Billing and Revenue RPM

Financial Considerations for RPM

Optimize Health | 17 December 2021
4 minute read

Remote Patient Monitoring (RPM) programs are growing rapidly. The Centers for Medicare & Medicaid Services (CMS) has continued to expand coverage and eligibility of RPM programs because they work. Clinical research has consistently demonstrated that RPM programs can reduce hospitalizations, readmissions, and overall healthcare costs.

When implemented correctly, RPM programs can generate significant clinical benefits for your practice. However, beyond the service fees to an RPM software vendor, there are direct and indirect costs to consider. Likewise, there are also potential opportunities to help reduce overall costs to the healthcare system by providing RPM. It is also important to understand the implications on patient financial responsibility.

RPM Cost Considerations

To evaluate the financial benefits of an RPM program, it’s important to look at the full cost of a program, including vendor fees, as well as the cost of your staff’s time.

  • Provider Engagement: RPM starts with the ordering provider. They must understand the process for ordering RPM and the impact of RPM on a patient’s treatment plan. When crisis readings occur, providers must be available to handle the escalation so care becomes proactive rather than reactive. This could also include the time your clinical and admin staff spend engaging providers to order RPM.
  • Patient Monitoring: The key to successful clinical outcomes and appropriate compensation for RPM services is high levels of patient engagement. Monitoring staff need to have sufficient time to encourage patients to take readings and communicate with them regularly about treatment plans and goals. For most practices, this often means hiring additional staff or outsourcing monitoring.
  • Administrative Time: While clinical monitoring is the heart of RPM, the program will likely not get off the ground without administrative support. Administrative responsibilities include scheduling patients for RPM onboarding, device management, and billing.
  • Technology: This includes the cost of software as well as devices. Investing in the right technology partner is critical. When considering software, a few things to think about are:
    • Does the software make it easy to figure out which patients need attention?
    • Can you communicate with patients directly from the software?
    • Does it provide automated time-tracking to make billing and compliance easy?

RPM’s Role in Decreasing Overall Costs to the Healthcare System

  • (Accountable Care Organization ACO) Value-Based Reimbursement: CMS continues to support RPM because it reduces overall healthcare costs while improving outcomes, which completely aligns with the goals of ACOs. Reductions in cost from RPM can help contribute to ACO incentive payments, which are passed onto member practices. For example, 40 percent of the final score for MIPS incentive payments is based on quality measures, which include Controlling High Blood Pressure and Screening for High Blood Pressure and Follow-up Documented. 
  • Increase in Value of In-Office or Telehealth Visits: With a completely independent set of CPT® codes, RPM is designed to be supplemental to routine office visits – not a replacement. With RPM, providers have the opportunity to see real-time data. When clinically appropriate, this data can allow patients to obtain more valuable clinical care during office visits. If elevated readings result in proactively identifying and treating health issues through additional practice visits, rather than an ED admission or hospitalization, everyone wins. Clinical outcomes are better. Costs are lower for the patient and the overall healthcare system, since the practice is utilizing healthcare resources in a lower-cost environment.

Impact of Device Purchases

A significant cost of an RPM program is the purchase of FDA-approved devices, such as blood pressure cuffs, weight scales, and glucometers. Typically, these should be purchased from your RPM company so they are provisioned for and connected to your RPM software.

Most RPM companies offer two options for procuring high quality devices.

  • Purchase Devices Upfront: Providers can purchase devices upfront. Depending on the number of devices, this could be a significant upfront cost, but will ultimately be the lowest cost option.
  • Bundled Monthly Payment, No Upfront Cost: For providers who are hesitant about a high investment, they can opt for a monthly payment per patient that includes the cost of the software, services, and the device. This will be a higher monthly fee than if devices are purchased upfront and will result in a higher cost paid per device over the long-term.

The right solution for your practice will depend on your RPM goals and financial situation.

RPM Patient Financial Responsibility

RPM is a Medicare Part B service. Patients without supplemental insurance will have a 20 percent co-pay after their deductible is met. This could be up to $375 for patients with high monitoring needs. While some patients may be hesitant to pay for this, there is a strong economic benefit for patients as well as practices.

A single hospitalization without Medicare supplemental insurance could result in a bill over $1,500 and clinical research supports that RPM substantially reduces hospitalizations. Co-pays and deductibles may also apply to commercial patients, but the same logic of preventing higher medical bills applies as well, particularly for patients with chronic diseases.

Ready to Learn More? 

If you would like to dive into the financial and clinical implications of RPM at your practice, please schedule a free consultation with one of our RPM experts.