As our nation ages, an increasing percentage of a provider’s patient base will have multiple chronic conditions. These patients are the most costly to the health system overall due to hospitalizations and emergency department visits. For providers, these patients can also prove expensive in the way they impact outcomes and patient satisfaction—both critical elements in the pay-for-performance reimbursement model.
One of the most effective ways to mitigate the financial risk that comes with having a greater population of chronic care patients is through chronic care management (CCM) program that includes remote patient monitoring (RPM) and telehealth. To date, very few providers have chosen to participate in a CCM program. While 35 million Medicare patients in the US qualify for a CCM program, only a small fraction are actually enrolled. Why? The answer for many is the extra effort it requires. With providers already being stretched thin, many just don’t see the reward as worth the effort.
Chronic Care Management
But that is no longer the case. Finally, CMS has taken steps to reduce the heavy lift of CCM while improving financial incentives, issuing its final proposed rules for care delivered under the Medicare Physician Fee Schedule for 2020. This includes new coverage for CCM, as well as new provisions for RPM. Under the new schedule, RPM can be performed by other types of caregivers, not just physicians. This included nurse practitioners, physician assistants, nurse-midwives, clinical nurse specialists, registered nurse anesthetists, clinical psychologists, licensed clinical social workers, and registered dietitians and nutritional professionals. The new provisions also allow providers to partner with third-party vendors for CCM.
All of this means providers can take advantage of all the benefits—and revenue—these programs have to offer without adding more hours to their day. This includes $42 per month for each patient enrolled in a CCM plan.
It is estimated that organizations can gain $75,000 in annual net new revenue per provider if just 50% of eligible patients were enrolled in a CCM program where care is provided by LPNs, RNs, and Mas.
Remote Patient Monitoring
RPM is really the foundation of an effective CCM program. Caring for patients outside the exam room removes the burden for patients of having to drive, potentially long distances, to be seen for something that could have been monitored from home and assessed via telehealth. It can also be a differentiator for attracting and retaining patients. In a recent survey, 84% of respondents said they would choose a provider who offers telehealth over one who does not.
The new RPM codes are fairly straightforward:
- Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial set-up, and patient education for the use of equipment.
- Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial device(s) supply with daily recording(s), or programmed alert(s) transmission, each 30 days.
- Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; initial 20 minutes.
- Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; additional 20 minutes (New for 2020).
Telehealth, too, can now contribute to the bottom line. As part of its efforts to protect patients, providers, and staff from COVID-19, CMS relaxed the majority of its regulatory requirements regarding telehealth, which previously centered around patients living in rural communities. Today, telehealth appointments are being reimbursed the same as in-person appointments, although there is no certainty around how long that will last once the pandemic is gone. What is certain is that telehealth dramatically reduces costs for providers and payers alike, while providing better health for our population. And some industry experts estimate the telehealth market could be worth $66 million by 2021.
The Time Has Come
The parameters and incentives around CCM, RPM, and telehealth have changed. Much of the heavy-lift that has kept providers from adopting these programs has now been removed. Now is the perfect time for providers to take a fresh look at the financial benefits they have to gain by engaging in this dynamic trio.