By Juan Pablo Segura, co-founder, Babyscripts.
In a system that is straining under the pressure of an increasingly sick and aging population, the benefits of digital healthcare are indisputable. Technology has played a crucial role in the industry’s continued transition to value-based care, driving costs down while increasing access to personalized care. But despite the rapid gains that technology has affected, policy-makers have been slow to catch up. Until recently, the Centers for Medicare and Medicaid Services (CMS) enforced rules dis-incentivizing doctors to consider using new technologies.
Yet effective January of this year, CMS instituted important changes to their reimbursement policies that encourage the use of digital health tools. Most significant among these changes is the un-bundling of the Medicare/Medicaid CPT code 99091, a decision that specifically affects the adoption and deployment of remote patient monitoring (RPM) devices. In the past, CMS has only offered financial incentives for live, audiovisual virtual visits, excluding RPM—and thus excluding a major demographic from the possibility of affordable and accessible care. With the un-bundling, financial incentives for RPM are not only available, but also are deployed across multiple providers, allowing nurses and care managers as well as physicians to analyze and monitor data, creating efficiencies and lowering costs.
The creation of a code specifically for RPM marks an important shift in the stance towards digital health, establishing it as a standalone benefit with intrinsic value. With this policy, CMS is acknowledging and validating the research that has shown the tremendous benefits of RPM, primarily the economic benefits that come from transitioning the center of care from expensive hospitals and tertiary care clinics to the home.
But while the CPT un-bundling represents an important victory for RPM, it also serves to highlight the policy’s inadequacies and the large margin for growth. With the update, care providers no longer have to worry about fully funding RPM from their original operating budgets, but the reimbursement rate ($60 per patient per month) is still far too low to be effective in most cases. Other requirements, such as a prior wellness visit with the patient and a limit of one charge to the code per month, further restrict its effectiveness.
Perhaps most problematic, while the un-bundling will have an immediate positive impact on patients over the age of 65, a large patient demographic could be outside the bounds of its effects. Commercial plans are under no requirement to follow the updated CPT guidelines, and more importantly, neither is Medicaid. And while Medicaid is the smaller of the two government run-healthcare plans (compare Medicaid’s revenue of $565.5 billion to Medicare’s $672.1 billion), it is outpacing Medicare by 10 percent in rates of spending (increasing by 3.9 percent in 2016 compared to Medicare’s 3.3 percent).