Remote patient monitoring ROI has become a crucial consideration for healthcare providers since Medicare began covering it in 2020. Is adopting remote patient monitoring worth the investment? Billing code updates continue to create more opportunities for reimbursement. To clarify whether adopting RPM is the right move for your practice partners, let’s examine what kind of return on investment (ROI) to expect.
Remote Patient Monitoring Reimbursement
Medicare reimbursement does provide a quick return on investment. This is because the billing period for remote patient monitoring CPT codes is 30 days or at the end of the calendar month. The only exception to this rule is CPT 99453, which can be billed after 16 days of monitoring. However, this code can only be billed once. The other four CPT codes are recurring reimbursements.
Referenced below are the five current RPM reimbursement codes. The average estimated reimbursement rates listed are rounded numbers that are based on non-facility averages and will vary by region.
RPM CPT Codes
CPT 99453 covers the cost of medical device set-up and patient education for vital sign monitoring equipment. RPM devices, for example, include Tenovi Cellular-Conected Blood Pressure Monitor, Tenovi Scale: Cellular-Connected Weight Tracking, Tenovi Cellular-Connected Blood Glucose Meter, and Tenovi POx: Cellular-Connected Pulse Oximeter. The average reimbursement rate is $19.65.
CPT 99454 pays for supplying the rpm devices for daily recording or programmed alert transmissions. This code can be used more than once. To bill for this code, the patient must use the device at least 16 days per month. The average reimbursement rate for this code is $46.50.
CPT 99457 covers the initial 20 minutes of treatment management, which requires remote or virtual communication with the patient. Communication can occur via video calls, text messaging, email, or phone calls. The average reimbursement rate for this code is $48.14.
CPT Code 99457 is billable as ‘incident to’ under general supervision. Medicare providers can contract third-party companies to assist with remote patient monitoring services. The advantage here is the opportunity to manage more patients and generate more revenue without significantly impacting workflow.
CPT 99458 addresses every additional 20 minutes of RPM services, including data interpretation. Documentation of how the time was used is required. The average reimbursement rate for CPT 99458 is $38.64.
CPT 99091 provides for a minimum of 30 minutes in a calendar month for clinical staff time associated with gathering, interpreting, and processing data that the patient transmits. This includes at least one phone or email communication involving medical management or monitor advising. The average national pay rate for CPT 99091 is $52.71.
How to Calculate Remote Patient Monitoring ROI
Now that you understand the billing codes for RPM services let’s review how to calculate ROI. The first step for calculating ROI is determining the expected reimbursement amount. If you bill each code once every month, yearly revenue can be estimated using the following equation:
[($46.83 + $48.14 + $38.64 + $46.83) (12) + $18] x (# of enrolled patients)
To put this into perspective, for every:
- 30 patients = $68,538.60
- 50 patients = $114,230.00
- 200 patients = $456,920.00
The final step is to subtract the cost of remote patient monitoring services. Remote patient monitoring companies offer various pricing models depending on how much additional work the healthcare practice wants to take on.
For example, a full-service model will take care of tasks such as:
- Device set-up
- Patient education
- Data review
- Patient interaction
In contrast, a more basic service model may cover device set-up and patient education, but it could require physicians to perform data review and patient interaction independently. Although a basic service model will yield more ROI, it will also add more tasks to the physician’s workload.
Therefore, it is essential to evaluate the cost of the physician’s time and other components involved in remote patient monitoring services for improved quality of care. Consider these additional costs during decision-making: shipping devices to patients, onboarding patients, and technical support. As a result, you may find that a full-service model is worth the investment.
Remote Patient Monitoring and Long-Term ROI
Even without Medicare reimbursements, remote patient monitoring can lower healthcare costs long-term. By focusing on preventive care over reactive care, healthcare organizations can avoid costly procedures and resources. In the following sections, we’ll review the long-term benefits of remote patient monitoring.
Benefit #1: Reduces Hospital Readmission Rates
Medicare is shifting its goals to promote value-based care over quantity. One of the ways it has done this is through the Hospital Readmissions Reduction Program (HRRP), which penalizes hospitals for excess readmissions. If patients with any of the following conditions are readmitted to hospitals within 30 days of discharge, the facility is subject to payment reductions.
