Billing and Revenue Conditions and Outcomes RPM

Why RPM Makes Clinical and Financial Sense

Optimize Health | 14 December 2021
4 minute read

Remote Patient Monitoring (RPM) provides a unique opportunity for healthcare providers to gain insight into their patients’ health outside of routine office visits. The ability to get timely data on key physiological measurements, like blood pressure, blood sugar, weight, and blood oxygen levels, can truly change how providers deliver care. And, if certain requirements are met, there are potential billing and reimbursement opportunities, making it a great incremental source of revenue. 

How RPM Changes the Care Delivery Model 

RPM offers several key benefits that can impact your practice’s clinical and financial outcomes:

  1. Shift from Reactive to Proactive Care: In the traditional world of in-office visits only, providers are limited to occasional care or reacting to ER visits and/or hospitalizations. With RPM, you can provide daily care to prevent ER visits and hospitalizations.
  2. Care at Scale:  RPM changes the dynamic of how you allocate patient care resources. Practices are no longer limited to set blocks of time for patient appointments. RPM technology allows you to efficiently and effectively review data for large numbers of patients and prioritize those requiring the most care. RPM staff can support more patients at a lower cost of care.
  3. Drive Patient Behavior Changes: RPM drives real-time interventions. Patients are more motivated to take readings when they know someone is checking on them. And they may be more willing to reach for an apple over a bag of chips when they know someone will be looking at their blood pressure in a few hours vs a few months.

RPM does NOT replace in-office visits. It is designed to be supplemental care between office visits. In fact, RPM can make your in-office visits more productive, since you will have the data to prioritize who needs in-office care the most. For example, rather than seeing all hypertensive patients every 6 months, you may opt to see those struggling to control their blood pressure quarterly and those that are managing their blood pressure well with RPM annually.

The Revenue Impact of RPM  

In 2018, the Centers for Medicare & Medicaid Services (CMS) introduced a set of CPT® codes that defined billing opportunities for Remote Patient Monitoring. Why? The cost of caring for patients with chronic conditions is increasing rapidly. CMS can’t add more hours to your days for in-office visits, but they can reimburse you for technology that helps you manage more patients. CMS has continued to expand RPM reimbursement because it is effective in reducing hospitalizations, readmissions, and overall costs.

The CPT® codes were set up so that the more you engage with patients, the more reimbursement you can receive. This aligns everyone’s goals since research demonstrates more engagement leads to better outcomes. RPM is a financial and clinical win-win-win for patients, providers, and payers, which is exactly why other payers are following CMS’ lead:

  • 43 states and the District of Columbia now cover remote care
  • 29 state Medicaid programs cover RPM with new states adding reimbursement every year
  • FQHCs are increasingly utilizing RPM to reach the 21 million people living in “healthcare deserts” and HHS is distributing over $6 M in grants to cover telehealth in rural areas

The bottom line – RPM is no longer just for Medicare patients. Many RPM providers offer Eligibility Verification services so you can easily determine which of your patients may be eligible for RPM services.

With the increasing coverage combined with patient demand, can you afford NOT to offer RPM?

RPM Staffing Costs and Options

While RPM does allow you to treat patients at scale more cost-effectively, it does require significant staff time when implemented well. It’s simply not realistic to expect a clinical staff member to manage a full schedule of in-office visits AND monitor RPM patients. If RPM is everyone’s job, it can quickly become no one’s job. Engaging patients through the RPM program must be someone’s job.

There are two options for staffing your RPM program, each with pros and cons. The biggest question practices need to ask themselves is, “Do I have the right resources to dedicate to RPM?”

Self Managed RPM: This could be the right solution for practices that either have staff with extra capacity or are willing to hire, train, and manage additional clinical staff for RPM. The typical break-even point for dedicating a full-time staff member to RPM is 100 patients.

Partner Managed RPM: If you would prefer to keep your staff focused on their current responsibilities and outsource monitoring to experienced nurses that become an extension of your own staff, we would recommend partner managed RPM. Partner managed RPM can help you grow your program to any volume at any pace as it offers “just-in-time” staffing. Staffing flexes to your needs rather than forcing your RPM program to fit into whatever time your staff has available.

There will be higher fees associated with partner-managed RPM, but the value of using RPM experts allows you to provide more valuable care to patients. Your outsourced RPM staff will be focused on RPM, which typically results in better clinical results and additional service opportunities for partner-managed programs.

Ready to Learn More? 

If you have questions or want help creating a financial model for RPM specifically at your practice, please schedule a free consultation with one of our RPM experts.