RPM services are tools to help achieve the objective of improving patient care outcomes, access to care, and make health care deliverables more cost effective.
RPM services use various technological means to advice patients with respect to their healthcare needs once they are on-boarded for such services. They can also be used to collect medical / other forms of health data from patients remotely so that the collected information can be electronically transmitted securely to other healthcare providers in a different location for assessment and recommendations.
RPM services focusses on empowering patients to manage their health conditions with remote assistance wherever possible, e.g., diabetes, hypertension, cardiovascular disease, etc. Through RPM services, one 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.
Care providers monitor these patients remotely and act on the information received per the prescribed care plan. A clinician/physician provides care, based on such data collected by the patient by reviewing, interpreting, and responding to the data collected. In certain cases, a clinician/physician needs to go beyond this, just by looking at the data that is transmitted, as there could be scenarios where the clinician/physician needs to engage patient via a video call for more effective communication via virtual means to prevent any abnormal outcome.
The whole idea of this service model is to prevent the patient come to a clinic/ hospital for such advices. RPM programs help keep patients healthy, allow older and disabled individuals to live at home longer and avoid having to move into healthcare facilities. RPM can also serve to reduce the unwanted hospitalizations and lengthy stay in hospitals—all these measures improve quality of life and containment of costs.
New RPM Codes likely to come into effect from CY 2019
The new Chronic Care Remote Physiologic Monitoring codes are:
- CPT code 99453: “Remote monitoring of physiologic parameter(s) (e.g, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment.” The proposed Medicare payment for these services is $21.
- CPT code 99454: “Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.” The proposed Medicare payment for these services is $69.
- CPT code 99457: “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.” The proposed Medicare payment for these services is $54.
What are the positives?
- Only 20 min per month instead of 30 min
- Reimbursement for initial setup and education
- Clinical Staff allowed (Clinical staff allowed. CPT 99091 is limited only to “physicians and qualified health care professionals” and does not expressly allow the RPM service to be delivered by clinical staff (e.g., RNs, medical assistants, etc.). This means the physician or qualified health care professional must perform the full 30 minutes per 30-day period, which is a lot of time for these highly trained professionals. For some providers, this is too resource-intensive to justify the $58.68 per month reimbursement rate. The new code allows RPM services to be performed by clinical staff.)
- No direct supervision - direct supervision means the physician must be present in the office suite and immediately available to provide assistance and direction throughout the time the auxiliary personnel is performing services.