MedCity Influencers

CMS’s newly released Remote Therapeutic Monitoring codes allow providers to bill for digital health, but only if payers adopt them

In addition to helping providers meet consumer expectations, remote therapeutic monitoring can serve to augment and de-load overburdened practices while also opening new revenue streams.

Early this year, the Centers for Medicare & Medicaid Services released a group of new reimbursement codes that have the potential to catapult digital health solutions for musculoskeletal (MSK) and respiratory care to the next level.

Providers are now able to bill payers using Remote Therapeutic Monitoring codes, or RTM, for digital MSK or respiratory services related to the cost, set-up, and monitoring of software and devices that measure patient therapy adherence and therapy response. For providers who have been impacted by pandemic-related burnout and staffing shortages, these codes now provide the financial structure and incentive to scale digital treatments and therapies for their patients who suffer from MSK or respiratory problems. MSK conditions alone are a huge driver of US healthcare spending and disability with one out of two people impacted by an MSK-related issue.

It’s no secret that the pandemic has led to health systems’, clinics’, physicians’, and consumers’ increasing reliance on digital health to improve the quality of and access to healthcare. Even before the pandemic, digital health was on the rise, as reflected in increased patient use, a trend supported by CMS, which in 2019 released Remote Patient Monitoring reimbursement codes for the collection of digital data. The codes were tried and tested over the pandemic as commercial payers covering RPM surged. However, RPM was limited to physiologic data more in line with primary care and cardiovascular health, with MSK and respiratory care being left out of the initial list of billable services.

That changed in January with CMS’s much-anticipated release of RTM codes, which address the gap in care for these two very pervasive health conditions. But for the codes to actually close the gap and improve access and care, commercial payers need to adopt them.

What’s good for providers is good for patients

Covid has caused a resource shortage among providers: Chief among them are nursing and staffing shortages related to situational changes at home or burnout. In a 2022 survey, one-third of nurses reported they plan to quit their jobs by the end of the year, 44% of whom cited burnout as the number one reason. The presence of fewer working clinicians and support staff risks jeopardizing the quality of care and safety of patients.

In addition, consumers continue to be reluctant to travel to clinics, be it related to the pandemic, finding time in their schedule, geographic distance, or, more recently, the high cost of gas. As more consumers become comfortable with digital health, they are expecting more varied service offerings from digital health providers, especially when convenient and fast.

In addition to helping providers meet consumer expectations, RTM can serve to augment and de-load overburdened practices while also opening new revenue streams. Knowing that more digital services are reimbursable, providers may be more apt to partner with digital health platforms, creating lucrative partnerships and expanding health care options to people in need.

RTM codes offer flexibility for both providers and patients as well as incentivize practitioners to engage with the patient over the course of his or her healthcare journey. Addressing total health in a digitally flexible manner is especially important for people with MSK conditions, who have mobility challenges and can benefit from ongoing engagement to encourage necessary behavior change, the key to potential better outcomes. While what is good for providers is good for patients, RTM creates more options for value-based solutions and drives down costs.

Shift payers to value-based care

Payers have long signaled their interest in moving toward value-based care, but have struggled to do so because of legacy infrastructure from more traditional fee-for-service (FFS) models. RTM moves the needle closer toward outcomes-based payment models. Though still inherently structured as FFS, it allows for greater resource utilization to be focused on those of greater need and less for patients who are performing well without additional resources.

By using technology that is driven toward value, providers are better equipped to address the physical, emotional and psychological needs of the patient as well as the economic and downstream costs that are associated with them. With these codes, providers can step back from being the gatekeepers for in-office health care, only allowing delivery of services during face-to-face connections, and can transition to more of a coaching role. Acting as guides rather than gatekeepers, providers can drive greater self-efficacy and accountability in their patients, which has been shown to lead to a better experience with superior outcomes. 

Typically, payers and providers wait 6-12 months after CMS releases new codes before adopting them in order to see how they will perform. For RTM codes, however, there is no reason to wait to adopt. A precedent for these types of codes has already been set since the release of the previous Remote Patient Monitoring (RPM) codes in 2019. RTM codes build upon ongoing efforts to create a reimbursement system better suited to the new era in telehealth. These latest codes plug a gap in reimbursement that was unavailable in the first iteration of codes. As such, there is already a tried and tested path toward adoption with RPM serving as the example.

Telehealth is here to stay. It doesn’t make sense to stick to the tried and true face-to-face FFS model. The true power of telehealth is really in its ability to facilitate connection to the consumer. RTM codes finally make it financially viable for providers and more accessible to health care consumers. To payers and providers, adopt RTM codes now. Please don’t wait.

Photo: nito100, Getty Images


Avatar photo
Avatar photo

Sean Kinsman

Sean Kinsman, DPT serves as the Chief Clinical Officer at RecoveryOne, a leading digital health innovator dedicated to improving health outcomes for recovery from musculoskeletal (MSK) injuries of all types and reducing costs. Dr. Kinsman has been instrumental in driving RecoveryOne’s expansion into clinical care and is the architect behind their network of clinicians who service patients through their digital treatment pathways. He is a Board Certified Orthopedic Clinical Specialist.

Prior to joining RecoveryOne, Dr. Kinsman contributed to the world-renowned “MICU Study” while working in clinical practice at Johns Hopkins Hospital. He was also a key contributor to Johns Hopkins’ Hemophilia Clinic and Cystic Fibrosis teams.

He also served as part of a multi-disciplinary team of Stanford physicians where he contributed to the creation of an innovative, intensive recovery program for patients who developed dependence to prescription opioids. He earned his BS, MA and DPT at Northeastern University, Boston, MA.

This post appears through the MedCity Influencers program. Anyone can publish their perspective on business and innovation in healthcare on MedCity News through MedCity Influencers. Click here to find out how.

Shares1
Shares1