The Peterson Center on Healthcare released a new report that recommends policymakers narrow payment guidelines for a service they think could rocket spending in the public sector.
The costs of remote monitoring on Medicare have grown significantly in the years since the codes became available to providers, from $6.8 million in 2019 to $194.5 million in 2023. The services can be used for a host of chronic conditions that many Americans suffer from, including diabetes, hypertension and heart disease.
The Peterson Center takes issue with the increasing number of Medicare, Medicaid and Medicare Advantage patients who have been prescribed remote monitoring and the increasing amount of time their providers keep them using the technology.
The report finds that chronic conditions only benefit from intense monitoring by providers for a short period of time, which varies by condition. Without additional guardrails, the report says public spending on remote monitoring could increase dramatically.
Under the current requirements for remote monitoring, CMS does not dictate which conditions should be monitored or for how long. Because CMS currently does not limit the amount of time that a provider can charge Medicare, Peterson calls them “forever codes.”
The codes have only been in existence since 2019, but Peterson recommends policymakers steer providers towards high-value services and away from ongoing monitoring with no discernible clinical benefit.
“At some point we’ll start to see the utilization level off … but I have no idea if it levels off at $400 million a year or $4 billion,” Caroline Pearson, executive director of the center, said. “The total addressable market is very large.”
Pearson is particularly worried about companies that are promoting remote monitoring as a revenue stream for providers. She said that clinically effective remote monitoring companies try to graduate patients off the services as quickly as possible.
“On average, the length of time patients engaged in continuous RPM use increased steadily from 1.7 months in 2019 to 5.2 months in 2023 in Traditional Medicare," according to the report. In 2023, services were used by nearly half a million Medicare beneficiaries.
The number of providers that keep patients on remote monitoring for nine months or more has increased from 4% to 23%. “There’s no need to wait to see what the total annual billing is to try to steer towards payment for clinical benefit,” Pearson said.
Peterson recommends that policymakers erect tailored guardrails for the codes by condition. It also suggests that policymakers require providers to document more data on their use of RPM and RTM, such as the physiologic data being collected, the ordering provider, the condition, and what digital solution is used.
The report explores the benefits of remote monitoring for hypertension, diabetes and musculoskeletal conditions. While it found that patients with hypertension and musculoskeletal conditions benefited from remote monitoring, patients with diabetes saw limited benefit, the report found.
Peterson asserts that remote monitoring has the most benefit when it is used for a focused duration for a patient and provider to get a condition under control.
Hypertension responds particularly well to RPM, PCH found. During a six-month period, providers can use the data from regular blood pressure readings to adjust a patient’s medication and get their condition under control.
If a provider wants to continue the services beyond six months, they should provide additional justification, PCH writes. Pearson said that durable medical equipment and continuous glucose monitors should both operate under this model.
Peterson also recommends payers only cover remote monitoring for conditions that have clinical evidence to prove the services are beneficial. Some private payers have adopted this model, the group says. Moreover, public payers should offer higher reimbursement for conditions like hypertension that respond better to remote monitoring.
PCH specifically takes issue with the use of remote monitoring for diabetes, which it says does not respond well to RPM. While diabetes is the second most common condition to be billed for RPM, Peterson found that “most patients do not experience clinically meaningful benefits from RPM use.”
The report says that patients starting treatment for uncontrolled diabetes may see benefits in the short term, but monitoring stable diabetes does not provide much benefit.
The Peterson Center’s evaluation found that remote monitoring services were most used by non-white urban patients who are dually eligible. Policy makers should adjust payment rates to encourage more uptake by rural providers, as patients that live far from a clinic can benefit most from the virtual care technologies.
In an interview, Pearson emphasized that there could be trade-offs included in redesigning remote monitoring codes to offset issues raised by other advocates. Pearson said that changing the codes would likely be an uphill battle in the AMA’s coding committee that could take several years.
Pearson stressed that the center desires to decrease billing and coding complications for providers. “Providers are always surprised when they see some of the clinical data that is weak, because they are not doing evidence reviews … I think everybody’s got the same objectives, and at the end of the day, revenue conversations get complicated, but I think we can get there,” she said.