If you’re a Doctor who treats chronically ill patients, then the recent announcement from The Centers for Medicare / Medicaid Services (CMS) will be exciting news for you!
The Growing Dilemma Primary Care Physicians Face With Chronically Ill Patients
First, some background regarding the challenges many Doctors are facing in regards to treating the chronically ill.
By the year 2020, it’s expected that 157 million Americans will have a chronic disease, with 81 million Americans suffering from multiple chronic health conditions. The burden of this influx of patients will fall mainly on Primary Care Physicians (PCPs). The sheer volume of patients needing continuous monitoring, along with other changes to the healthcare system, make the practice of medicine far more challenging in (both in regards to treatment and financial) today for PCPs.
How will you be able to handle the load?
The Need To Utilize Technology For Improved Patient Care
An answer to providing better treatment & improving patient satisfaction all while improving the PCPs revenue stream lies in CMSs new attitude regarding Remote Patient Monitoring.
Remote patient monitoring is when a PCP’s office utilizes devices to perform routine tests (like checking glucose levels for patients with diabetes or checking blood pressure for patients receiving cardiac care) and then sends the data to the doctor’s office in real time, over the Internet, using existing cellular technology. The PCP’s team is then able to assess the information and make any proactive adjustments to the patient’s treatment plan.
By 2021, it is projected that 50.2 million people worldwide will be remotely monitored. This phenomenon is due to 2 factors:
- rising acceptance in several key medical verticals
- cellular technology becoming the de-facto standard communication device for medical monitoring devices
As Medicare & Medicaid spending continues to grow at enormous levels (almost $1.3 trillion in 2017), CMS understands that affordable new wireless remote monitoring technologies exist and that these devices can help track patients more proactively, help prevent relapses, and greatly reduce costly readmissions.
The problem is that these technologies have not had enough reimbursement attached to them to make financial sense for most physicians. The only code tied to remote patient monitoring was CPT code 99091, which is defined as: “the collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time.”
However, this code is 16 years old, and as such, fails to optimally describe how RPM services are furnished using current technology and staffing models. Specifically, the combination that only Physicians & Qualified Health Care Professionals could perform these tasks and reimbursement was so cost ineffective made implementing telehealth functions a detriment.
Not any more…
CMS New Releases New Billing Codes For Remote Patient Monitoring
In January 2019, the CMS created three new codes for RPM services, retitled “Chronic Care Remote Physiologic Monitoring.” These 3 RPM CPT codes do a far better job reflecting how providers can more effectively and efficiently use RPM technology to monitor and manage patient care needs, including chronic care management.
What Are The New Remote Patient Monitoring Codes?
The new Chronic Care Remote Physiologic Monitoring codes are:
- CPT code 99453: Initial setup. Pays approximately $21. “Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment.”
- CPT code 99454: Device/transmission fee. Pays approximately $69 per month. “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.”
- CPT code 99457: Monitoring and treatment. Pays approximately $53 per month for 20 minutes of time spent viewing data and communicating with patients. “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.”
Think about this for a minute. You can now provide a better service for chronically ill patients, utilize staff for initial set up and monitoring, reduce patient flow & readmissions, and bill approximately $143 per patient per month. Again, the purpose is to encourage PCPs to utilize the new technology because it is in the best interest of the patient.
Example: If you have 200 chronically ill patients that can benefit from this service, you can actually improve their care, make their lives easier since they don’t have to leave the house for monitoring, and generate an additional 28,600 per month (or $343,200 per year).
How To Get Started Using Remote Patient Monitoring
The simplest way is to find a Remote Patient Monitoring company that provides both the Telemonitoring Equipment and the Software. The Telemonitoring Equipment (Blood Pressure, Blood Glucose, Pulse Oximetry, Scale Devices) goes in the Patient’s Home and communicates (via the cellular signal) near real-time to the Doctor with up-to-date patient vital information.
A company I recommend using is Coordination Centric. They have “The Bridge“ Telemonitoring Software is our State of the Art Clinical Call Center Software for the management of large scale telemonitoring operations. In addition to The Bridge Software, Coordination Centric also offers Connectivity Management, Customer Support, Training, Newsletters and Monthly Q/A.
If you’re interested in learning more, you can visit their website at https://coordinationcentric.com or call them directly at 1.844.823.6874.