The health conditions/procedures include:
- acute myocardial infarction
- chronic obstructive pulmonary disease
- heart disease and heart failure
- pneumonia
- coronary artery bypass graft surgery
- elective primary total hip arthroplasty and/or total knee arthroplasty
Remote patient monitoring allows clinicians to identify complications early and quickly intervene to reduce hospital readmissions and avoid penalties. In fact, a systematic literature review published in BMJ Open showed remote patient monitoring reduced acute care use for patients with cardiovascular disease and COPD.
Benefit #2: RPM Decreases Emergency Room Visits
Another ROI for remote patient monitoring services is decreased emergency room visits. It is estimated that up to 30% of emergency room visits are potentially unnecessary. With effective RPM care between visits, most ED visits are avoidable. It is much more difficult to treat a developed chronic condition than it is to treat early symptoms of one.
Clinical trial research has shown that remote patient monitoring decreases heart failure-related emergency department visits, urgent in-office visits, and, in general, total healthcare use in patients with ICD or defibrillators for resynchronization therapy. RPM allows clinicians to detect, identify, and treat complications before they require a costly trip to the emergency room.
Benefit #3: RPM Transmits Steady Stream of Health Data
A steady accumulation of reliable, valid real-time health data is an extremely valuable ROI for patient monitoring systems. Many factors may interfere with vital sign readings at an in-office appointment. For example, some patients experience elevated anxiety in a clinical setting, which could lead to white coat hypertension. This is a condition in which patients experience a higher-than-usual blood pressure reading at a doctor’s office when compared to other settings.
Furthermore, research published in the New England Journal of Medicine showed that white coat hypertension was not benign, and masked hypertension was associated with a higher risk of mortality than sustained hypertension. These findings underscore the importance of detecting which type of hypertension a patient is experiencing. RPM is one solution used to control white coat syndrome.
RPM requires patients to use their devices at least 16 days every month. Therefore, when patients regularly take health readings from the comfort of their own homes, clinicians get a more accurate depiction of the patient’s condition between visits.
More data between office visits allows clinicians to fine-tune treatment plans. Physicians can check how their patients respond to medications and promptly adjust prescriptions as necessary.
Benefit #4: Improves Patient Adherence to Treatment Plans
Perhaps the most effective ROI remote patient monitoring offers is increased patient engagement. Telemedicine and e-Health research reported that higher levels of engagement among diabetic patients using RPM technology are associated with better glycemic control outcomes.
Ultimately, patients’ everyday decisions have the most significant influence on their health. Clinicians can create effective treatment plans. However, if patients don’t consistently follow them, management will not be successful. Knowing that a clinician regularly monitors their health and can intervene in between visits encourages patients to adhere to their treatment plans.
Benefit #5: Allows Clinicians to Care for More Patients
Unlike telehealth, remote patient monitoring has no originating site restrictions, making it accessible to more patients. Additionally, not all remote patient monitoring services must be directly performed by the billing physician.
As previously mentioned, CPT 99457 can be billed ‘incident to’ under general supervision. Medicare providers can contract third-party vendors to assist with RPM services. This enables clinics to manage more patients and generate more revenue without significantly impacting workflows.
With the adoption of telemedicine, one large Federally Qualified Health Center saw reduced missed appointments, translating into cost savings. Savings were more pronounced with implementing a support team that conducted previsit device and connectivity testing. The revenue from averted missed appointments totaled $45,578 per month.
Understanding ROI on Remote Patient Monitoring: Key Points
Both short- and long-term ROIs can be gained from remote patient monitoring. Not only does RPM lower costs for the healthcare industry, but it also improves patient outcomes by promoting timely care. Selecting the right remote patient monitoring system and making appropriate changes to existing workflows will go a long way in serving patients and increasing the organization’s bottom line.
Tenovi remote patient monitoring devices are easy to use for patients. There is no syncing and no app required. Physicians automatically and securely get patient measurements within seconds. Schedule your free demo and consultation today.
