Medicare has just announced it is introducing pivotal changes in the reimbursement process for Remote Physiologic Monitoring services (more commonly referred to as Remote Patient Monitoring (RPM). These modifications aim to increase the accessibility and sustainability of RPM programs for Community Health Centers (CHCs), marking a major improvement in patient care and technological integration. We anticipate the adjustments will drive better patient outcomes, especially for those managing chronic conditions, by making RPM services more financially viable and operationally efficient for healthcare providers. The development will support innovation and efficiency in healthcare delivery and help more patients get timely and effective care through RPM services.
Background and Challenges
Community Health Centers have historically encountered significant challenges in implementing RPM services effectively. A prominent issue has been the absence of a separate reimbursement structure for these services by Medicare. Until recently, Medicare has not reimbursed RPM services separately from the FQHC PPS payment. Medicare took the position that RPM was a component of care management under the PPS qualifying visit and was therefore covered through the associated PPS payment rate.
This lack of distinct reimbursement made it financially challenging for CHCs to sustain RPM programs, hindering their ability to offer these services comprehensively. Operational challenges further compounded the financial constraints. CHCs often deal with limited resources, technological barriers, and a lack of clarity in billing and reimbursement protocols for remote patient monitoring services. The absence of clear, supportive policies made it difficult for these centers to leverage RPM’s full potential to enhance patient care, particularly in managing chronic diseases.
Additionally, the historical approach to reimbursement did not fully recognize the comprehensive nature of RPM for Community Health Centers. It often overlooked components such as patient education, device distribution, and the ongoing clinical support necessary for the success of RPM programs. This narrow view limited the ability of CHCs to maximize the use of RPM services to improve patient outcomes and manage chronic conditions effectively.
The upcoming changes in Medicare reimbursement contained in the 2024 physician fee schedule will address these longstanding challenges, providing CHCs with a more supportive framework to integrate and optimize RPM services. The goal is to unlock the full potential of RPM to enhance patient care, improve health outcomes, and make healthcare delivery more efficient and responsive to patients’ needs.
New Reimbursement Guidelines
The Medicare Physician Fee Schedule has announced pivotal changes that redefine the reimbursement landscape for RPM services in CHCs. The new guidelines include RPM services in the general care management code, signifying a more integrated and recognized role for RPM in patient care and reimbursement structures.
These modifications will give CHCs more transparent and favorable billing options. The changes will enhance the financial feasibility of RPM services and encourage CHCs to embrace these technologies confidently. Integrating RPM into broader care management codes also demonstrates strategic alignment, positioning remote patient monitoring services as a central element in patient care and management strategies.
In the upcoming Medicare Physician Fee Schedule changes, the addition of RPM to GO511 holds significant implications for CHC reimbursement processes. Understanding how GO511 applies to the new guidelines will be essential for CHCs to plan and implement RPM services in conjunction with the reimbursement structures. This webinar from McKesson is an excellent resource for CHCs looking to gain comprehensive information about the billing guidelines.
These various changes are not only procedural but align with a broader vision of elevating the role of RPM in healthcare delivery. The new guidelines will unlock significant opportunities in RPM for Community Health Centers, enabling them to leverage RPM services more effectively to improve patient care and organizational efficiency.
Grants and Funding Opportunities
Various grants and funding opportunities have historically helped Community Health Centers bolster Remote Patient Monitoring. Grants from the Health Resources and Services Administration (HRSA) and the Federal Communications Commission (FCC), in particular, have provided CHCs with financial support to implement RPM technology. For example, the HRSA awarded $89.5 million in 2021 in supplemental funding to health centers receiving the Health Center Program operational grant (H80) funding. To qualify, the CHCs were required to:
- Achieve blood pressure control in less than 58.9 percent of patients 18 to 85 years of age diagnosed with hypertension; and
- Serve at least 100 patients 18 to 85 years of age diagnosed with hypertension.
CHCs used these funds in various ways, such as acquiring necessary equipment and technology, improving infrastructure, and enhancing service delivery. However, successful RPM implementation goes beyond device acquisition. It involves a comprehensive approach that includes software and clinical services to ensure patients receive holistic and continuous care.
The Covid-19 Telehealth Program initially awarded over $200 million, enabling healthcare providers to facilitate connected care services like RPM during the pandemic. A second round, adding $249.95 million, further supports healthcare providers by funding telecommunications and connected devices necessary for RPM services amidst COVID-19.
The availability of these grants represents a commitment to supporting CHCs in their quest to offer improved and technologically advanced healthcare services. It also reflects a broader strategy to promote RPM as a vital component of contemporary healthcare, facilitating better outcomes and improving healthcare delivery in community health settings.
The Impact of the New Guidelines
The new 2024 physician fee schedule reimbursement guidelines will relieve CHCs of some financial constraints and allow them to optimize remote patient monitoring services. These changes have the potential to unlock significant benefits, including enhanced care and improved operational efficiencies.
We expect the revised guidelines to foster a more favorable environment for integrating RPM into mainstream healthcare services. This change will improve disease management and access to necessary medical interventions, empowering CHCs to achieve sustainable and impactful RPM implementations.
For example, a Community Health Center in Arizona initially purchased 200 RPM devices in November 2021, but faced challenges implementing the program. For over a year, the devices remained undistributed, and the CHC could not utilize RPM to its full potential. Recognizing the need for a more comprehensive approach, the CHC integrated RemetricHealth’s clinical support services into its RPM program in July 2022.
This strategic addition proved to be a turning point. With the enhanced clinical support, the CHC successfully distributed the devices. The number of patients actively participating in the program grew to 200, patient engagement increased, and the overall effectiveness of the RPM services improved significantly. The majority of patients are doing very well and still active on the program, and the organization is experiencing the benefits of the program.
The case emphasizes the critical role of clinical support in successfully implementing and optimizing RPM for Community Health Centers. It illustrates that devices alone are not enough; a holistic approach that includes robust clinical support is essential to realize the full benefits of RPM, improve patient outcomes, and make the program a viable and beneficial part of healthcare delivery at CHCs.
A Pivotal Opportunity for Community Health Centers
Embrace the upcoming changes in RPM reimbursement as a pivotal opportunity for your Community Health Center. Maximize the benefits of these adjustments with advance preparation and strategic planning. Act now to position your CHC at the forefront of enhanced patient care and operational innovation.
For more information on the 2024 physician fee schedule changes and how to implement remote patient monitoring services to increase profitability, request a demo of our RPM solution today!