Remote Patient Monitoring (RPM) is proving to be a powerful telehealth program. Benefits of RPM include improved care outcomes, new revenue for your organization, and an enhanced patient experience. RPM is still relatively new. The current RPM reimbursement codes have been in place since January 2020.
Chronic Care Management (CCM) is an older reimbursable virtual care program. CMS started reimbursing CCM in 2015. The care team was required to spend twenty or more minutes per month of non-face-to-face time on patient care. That twenty minutes per month is today's CCM CPT Code 99490 (look familiar? — that is where we get RPM CPT code 99457). In many ways RPM grew out of the success of CCM in terms of a monthly cadence of providing high-touch non-face-to-face (i.e. "virtual") care management services to the most at-risk patients.
With CCM, the results proved to be successful in improving those patients' health status, and reducing acute events requiring expensive emergency room visits, ambulances, and hospitalizations. This paved the way for RPM in 2020.
Today, 1bios has customers using our platform and services to deliver "stand alone" and “joint” programs. Some only provide “stand alone” RPM; some provide “stand alone” CCM. We have others delivering "joint” programs like RPM AND CCM together, or another combination of virtual care programs. These other programs include Principal Care Management (PCM), Transitional Care Management (TCM), Complex CCM (C-CCM), Qualified Healthcare Professional CCM (QHP-CCM), and Behavioral Health Integration (BHI).
Note that 1bios is adding Remote Therapeutic Management (RTM) and other reimbursable virtual care programs to this list in 2022. The overall success of virtual care programs is driving their expansion.
With few exceptions, our customers delivering both RPM and CCM, or other “joint programs”, are seeing superior results versus those offering a single "stand alone" program (e.g. just RPM or just CCM).
Why are results better when using multiple telehealth programs? We see three benefits creating these superior outcomes. Here is why you should consider providing RPM, CCM, and potentially other virtual care programs to your patients instead of a stand alone RPM service or only a CCM offering.
- Better Health Outcomes: When a patient is enrolled in more than one reimbursable virtual care program, they will get a higher level of touch and care. This could mean more devices to help with monitoring, higher touch, and more frequent connection from the monitoring team and more robust care coordination.
- More Funding/Revenue: An RPM only patient is reimbursable on average $100 - $200/month. A patient who needs RPM and CCM is reimbursable on average $200 - $300/month. You will be paid more when you spend more time and resources both human and technological. You are creating the greatest likelihood that you will improve the patient's health status or at least reduce the likelihood that the patient will visit the emergency room, be in an ambulance, or be hospitalized.
- Best Patient Experience: Some patients will be a great fit for CCM only because adding a monitoring device won’t improve the level of care for their chronic condition(s). Or, they or their caregiver(s) won’t be capable of utilizing the device. On the other hand, some patients will only qualify for RPM because they don't have two or more chronic conditions. The point here is that if you only have one virtual care management program, you may be limited to who you can enroll or have gaps in your capability to provide the best fit (single or combination) of virtual care programs to your patients.
CMS is explicitly reimbursing for RPM and CCM together to achieve the above benefits. If you are already providing one, it is likely you will also benefit by adding more virtual care options to your existing program.
At 1bios, we've built our system specifically to support RPM, CCM, PCM, C-CCM, QHP-CCM, BHI, RTM, and more. You can deliver any single program to your patients or combinations like RPM and CCM where a single patient is enrolled in both. We will continue to expand the list to include RTM and more in 2022. Our recommendation is that you ensure your CCM, RPM or other virtual care delivery systems can go beyond a single codeset.
For more information on what to look for in software features and functionality in a full featured RPM, CCM and other virtual care programs system, check out our other articles, or download our e-book.