Remote therapeutic monitoring: How CMS reimbursement is propelling digital health innovation forward

Digital health innovations hold great promise for improving healthcare delivery, but their implementation at scale is often undermined by reimbursement challenges.

During a December Becker's Hospital Review webinar sponsored by emocha Health, virtual care leaders and a legal expert discussed remote therapeutic monitoring and its significance as a newly CMS-reimbursed care modality. Panelists were:

  • Michael Dalton, Vice President of Virtual Care, Cleveland-based The MetroHealth System 
  • Carrie Nixon, Cofounder and Managing Partner, Nixon Gwilt Law
  • Sebastian Seiguer, CEO, emocha Health

Four takeaways:

  1. RTM can improve health outcomes and bend the cost curve. RTM is a new digital health vertical that is complementary to remote patient monitoring and focuses on non-physiologic therapeutic data as a source of insight into patients' adherence to therapy. RTM data may be self-reported by patients or collected by a peripheral medical device. The device(s) and time spent monitoring therapeutic data and managing a patient’s care is now reimbursable through codes created by the American Medical Association in 2021. CMS began covering RTM services on Jan. 1, 2022. CMS’ action in adopting these additional device and monitoring codes is "an acknowledgment that more continuous touches with a patient can move the needle on not only outcomes, but on the cost of care overall," Ms. Nixon said. Problems with therapies can be identified earlier which can help reduce unnecessary readmissions. Greater involvement of the whole care team—including the patient—contributes to achieving health goals. 
  2. To demonstrate RTM's value, it is best to work with service line leaders first. RTM champions can win support for RTM initiatives within their organizations by showing how these initiatives integrate within existing continuum of care management programs, not by "stacking them on top" of those programs. To guide that process, clinical leaders are key. "Work with them to understand where remote therapeutic monitoring might come within that continuum of care," Mr. Dalton said. He said MetroHealth applies this approach to first figure out a clinical use case and only then an appropriate reimbursement model for it.
  3. Examples of RTM use cases include medication adherence, pain management, and therapeutic measures relating to respiratory or musculoskeletal conditions. The focus on these use cases is largely due to their subjective component (e.g., ability to self-administer certain medications, perception of pain, respiratory distress, or mobility issues) which makes them a good match for RTM. For example, virtually delivered asthma inhaler technique coaching sessions can serve as an extension of services provided at brick-and-mortar locations and can also integrate with chronic care management programs.
  4. RTM enables direct observation beyond a hospital's four walls. Medication non-adherence significantly contributes to increased morbidity and mortality. emocha Health aims to reverse that trend by enabling patients to video record themselves while narrating how they are taking—and then actually taking—their medication at times that are most convenient for them. Providers directly observe those moments by reviewing the videos and offering asynchronous feedback. "We use video-powered human engagement to help patients do significantly better by properly taking their medication every day," Mr. Seiguer said. Mr. Seiguer noted that one healthcare organization significantly reduced asthma technique errors in just two weeks by using emocha Health's RTM program. "We're thankful CMS has provided a mechanism for the healthcare system to be compensated for managing medication adherence outside of the four walls." 

The federal government has signaled its readiness to propel digital health forward by assuring reimbursement. It is now up to providers to make the most of it. 

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