During the pandemic, remote patient monitoring (RPM) saw a significant surge in popularity. However, regulations have not kept up with the service's outsized growth. To help health systems use the technology responsibly, Advisory Board's Lauren Woodrow outlines three things leaders should consider when evaluating their RPM programs. 

RPM booms in popularity

In 2019, Medicare made it easier for providers to bill for remotely monitoring routine vital signs, such as blood pressure, weight, and blood sugar. Previously, coverage for RPM was limited to certain patients, such as those with pacemakers.

Medicare also began allowing physicians to be paid for RPM even when it was performed by clinical staff working in different places than the physician — a change that telemedicine companies advocated for.

Between 2019 and 2021, the number of RPM services billed to Medicare saw a significant jump, going from fewer than 134,000 to 2.4 million. Total Medicare payments for the four most common RPM billing codes also increased from $5.5 million in 2019 to $101.4 million in 2021. Similarly, the number of providers who repeatedly billed for RPM increased from around 400 in 2019 to around 3,700 in 2021.

"The patient need is so enormous," said Chris Altchek, CEO of the RPM company Cadence. Currently, around two-thirds of Medicare beneficiaries have high blood pressure, which is the most common metric tracked by RPM.

According to Denton Shanks, a physician at the University of Kansas Health System and a medical director at the American Academy of Family Physicians, RPM helps patients manage their health conditions and allows physician practices to be more efficient.

"For the vast majority of patients, once they are enrolled, they see a benefit, and we see a benefit as their vital signs come in the normal range," Shanks said.

Providers who are not paid by Medicare to offer RPM services have also seen benefits. For example, Frederick Health pays for the RPM program itself and does not bill Medicare. Lisa Hogan, who runs Frederick's RPM program, said RPM has helped the health system save $10 million a year by reducing hospital admissions and ED visits.

Is lack of oversight leading to a 'wild West'?

As use of RPM continues to grow, some experts have expressed concerns about a lack of oversight and limited research on the best way to use the technology.

"It is the wild West where any patient can get it if a doctor decides it is reasonable and necessary," said Caroline Reignley, a partner at the law firm McDermott Will & Emery who advises health providers.

Currently, there are a few small studies that suggest RPM can improve patient outcomes, but researchers say it's unclear which patients see the most benefit or how long they need to be monitored.

"The research evidence is not as robust as we would like to show that it is beneficial," said Ateev Mehrotra, a researcher at Harvard Medical School.

In January, the Bipartisan Policy Center released a report saying that there was a "lack of robust evidence on the optimal use of remote monitoring" and that some policy and medical experts "question whether we are effectively 'rightsizing' the use of these services, ensuring access for patients who need it most, and spending health care dollars in effective ways."

There have also been concerns about fraudulent RPM companies and services. Currently, federal law enforcement officials are investigating RPM-related complaints, including that some companies are signing up Medicare patients for the service without their physicians' knowledge or that they're billing Medicare for RPM services even when no monitoring happens.

According to Meena Seshamani, director of CMS' Center for Medicare, the agency is working to balance the need to provide patients with access to emerging technologies with the need to combat fraud and properly pay providers for their services. (Taylor, Becker's Clinical Leadership, 3/18; Galewitz/Hacker, KFF Health News, 3/18)