CPT Editorial Panel Suspends RPM Coding Changes – What Now?
An attempt to get compensation for remote patient monitoring programs have stalled, and that could make healthcare systems and hospitals think twice about launching or expanding their platforms.
The roadblock comes from the 21-member membership of the American Medical Association CPT Editorial Panel, which has failed to agree on changes to the CPT codes for RPM services. At last month’s meeting, the panel suspended the proposed changes indefinitely.
RPM was initially recognized in 2019 by the Centers for Medicare and Medicaid Services through a small set of codes for remote physiological monitoring services, allowing physicians to seek reimbursement for collecting patient data through certain medical devices outside the hospital setting.
CMS has since slowly modified and expanded these codes, adding codes for remote therapeutic monitoring.
The issue has hindered the development of new RPM programs because health care systems and hospitals often rely on Medicare reimbursements to maintain these programs. Without that financial support, some organizations may decide not to launch or expand their platforms.
Oren Nissim is CEO and co-founder of Brook Health, a remote patient monitoring company, and is an expert in RPM reimbursement. We sat down with Nissim to discuss the problem this creates RPM providers, healthcare providers, and patients, and how the speed of innovation is finally showing up, but these debates are slowing progress for everyone.
Q. Please describe what was discussed at the May CPT Editorial Panel meeting and what happened.
A. The May CPT Editorial Panel meeting discussed proposed changes to CPT code language for services such as remote patient monitoring. The proposed changes were intended to adjust reimbursement requirements, such as the number of data points that must be collected from a patient each month and the amount of time a provider must spend on the data to qualify for reimbursement.
The panel discussed whether these requirements were justified or whether reimbursement would be possible with fewer restrictions for the patient and provider.
However, during the meeting, the panel did not reach an agreement or a solution. Many stakeholders in the market have indicated that the current requirements appear too high and that more flexibility and reasonableness should be introduced. The panel has not yet concluded whether this is indeed the case.
The main problem seems to be the lack of a clear definition of the type of involvement that should be provided effective RPM services. RPM was not simply intended as a means of payment for devices placed in patients’ homes; While these devices are necessary to provide the services, they are not the service itself.
The panel likely needs more data and a better description or decision on what constitutes a good form of engagement in order to make an informed decision on the proposed changes to the CPT code language for RPM reimbursement.
Q. The May CPT Editorial Panel meeting could make hospitals and health care systems think twice before launching or expanding RPM. Please explain your feelings about the outcome of the meeting.
A. The outcome of the May CPT Editorial Panel meeting should not necessarily cause hospitals and healthcare systems to reconsider launching or expanding RPM programs. Instead, it should put pressure on those involved to focus on the form of engagement that drives results and understand that providing a device and connectivity in the home is just the cost of creating an engagement model.
RPM is designed to save money through engagement on both the patient and provider sides that would lead to the right health outcomes.
The panel is likely hesitant to make changes because they believe the feedback received is not entirely accurate. The language in the CPT codes is designed to define the type of engagement, and while some flexibility may be necessary, significantly lowering the bar is not the right answer.
Lowering the bar too much would not create a good form of engagement, but would instead make it easier to obtain reimbursement without providing the intended value.
The focus should be on developing a better form of engagement and working together to achieve this goal, rather than insisting on limitations to the current form of engagement. The current form was intended to spark a discussion, and that’s happening now.
However, the discussion should not be one-sided, with stakeholders merely pushing for more flexibility. Instead, the emphasis should be on the original objectives of RPM: achieving better results and cost savings. If programs cannot demonstrate support for these objectives, they should not participate in RPM.
Q. What are some real-world examples of the impact of the reimbursement issue on patients and physicians?
A. The reimbursement issue impacts patients and physicians in several ways, especially when it comes to co-payments for RPM services. While the CPT review in May is not directly the cause of this issue, a bill proposed in Congress to remove co-payments from the RPM has brought it to the forefront.
Patients, especially those on Medicare, may have difficulty paying monthly copayments for RPM services, which are provided to help manage their chronic conditions at home. In the past, these patients were placed in nursing homes or received expensive, labor-intensive home visits from nurses.
While Using technology for RPM is the right approach; penalizing patients with co-payments can be harmful, especially for those who live on a pension or have limited income.
While RPM co-pays are relatively low, ranging from $10 to $30, they are still a barrier, especially considering these are monthly recurring costs. The perception of having to pay taxes for these services can deter patients from participating, ultimately hurting the success of RPM programs.
Q. You also suggest that the speed of innovation with RPM is finally showing up. Discuss the state of the technology and where it is going.
A. The pace of innovation in RPM is increasing, with technology playing a critical role in expanding and expanding the human engagement model. AI in particular has the potential to improve the conversation between healthcare providers and patients, allowing for more efficient information collection without the need for in-person meetings.
By using AI properly, healthcare providers can get more signal and less noise from patient data, leading to better insights and improved care.
The adoption of RPM technology is accelerating and is expected to reach mass market size within the next five years. As technology becomes more accessible and affordable, the friction in implementing RPM solutions is removed. The focus now shifts to ensuring correct and responsible implementation of these technologies. AI is an accelerator, allowing healthcare providers to deliver more efficient and effective care.
It is critical to recognize that while AI can automate certain tasks, human involvement remains essential to oversee home care protocols and address healthcare issues and medical feedback. AI can help gather information and ask routine questions, but while we see a promising evolution, AI cannot completely replace the human touch.
As RPM technology becomes more widely available, it has the potential to transform care for patients with chronic conditions, just as GPS technology has transformed navigation. The right use of AI and other RPM technologies will be critical to unlocking this potential and improving patient outcomes while reducing healthcare costs.
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