For many hospitals and health systems, deploying data-driven remote monitoring programs can be a challenge when operating within a fee-for-service (FFS) model, as finding the financial support for such programs can be difficult. Remote patient monitoring (RPM) has been proven to reduce hospital readmissions and improve outcomes, resulting in cost savings – yet many providers are hesitant to implement such programs without a proven financial model.

However, recent developments – including reimbursement codes released just a month ago – are providing more opportunities than ever before to make the case for remote monitoring from a financial perspective. In a new survey from Becker’s Hospital Review and Validic™, more than 100 hospital and health system leaders shared their views on the new opportunities to financially support data-driven remote monitoring programs across an organization.


CMS Support of Remote Monitoring

In the 2018 Physician Fee Schedule Final Rule published earlier this month by the Centers for Medicare and Medicaid Services (CMS), the organization released three new CPT codes for reimbursement for remote monitoring. CPT codes 99453 and 99454 reimburse for setting up technologies, patient education and transmission of data for the “remote monitoring of physiologic parameters,” and CPT code 99457 covers “20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month” reviewing and utilizing said data.

These new codes show continued support from CMS to move toward a value-based model of care, encouraging the use of care services that focus on patient outcomes. And, these codes also demonstrate the CMS emphasis on making care delivery more efficient as a means to reduce physician burnout. Considering that a lack of reimbursement was the most-cited (30 percent) barrier for survey respondents to implementing remote care programs, these new codes offer significant opportunities to launch and scale RPM for various use cases.

The Importance of Value-Based Care

For survey respondents whose organizations see the most revenue from FFS models, only 66 percent had deployed some sort of remote monitoring program or had plans to do so, compared with more than 75 percent of respondents who used a pay-for-performance model. As value-based care continues to grow within the U.S. healthcare system, providers are finding more opportunities to deploy remote monitoring programs that can improve patient outcomes, decreasing costs and risk for readmissions penalties as a result.

“By and large, most institutions that have adopted remote patient monitoring thus far have been paying for it and not getting any reimbursement,” said Dr. Tufia C. Haddad, MD, chair of IT for the oncology department and medical oncologist at Mayo Clinic. “As the value of remote patient monitoring has been increasingly demonstrated, it’s now being endorsed and supported, and there is a reimbursement model that’s evolving through CMS.”

To learn more, read the full survey results or stay tuned for the next blog.

Missed the last blog discussing the value of interoperability in healthcare data and systems today? Check it out here.

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