Included Health CEO Owen Tripp

Remote Care

Peterson Center on Healthcare Takes Aim at Remote Patient Monitoring

The Peterson Center on Healthcare is back with another report that doesn’t mince words when it comes to remote patient monitoring: “RPM reimbursement in Medicare is misaligned with the clinical value of these tools.”

The report synthesized Peterson’s past evaluations of diabetes, hypertension, and musculoskeletal solutions, which encompassed the trio of conditions associated with the highest spending and utilization for remote monitoring services.

Although only ~1% of Medicare patients are in RPM programs, utilization has grown exponentially since the start of the pandemic.

• There’s been a tenfold increase in Medicare patients using RPM services from 2019 to 2023 (44k to over 451k patients). 

• Medicare expenditures for RPM skyrocketed from $6.8M to $194.5M over the same time period.

There’s also been a steady rise in long-term monitoring, even though research suggests most of RPM’s benefits accrue within the first few months.

• The average RPM episode duration was just 1.7 months in 2019, jumping to 5.2 months by 2023. Over 22% of RPM episodes now last over nine months.

• There’s currently no limit on how long providers can use RPM for a specific patient, meaning they can be reimbursed “on a monthly basis in perpetuity for anyone with a diagnosed chronic condition, even if they are already well-managed.”

PCH offered three recommendations to policymakers to combat these issues:

• Base coverage and reimbursement on proven clinical value for different conditions. 

• End indefinite billing practices for “forever codes” that encourage waste. 

• Improve data collection to enable evidence-based decision making about the value and use of remote monitoring. 

The Takeaway

As providers adopt new technologies that extend care beyond the walls of the hospital, aligning incentives with high-value care sounds like an obvious approach to reimbursement, but PCH’s report makes it clear that current policies need an overhaul if they’re going to maximize the effectiveness of RPM programs.

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The Wire

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• Plummeting ED Reimbursement: A recent RAND report found that declining reimbursement and increases in claim denials are putting the viability of hospital-based emergency care in the U.S. at risk. The report showed that Medicare and Medicaid reimbursements to ED physicians each fell by 3.8% from 2018 to 2022 after adjusting for inflation. ED physicians saw even steeper declines from private payors over the same period, with a 10.9% decrease for commercial in-network visits and a 47.7% fall off for commercial out-of-network visits.

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• TytoCare Rhonchi Clearance: TytoCare just became the world’s first virtual care company to receive FDA clearance for AI-based detection of all three major abnormal lung sounds: wheezes, crackles, and rhonchi. By combining a smart digital stethoscope with a proprietary database of 1.8M lung sound recordings, the Tyto Insights for Lung Sounds suite can now analyze the three most clinically significant abnormal lung sounds in real-time and flag abnormalities for clinical review – directly within its Home Smart Clinic and Pro Smart Clinic solutions.

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The Resource Wire

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The Industry Wire

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5. Staffing and funding cuts could impact physician shortage.
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