circulation via light reflectivity and a 12-lead electrode T-shirt that produces a medical-grade EKG. And looking forward, it is not outlandish to expect technologies such as affordable home-based CRISPR blood tests to diagnose cancers or a myriad of other specific diseases, smartphone-generated MRI-quality medical imaging using near-infrared light, or clinical decision support software that will perform functions like interpreting an EKG or stethoscope sounds for the patient.
So Who Pays for This Stuff?
There are currently two primary financial models for the deployment of an RPM program: purchase or lease. The cost of the equipment and services is borne by the provider; however, these expenses are most often reimbursable through insurance. In January of 2021, CMS released new guidelines regarding RPM reimbursement. The payment schedule (below) forms a foundation that could, create a significant profit center for providers (monthly recurring revenue). This is in addition to mitigating or eliminating the 2% CMS penalty for excessive hospital readmissions.
CPT Code 99453 (Setup)
Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial setup and patient education on use of equipment.
One time setup/education of $21 (regionally adjusted).
CPT Code 99454 (Equipment and Monitoring)
Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.
$69 per patient/month (regionally adjusted)
CPT Code 99457 (Interventions)
Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.
$54 per patient/month (regionally adjusted)
CPT Code 99458 (Interventions)
Remote physiologic monitoring treatment management services for each additional 20 min.
($43)
The Bottom Line
Remote patient monitoring leads to improved disease management and lower hospital readmissions, resulting in healthier patients, reduced costs to the provider, and the establishment of a new provider profit center. I’d call that a win-win-win.
If you want to know more about remote patient monitoring and how it can help your healthcare organization, reach out to Connection today.
Dr Keith Nelson
Dr. Keith Nelson is the Director of Healthcare Strategy at Connection and is responsible for formulating and implementing Connection’s go-to-market strategy for the healthcare industry. His responsibilities include identifying and developing differentiated use case driven technology solutions for Connection’s healthcare clients, promoting Connection’s healthcare practice, and driving strategic client and partner engagement. Before joining Connection, Keith led the healthcare vertical at Ingram Micro. Prior to that, he was a consultant to the healthcare industry, providing guidance to hospitals, large physician groups and vendors in the areas of business development, marketing, finance and improving operational efficiency. Concomitantly, Keith worked with various private equity firms focusing on roll-ups in the healthcare sector. He has held senior management positions at MDNY Healthcare, HealthAllies (now a subsidiary of United Healthcare), and was the founder of the Renoir Cosmetic Physician Network. Prior to that, Keith spent ten years in private medical practice focusing on surgical reconstruction of the foot and ankle and chronic wound care. He has an MBA in Finance, as well as a Doctorate in Podiatric Medicine, and is Board Certified by the ABPM.
