When I first started working in the healthcare consulting business I worked with a physician who had a propensity to spend more money than he made. So I made him promise me that he wouldn’t spend another dollar on the practice unless he called me first to talk about the purchase.
He agreed. But it wasn’t long before he broke his promise.
The next time we met he was excited to show me his new patient monitoring system.
Mind you, this was probably 30 years ago.
The equipment was costly. Its capabilities were limited. And to make matters worse, insurance companies didn’t reimburse for the care it helped provide. Insured patients had to cover 100% of the costs, which was not something they were keen to do.
Needless to say, the expensive patient monitoring system quickly turned out to be a lousy business investment.
At that time, remote patient monitoring was a cool idea, but still not practical to implement. The technology wasn’t good enough to be cost-effective, patients didn’t understand how to use it, and the healthcare billing system was not set up to accommodate remote patient care.
Of course, all of that has changed since then.
Medicare and other insurance companies began paying for remote patient monitoring in 2019.
Can you imagine providing your patients with the support they need, getting paid to do it, and all the while giving patients who need to see you face-to-face the care they desperately seek?
I believe that remote patient monitoring, a key component of telemedicine, is something worth exploring for your office.
Let’s take a closer look at some of the questions you might have.
What is remote patient monitoring (RPM)?
Here’s how the the Center for Connected Health Policy defines remote patient monitoring:
“Remote patient monitoring (RPM) uses digital technologies to collect medical and other forms of health data from individuals in one location and electronically transmit that information securely to health care providers in a different location for assessment and recommendations. This type of service allows a provider to continue to track healthcare data for a patient once released to home or a care facility, reducing readmission rates.
Monitoring programs can collect a wide range of health data from the point of care, such as vital signs, weight, blood pressure, blood sugar, blood oxygen levels, heart rate, and electrocardiograms.”
What are the specialties with the most RPM eligible patients?
Specialties that have a high level of patients with chronic conditions are likely to benefit from implementing an RPM program.
Among others, these include:
- Primary Care Providers
- Cardiologists
- Nephrologists
- Weight Loss Specialists
- Diabetes Specialists
How do you get paid for RPM services?
Many insurance companies are now covering RPM services. In fact, there are over thirty CPT codes that are used for non face-to-face care.
The following are examples and approximate payment amounts based upon national averages of some of the more typical remote physiological monitoring codes used.
| Code | Approx. $ | Pay Frequency | Requirement |
|---|---|---|---|
| 99453 | $21 | Per Instance | Patient device setup/education on use |
| 99454 | $69 | Every 30 Days | Remote monitoring of vitals, patient compliance |
| 99457 | $54 | Monthly | First 20 minutes of non-face-to-face care, patient communication |
| 99458 | $43 | Monthly | Each additional 20 minutes of non-face-to-face care |
| 99091 | $57 | Monthly | 30 minutes collection and interpretation of RPM date by a physician or qualified healthcare provider |
| 99452 | $38 | Every 14 Days | 16 minutes of non-face-to-face consultation with a specialist |
| 99446-51 | $19 – $74 | Per Instance | Consultation time 5-31 minutes, payable to consultant/specialists |
RPM care services added to your practice could provide for a continuous, long-term stream of revenue.
It’s estimated that a qualifying patient could provide a practice with approximately $2,013 per year.
Assuming you have 250 qualifying patients, that’s over $500,000 of potential additional revenue!
The New Year ushers in New Rules
On December 1, 2020, the Centers for Medicare and Medicaid Services (CMS) finalized new policies related to RPM services reimbursed under the Medicare program.
Some of the changes include:
- Patients must use appropriate devices
- Electronic data transfer is mandatory
- CPT 99457 must include “some” communication during the 20 minutes
- CPT 99454 requires a minimum of 16 days of measurements (requirement relaxed during COVID-19)
I mention this to highlight the importance of doing your due diligence if you decide to explore these services for your practice.
Develop a Playbook for your RPM
If you think remote patient monitoring might be right for your practice, here are some steps to consider.
Identify the need. How many patients do you currently serve that would benefit from this type of service?
Create the right team. This involves creating a business plan. In addition to looking at the numbers, find people who can anticipate barriers to implementing the technology and look for optimal solutions for implementation.
Design your workflow. Document your current workflow and identify tasks or processes that may need to change on account of adding RPM services. How will you educate your patients? Are there things to consider in managing the devices? How will the monitoring of data occur? Does your billing and coding team know the applicable rules?
Involve your clinical staff and give consideration to your patients. For RPM to be successful, your team must understand it and embrace it. Keep your focus on the patients. I’ll say it over and over again – if it is good for your patients, it will be good for the practice. Both your patients and your care team must understand how it will be good for the patient. Without buy-in, you will not be successful in implementing this medical solution.
Patients must be:
- Confident with the technology they will use
- Motivated to participate in generating accurate data
- Educated on how their data will contribute to their overall care
- Empowered to troubleshoot problems they encounter
All of the above “must busters” involve dedicated and patient care coordinators that will need to educate and instill confidence in a generation that may not embrace technology as quickly as the generations to come.
Measure, Manage and Keep Moving. Establish goals that can be measured to keep you on track with this business strategy. You will surely encounter “bugs” along the way – things you didn’t think would happen, will. Things you thought would happen, will not. Having metrics will help you manage the program. It will help you determine when to expand or rework a specific RPM tool to improve the process.
Interested in learning more?
Healthcare services is a dynamic industry. Change is constant. Especially when it comes to revenue generation.
To stay in the game, you must continually adapt.
If you are looking to add remote patient monitoring, or any other innovative service to your practice, know that we stand ready to help.
As certified healthcare business consultants, we specialize in coming alongside independent healthcare providers to help you make decisions that are best for your practice. That includes analyzing whether or not RPM might be a good opportunity for your practice.
Click here to get in touch.
Or let us know what you think about the future of remote patient monitoring in the comments below!
Leave a Reply