Remote patient monitoring: balancing incentive with waste
January 09, 2018
By Dr. Dustyn Williams
The telemedicine industry and chronic care management just got a boost from Medicare: the unbundling of CPT 99091. Historically grouped with other charges for billing, the Medicare 2018 Physician Fee Schedule allows separate reimbursement for this code, which includes remote patient monitoring.
CPT 99091 covers the collection and interpretation of physiologic data such as blood pressure or glucose monitoring. This data must be digitally stored and/or transmitted by the patient or caregiver to a physician or other qualified health care professional meeting qualification requirements. Physicians can now receive $60 per month per patient for providing these services when the following criteria are met: 1) the patient must be informed in writing, and the consent be documented in the patient’s record; (2) a face-to-face service must be provided to the patient within the previous year, at which time the remote monitoring is initiated; and (3) the service can only be billed once in a 30-day period.
This development is good news for providers trying to balance revenue streams and time spent on chronic care. Now reimbursement goes beyond basic appointment monitoring and clinic portal access, encouraging more active use of technology to care for patients outside of clinic visits. It also opens the door for greater investment in technological innovation and better solutions. Additionally, it comes at a time when Bluetooth-enabled devices are becoming more affordable and acceptance and adoption of remote technologies for health care are increasing.
Yet, while these events are promising, the industry is wise to proceed with caution. Remote patient monitoring alone does not improve quality outcomes. If industry stakeholders are not strategic in their approach to realizing the potential of CPT 99091, it will become just an added charge to unsustainable health care costs without benefiting patients. As such, regulatory oversight is a critical part of the equation to protect patients and reward innovation that actually moves the needle on outcomes and costs.
The Opportunity
Remote patient monitoring is a critical component to coordinated care, and technology increasingly makes ongoing provider-patient collaboration for chronic care management easy. For instance, Bluetooth enabled devices such as pedometers, glucometers, scales, and blood pressure cuffs have become increasingly mainstream strategies for monitoring objective information.
On a higher level, telemedicine tools exist that are dramatically changing the paradigm for some of the most complex, high-cost conditions. DoseDr, a mobile chronic care management application, is one example. Developed to send medication reminders and physician-reviewed instructions to patients in real time, patient-reported data is aggregated and regularly analyzed by the telemedicine physicians. In the case of diabetes, patients enter their blood sugar levels into the application and receive the correct insulin dose to take, enhancing patient-provider communication, while improving A1c levels and patient engagement.
In two separate pilot studies, uncontrolled A1c levels greater than 9 percent were reduced to 6.4 in just three months – an achievement that often takes years to achieve through traditional office visits. While technology was critical to achieving this outcome, the full strategy required not only the right tools, but the people and workflow systems that support interconnectivity between the patient and provider.
The Challenge
Charges for remote patient monitoring represent a move toward real industry change that supports proactive and ongoing care management for better population health. Yet there is potential risk that this move will ultimately generate more charges, increasing the cost of care without changing outcomes.
Simply put, three things can go wrong.
1. First, some providers might collect and view patient data and then do nothing actionable with it. Remote monitoring implies that an opportunity exists to make a positive change, and that interventions are taken on behalf of the patient. Because this implication is not narrowly defined, the reality of human nature is that the code could be abused. The result is more waste and greater costs. To improve the outlook, the industry needs a call to uphold professional excellence and policies to audit the code’s use.
2. Second, providers may have good intentions to do right by CPT 99091 but may not focus on the right data. Managing the highest cost conditions – those with multiple comorbiditiess – requires the right tools and a focused approach to interventions that really matter. For instance: hypertension outcomes rely on ambulatory blood pressure monitoring; insulin-dependent diabetes outcomes rely on glucose assessments; and congestive heart failure outcomes rely on blood pressure and weight. Providers need to consider chronic diseases where treatment decisions can be reliably made by provider monitoring of user-generated data.
3. The third area of concern is competition. Only one charge per patient for CPT 99091 is allowed each month, although the likelihood of a patient who might benefit from remote patient monitoring having more than one physician is high. It is possible that two well-meaning, even effective providers will both attempt to take advantage of this code. As such, it makes sense to shift the responsibility of remote patient monitoring back to the primary care physician – the one who serves at the epicenter of care for chronic care management.
The Bottom Line
The introduction of CPT 99091 holds great potential for positive impact, and adoption and forward momentum of its use should continue. In tandem, the industry at large needs to recognize the potential for negative fallout if the code is not used responsibly. To circumvent harm, industry stakeholders need to call on each other to do good and rally for excellence. And if that fails, the industry needs to ensure fail-safes exist to protect against fraud, waste and abuse.
About the Author: Dr. Dustyn Williams is a hospitalist at Baton Rouge General Medical Center and co-founder/chief medical officer of DoseDr.
