Remote patient monitoring use is on the rise, but reimbursement needs to catch up

The reimbursement model for remote patient monitoring needs to evolve as it may be holding providers back from investing in these programs, according to panelists at the MedCity INVEST Digital Health conference. Key issues with the structure as it stands now include the fact that there are too many gray areas that result in claims denials.

By ANUJA VAIDYA Sep 23, 2021 at 7:24 PM

Interest in remote patient monitoring has been rising steadily over the past decade, and with the advent of the Covid-19 pandemic, adoption has accelerated. Now, more than 75% of hospitals and clinics believe that remote patient monitoring adoption will be on par with or surpass inpatient monitoring in the next five years.

But for the model to continue to evolve in accordance with demand, changes need to be made to the reimbursement structure supporting it, said Aurélie Deleforge, head of remote patient monitoring at cardiology-focused technology provider Cardiologs. Deleforge spoke on a panel about payment for remote patient monitoring — moderated by Jay Sultan, vice president of healthcare strategy at LexisNexis Risk Solutions-Healthcare — at the MedCity INVEST Digital Health conference on Thursday.

The current remote patient monitoring reimbursement structure presents several hurdles for providers who are interested in implementing the services.

Physicians say that it is not possible to make money from providing remote patient monitoring, as the payment rates are too low for them to scale their operations, Deleforge said. They may need to hire more people or implement technology to offer the services and complete the administrative tasks associated with it, which will lead to higher overhead for the physicians.

That is just one part of the issue. The other is that many physicians feel like their claims keep getting rejected due to the numerous gray zones that exist in the remote care reimbursement arena.

For example, two healthcare providers cannot bill remote patient monitoring codes for the same patient at the same time, Deleforge said. But there are cases where patients receive care remotely from two clinicians for different conditions. Under current regulations, both the clinicians would not be able to bill for the care provided.

“All in all, there is frustration that has been building up for clinicians on how to handle that uncertainty,” Deleforge said.

Tanvi Abbhi, co-founder of remote patient care company Veta Health, echoed Deleforge during the panel.

As it stands today, the reimbursement structure is not supportive enough for traditional fee-for-service providers to establish remote care programs, she said.

There is a gap between fee-for-service reimbursement and outcomes metrics because the value created by the remote care model is often realized over time and not within the episode of care that a fee-for-service payment structure recognizes.

“[We need to enable] folks who are in the fee-for-service model to experiment, to try and to implement these programs while continuously looking at those outcomes metrics,” Abbhi said. “At some point, we’d love to see [reimbursement and outcomes] better tied together.”

Though stakeholders in the remote care arena need to continue advocating for these changes with government and commercial insurers, they should not forget about another group of equally important payers: the patients.

There are companies in the space, like AliveCor, that enable consumers to record vitals and other metrics and share them with clinicians for a fee, which makes the patient the payer.

In these instances, though technology remains a key aspect of the remote care being provided, the patient experience becomes vital as well.

“You can’t decouple technology and engagement, those things can’t be separated because you have to build trust,” said Julie Viola, business marketing lead, healthcare informatics and virtual care solutions at Philips, during the panel.

Remote patient monitoring provides a good on-road to the healthcare system, she added. Rather than patients going straight from their homes to the emergency room, these services provide an opportunity for clinicians to intervene and prevent conditions from worsening.

But the infrastructure around remote patient monitoring, including how reimbursement is structured, needs to change to allow providers to truly make the most of it.