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When the CMS introduced the first reimbursement for remote patient monitoring in 2018, most physicians were sceptical about the long term nature of this initiative. After all, 2016 brought Chronic Care Management, the very first non face-to-face reimbursable program of its kind, and the uptake was minimal. The reports from 2020 were equally dire: very few physicians were billing for remote and virtual care and many questioned whether the pandemic will change things.
Here are our eight reasons we believe the adoption of remote and virtual care will grow in popularity and accelerate rapidly in the near future, and why medical practices should not wait to implement it:
Recent years have seen an accelerating growth in new CPT codes covering non face-to-face care. When CMS announced chronic care management in 2016, it took 2 years to create the next CPT code: the first dedicated remote patient monitoring code. But just one year later, in 2019, 3 new CPT codes for remote patient monitoring were added. Since then we saw creation of remote therapeutics codes, principal care management, behaviour health and many more, including those that now recognize care provided by qualified healthcare professional vs clinical staff. It is unlikely the CMS would sunset these, especially as the pandemic has proven catastrophic to those practices not prepared to care for their patients virtually.
The launch of chronic care management reimbursements in 2016 was ignored by many practitioners, as it offered to pay $43 for 20 mins of care a month, provided by the physicians themselves. With standard rates for patient visits being multiples of that, no wonder there were no takes. But with the relaxed rules that allowed clinical staff such as medical assistants to not just support these programs but their time being eligible towards these payments, a lot has changed. Over time, the CMS created 2 sets of CPT codes: those that pay QHPs (qualified healthcare professionals) at a higher rate compared to clinical staff. Then, the introduction of add-on codes allowed medical practices to get paid beyond the initial 20 minutes a month. Lastly, some of these reimbursements increased in value: CCM code 99490 went from $43 in 2016 to $64 in 2021*. And as often there is an opportunity to enroll patients in multiple care programs, the compounded reimbursement eligibility grew significantly. In 2022, a patient enrolled in a remote patient monitoring and chronic care management program could bring as much $120 a month for 20 minutes of care received by the clinical staff.
The physician fee schedule changes annually, and while Medicare increased its payment rates during the pandemic, this incentive disappeared on January 1, 2023. The decrease in payment rates post-pandemic left practices struggling to bring their revenue up: physicians either need to see more patients a day or find alternative ways to make up the differences. With programs like remote patient monitoring or chronic care management, practices can see as much as 50% added to their visit based revenue model. And because these programs are not managed by the physicians but rather the clinical staff, these are not only easy to implement but also cost efficient to run.
Non face-to-face care payments offer a rare opportunity to boost otherwise capped payments in several forms. In the value-based model, where the practice or the payer assumes the full risk, fee for service is often turned into a fixed monthly payment that covers all care provided. But services like remote patient monitoring are often excluded from the prospective payment system. This brings a double benefit to the practice as remote patient monitoring allows them to lower the risk and cost while creating a new, additional revenue stream. Similarly, better patient health outcomes achieved through CCM or RPM programs ensure practices avoid penalties and qualify for the higher bonus payments under MIPS/MACRA.
We have seen a steady relaxation in terms of rules and requirements for these no face-to-face care programs: whereas several years back, all services were required to be provided by the physicians themselves, or under a direct supervision in the same place of work, today these restrictions are removed, allowing clinical staff to oversee these programs remotely. A few years back, the CMS also issued clarifications on the interpretations of the CPT code language, making it easier to implement compliant programs.
Pandemic resulted in staffing shortages across all organizations. It is estimated that 500,000 healthcare workers permanently left the industry. This causes capacity issues to medical practices where physicians are required to work more now. But with non face-to-face programs that can be supported by clinical staff like medical assistants, healthcare organizations have a better chance of finding new staff. We have seen the return of retired nurses and part time stay home moms, often taking advantage of the remote nature of the job, to run these services, allowing medical practices to staff efficiently and easily for these programs.
Healthcare IT evolves fast and plays a major role in these programs' successes. The application of advanced technologies like artificial intelligence and automation, something Lara Health has adopted early on, makes implementation and management of remote patients monitoring and other novel care models easier.
Pandemic made telehealth visits the norm. But even before, patients were spoiled for convenience and excellent support in other industries, thanks to the next day Amazon deliveries or instant ride from Uber. As consumers experience better services in their daily lives, healthcare services will need to follow. Early adopters amongst medical practices will reap the benefits of high patient satisfaction and loyalty, especially important given the growing competition from technology first companies that offer instant access to 3rd party doctors and services traditionally limited to office based visits.
Lara Health platform offers an automated way to implement and manage remote and virtual care. From passive time tracking to proactive patient digital programs, we allow practices to offer highly successful care programs while retaining 100% of their revenue.
* National Medicare average payment amount