The telemedicine industry and chronic care management just got a boost from Medicare: the unbundling of CPT 99091. Historically grouped with other charges for billing, the Medicare 2018 Physician Fee Schedule allows separate reimbursement for this code, which includes remote patient monitoring.
CPT 99091 covers the collection and interpretation of physiologic data such as blood pressure or glucose monitoring. This data must be digitally stored and/or transmitted by the patient or caregiver to a physician or other qualified health care professional meeting qualification requirements. Physicians can now receive $60 per month per patient for providing these services when the following criteria are met: 1) the patient must be informed in writing, and the consent be documented in the patient’s record; (2) a face-to-face service must be provided to the patient within the previous year, at which time the remote monitoring is initiated; and (3) the service can only be billed once in a 30-day period.
This development is good news for providers trying to balance revenue streams and time spent on chronic care. Now reimbursement goes beyond basic appointment monitoring and clinic portal access, encouraging more active use of technology to care for patients outside of clinic visits. It also opens the door for greater investment in technological innovation and better solutions. Additionally, it comes at a time when Bluetooth-enabled devices are becoming more affordable and acceptance and adoption of remote technologies for health care are increasing.
Yet, while these events are promising, the industry is wise to proceed with caution. Remote patient monitoring alone does not improve quality outcomes. If industry stakeholders are not strategic in their approach to realizing the potential of CPT 99091, it will become just an added charge to unsustainable health care costs without benefiting patients. As such, regulatory oversight is a critical part of the equation to protect patients and reward innovation that actually moves the needle on outcomes and costs.
The Opportunity
Remote patient monitoring is a critical component to coordinated care, and technology increasingly makes ongoing provider-patient collaboration for chronic care management easy. For instance, Bluetooth enabled devices such as pedometers, glucometers, scales, and blood pressure cuffs have become increasingly mainstream strategies for monitoring objective information.
On a higher level, telemedicine tools exist that are dramatically changing the paradigm for some of the most complex, high-cost conditions. DoseDr, a mobile chronic care management application, is one example. Developed to send medication reminders and physician-reviewed instructions to patients in real time, patient-reported data is aggregated and regularly analyzed by the telemedicine physicians. In the case of diabetes, patients enter their blood sugar levels into the application and receive the correct insulin dose to take, enhancing patient-provider communication, while improving A1c levels and patient engagement.
In two separate pilot studies, uncontrolled A1c levels greater than 9 percent were reduced to 6.4 in just three months – an achievement that often takes years to achieve through traditional office visits. While technology was critical to achieving this outcome, the full strategy required not only the right tools, but the people and workflow systems that support interconnectivity between the patient and provider.
The Challenge
Charges for remote patient monitoring represent a move toward real industry change that supports proactive and ongoing care management for better population health. Yet there is potential risk that this move will ultimately generate more charges, increasing the cost of care without changing outcomes.
Simply put, three things can go wrong.
1. First, some providers might collect and view patient data and then do nothing actionable with it. Remote monitoring implies that an opportunity exists to make a positive change, and that interventions are taken on behalf of the patient. Because this implication is not narrowly defined, the reality of human nature is that the code could be abused. The result is more waste and greater costs. To improve the outlook, the industry needs a call to uphold professional excellence and policies to audit the code’s use.
2. Second, providers may have good intentions to do right by CPT 99091 but may not focus on the right data. Managing the highest cost conditions – those with multiple comorbiditiess – requires the right tools and a focused approach to interventions that really matter. For instance: hypertension outcomes rely on ambulatory blood pressure monitoring; insulin-dependent diabetes outcomes rely on glucose assessments; and congestive heart failure outcomes rely on blood pressure and weight. Providers need to consider chronic diseases where treatment decisions can be reliably made by provider monitoring of user-generated data.
3. The third area of concern is competition. Only one charge per patient for CPT 99091 is allowed each month, although the likelihood of a patient who might benefit from remote patient monitoring having more than one physician is high. It is possible that two well-meaning, even effective providers will both attempt to take advantage of this code. As such, it makes sense to shift the responsibility of remote patient monitoring back to the primary care physician – the one who serves at the epicenter of care for chronic care management.
Dustyn Williams
The introduction of CPT 99091 holds great potential for positive impact, and adoption and forward momentum of its use should continue. In tandem, the industry at large needs to recognize the potential for negative fallout if the code is not used responsibly. To circumvent harm, industry stakeholders need to call on each other to do good and rally for excellence. And if that fails, the industry needs to ensure fail-safes exist to protect against fraud, waste and abuse.
About the Author: Dr. Dustyn Williams is a hospitalist at Baton Rouge General Medical Center and co-founder/chief medical officer of DoseDr.