Remote therapeutic monitoring is reimbursable: here’s what you need to know


Since CMS released the new CPT codes for remote therapeutic monitoring last year, health systems have been eager to use them but are unsure of the criteria. Providers are recognized for the time they spend connecting with patients outside of the office.

With the new CPT codes, providers can get reimbursed for:

  • Educate patients on how to use a remote care management platform.

  • Monitoring of alerts from a platform and use of remote education by patients.

  • Direct messaging to the patient/provider within the platform.

  • Data collection via the platform, i.e. collecting patient feedback on pain levels, activity and movement.

To qualify for reimbursable RTM, providers must use software that the FDA considers a medical device. Force Therapeutics, a provider of a digital care management platform, has just received such a designation for its software.

We interviewed Bronwyn Spira, CEO and Co-Founder of Force Therapeutics, to delve deeper into RTM and CPT codes to help CIOs of healthcare provider organizations and other healthcare IT leaders understand this new way of receiving reimbursement. by the attention.

Q. Providers can now get reimbursed for educating patients on how to use remote care management platforms. How do healthcare provider organizations approach this education?

A. One trend that endures beyond the pandemic is that healthcare providers and payers are finally embracing remote care. By issuing new CPT codes for remote therapeutic monitoring, CMS tries to drive the behavior changes you want to see.

The ability to manage evidence-based, results-oriented care at home while allowing for individualized and adaptable care journeys for each patient, rather than a one-size-fits-all approach, is a game changer for providers and patients.

And it makes high-quality, evidence-based care more accessible to all patients, including populations that have historically been underserved due to barriers to care, such as income, insurance, language, mobility, transportation and others.

When it comes to patient education and using musculoskeletal care (MSK) as an example, the traditional way of providing patient education throughout the entire episode of care, especially post-surgery care, is highly fragmented.

Typically, the care team walks through the instructions and gives the patient a large printed packet. At the time of discharge, patients can be medicated, overwhelmed, and anxious, which is not ideal for absorbing complex information. Now that remote care management technology is an accepted and reimbursable modality, healthcare providers have more tools at their disposal to effectively educate patients and monitor their progress.

Using a digital care management platform that not only qualifies as Software as a Medical Device (SAMD), but also provides ongoing patient engagement and flexible care management capabilities, is critical to effective patient education and efficient.

This allows patients to access the resources prescribed by their providers anytime, anywhere, and as many times as they want. Educational content can be presented in multiple ways to accommodate different learning styles and preferences, making information digestible, understandable, and easy to share with a spouse or other care-at-home partner.

Providing education in bite-sized pieces, employing gamification techniques, and integrating questionnaires help patients absorb the information needed to fully participate in their own care plans and achieve the best outcomes.

Q. The monitoring of alerts from a platform and the use of remote education by patients are also on the cards now. How do health care provider organizations do this monitoring?

A. An important fundamental point is that, from a CMS point of view, it is not enough to provide education and a to-do list to the patient through a technology platform. It is critical that the platform engage the patient in a care plan prescribed by their provider in a way that helps the patient achieve the same or better outcomes at home than with traditional in-person care.

Therefore, there must be a measurable and defensible audit trail for all interactions with the care plan. Medicare and other payers will require that evidence, both to track outcome data and to prevent misuse of the new reimbursement codes.

The other key factor is that care management through the technology platform should not create additional work for providers: it must be well integrated into their workflows. Traditionally, remote monitoring was done with phone calls and in-person visits.

In a virtual care process, interactions still need to be meaningful, measurable, and well documented. With the parameters for significant touch points identified by the CMS, providers can work with their platforms to set up efficient workflows and even incorporate automation for manual tasks.

From the patient’s perspective, the digital care management platform should be easy and convenient to use as it tracks and measures patient engagement. When the patient logs in, the platform should automatically track the time they spend, the activities they do, the tasks and exercises they complete, and their responses to questions about pain, activity level, range of motion , etc.

As the data is returned to providers, they can be alerted if the patient strays or reports pain or other symptoms that require attention. All of these elements are coordinated to drive better patient outcomes and increased patient satisfaction.

The virtual care approach has been shown in multiple studies to achieve similar or better care outcomes. For example, a one-year retrospective analysis by a health system that implemented a full suite MSK digital care management platform showed that readmission rates for all total joint arthroplasty surgeries, regardless of surgeon variability , were reduced by more than 26% compared to the previous year. .

P. Available for reimbursement: direct patient/provider messages within one platform. How do provider organizations handle this message?

A. There are two important things when it comes to messages between patients and providers. First, all messages must be between the patient and her own care team. Health information cannot be generic, off-the-shelf, or outsourced to a call center.

Each patient has different needs, different comorbidities, and different support structures at home, so messages related to diagnosis, surgery, and follow-up care must be individualized for each patient by their provider.

Second, messaging activities must fit within the provider’s workflow. In today’s environment of labor shortages and physician burnout, providers simply cannot be expected to find additional time for a new activity.

Instead, we need to scale care delivery, making it easier and more efficient for clinicians. A digital care management platform should make communication with patients efficient and effective so that every member of the care team contributes appropriately to guiding patients toward the best outcomes.

For example, a platform can be configured to accommodate the workflows of different clinicians such as doctors, physical therapists, nurses, care navigators, etc. The platform can intelligently alert the appropriate care team member if patients need intervention, such as if they report unexpected pain or symptoms of infection.

Additionally, by providing preventative patient education, patients have more clarity about what to expect during their recovery and when to contact their providers if things are not going as normal. This level of ongoing interaction benefits both patients and providers in achieving desired results.

Q. Data collection through a platform (collecting patient feedback on pain levels, activity, and movement) is also reimbursable. How do supplier organizations manage this type of collection?

A. As I mentioned, to qualify for RTM reimbursement, the platform used by the provider must be deemed by the Food and Drug Administration to be a SAMD. Given the many devices that are commonly used today for remote patient monitoring, such as watches and fitness trackers, it is impractical to expect all patients to have the same device or for providers to access multiple portals to view data. based on the device they are using.

Therefore, a digital care management platform must bring together all relevant data points (activity, pain, feeling, functional outcomes) to create a holistic view of patients and their episodes of care.

A digital patient engagement and care management platform must employ an omnichannel approach, collecting information from email, protected messages, text messages, interactive voice response calls to be effective.

Digital care instructions should be accessible to all patients, regardless of their device or access to computers, so that they can actively participate in the recovery process by reporting their progress and completing patient-reported outcome assessments, building understanding of your activity levels, pain, medication use, swelling, and possible complications.

Clinicians can use real-time status updates to monitor patients’ therapeutic progress and identify patients who need intervention or support. Additionally, digital care management platforms provide the means for patients to interact directly with their care team instead of seeking care elsewhere or heading to the ER.

Combining vast amounts of patient data with ongoing interaction creates a continuous feedback loop so care teams can tailor a care plan to meet patient needs, every step of the way. Some patients will require very little personal assistance, freeing up time for patients who may need more help.

As we move into this new year, the ability to receive reimbursement for elements of remote care delivery will incentivize the use of digital care management technology. Providers will be able to deliver individualized care to a broader range of patient populations, and more patients will have access to the care they need to improve their health.

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Healthcare IT News is published by HIMSS Media.


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