Reimbursement for Remote Care Will Improve Outcomes and Costs

Three positive shifts that will result from accelerated adoption

By Bronwyn Spira, CEO and Co-Founder, Force Therapeutics
Twitter: @FORCETherEx

With its introduction of five new CPT codes for Remote Therapeutic Monitoring (RTM) in 2022, Centers for Medicare and Medicaid Services (CMS) made remote care reimbursable, opening the door to broader use and acceptance of at-home care. Expanding covered services to include patient-reported, non-physiological data for respiratory and musculoskeletal (MSK) care signifies CMS’s acknowledgment of the benefits of managing care virtually to achieve successful outcomes for patients. In 2023, CMS plans to expand coverage to include a CPT code for cognitive behavioral therapy monitoring.

While the U.S. saw a dramatic increase in the use of telehealth during the COVID-19 crisis, the fact that CMS is leaning into RTM highlights the need to go beyond what telehealth can provide. Remote care focuses on managing patients and their care in the home, while telehealth simply replaces an in-person visit with a virtual one. Now the focus is shifting to fully supporting at-home recovery enabled by digital tools.

Moreover, once CMS has made a decision to go in a certain direction, it historically follows a progression from suggesting, then mandating, then penalizing for regulatory changes. By creating a reimbursable event as an incentive, CMS will help accelerate adoption of digital therapeutics, leading to three positive shifts that will benefit MSK patients as well as providers.

Embracing remote care for positive patient outcomes

More than 50% of the U.S. population has an MSK injury that needs some type of orthopedic intervention. For many people with an MSK condition, there is a compounding effect from chronic pain, leading to depression and inactivity, plus comorbidities like cardiovascular disease, diabetes, or obesity. Research shows that the risks of neglecting an MSK diagnosis is significantly higher for Black and Hispanic individuals as compared with White individuals, emphasizing the impacts of racial and socioeconomic disparities.

In addition, many patients, especially low-income and rural populations who may be uninsured or underinsured, have additional care access barriers, such as lack of transportation, difficulty getting time off work, childcare arrangements, and copay costs – making it harder to attend in-person visits. With improved reimbursement for remote care, high-quality care will be more accessible to a wider range of populations.

With the right tools and technology in place, patients can participate in the same evidence-based care at home as they would in person, helping to overcome some of the health equity and access barriers that are now so prevalent. Care pathways can be individualized for each person by their care providers, enabling patients to engage in a proven process to recover from surgery or manage their conditions. And providers can actively monitor clinical status and social determinants of health for each patient to adapt care plans to evolving needs.

Achieving more cost-effective care

In addition to positive patient outcomes, shifting to care at home will have an enormous impact on costs. Considering all the patient touch points in a care episode, such as a joint replacement surgery (from pre-operative patient education and preparation to post-operative communication, monitoring, patient reported outcomes collection, care instruction, and physical therapy), a digital approach reduces costs over traditional in-person care.

With visibility into holistic, contextual patient data and ongoing communication with patients, care teams can preemptively educate patients before problems occur at home. If complications do arise, significant costs are avoided because providers can intervene quickly before a situation escalates to a costly emergency department visit or hospital readmission.

Provider organizations have documented these savings. A one-year retrospective analysis of digital remote care management at a large health system showed reduced readmission rates for all total joint arthroplasty procedures by more than 26%. In addition, using digital care management technology has been shown to lower the cost of each care episode by more than $2,000 per patient on average.

Digital care is here to stay

The advent of RTM reimbursement marks an important milestone that will accelerate adoption of digital remote care solutions. As CMS provides more guidance about RTM, and as more comprehensive RTM technology becomes available, the uptake will continue. In addition, as remote care is increasingly accepted and reimbursed, a wider range of patients can access the same high-quality, personalized care.

Providers who have embraced RTM find that using digital tools to engage their patients in care they have prescribed and individualized to each patient’s needs leads to better outcomes, higher patient satisfaction and dramatically lower costs. In addition, it lays the foundation for achieving a more holistic approach to managing a patient’s entire journey with a diagnosis, rather than treating each episode of care separately – improving overall patient health.