Wednesday, Senators Marsha Blackburn, R-Tenn., and Mark Warner, D-Va., introduced a bill that would increase reimbursement for remote monitoring in rural areas.
Representatives David Kustoff, R-Tenn., Mark Pocan D-Wis., Troy Balderson, R-Ohio, and Don Davis, D-N.C., also introduced the Rural Patient Monitoring Access Act in the House, which would expand access to remote patient monitoring in rural areas, where low payment rates discourage providers and RPM companies from providing services.
Patients in rural areas have a higher disease burden than the national average, including chronic conditions such as heart disease, hypertension and diabetes. It is harder for patients in rural areas to see a doctor, thus they could benefit more from routine monitoring of their conditions at home, the Peterson Center on Healthcare argued in a recent report on RPM services.
RPM has also been shown to improve patient outcomes like lowering blood pressure by half in hypertensive patients and helping patients with uncontrolled diabetes gain control of their blood sugar levels.
The Peterson Center on Healthcare recently released a report that found remote monitoring is most often provided to dually eligible urban patients, and it called on policymakers to change entrenched policies that discourage rural remote monitoring use.
Due to a billing policy in the Medicare program, called the geographic payment index, remote monitoring treatment management is paid approximately $11 less per patient per month than the national average, according to data by the Medicare Payment Advisory Commission.
In Mississippi and Arkansas, the average remote monitoring payment is $84 and $85, respectively, compared to the national average of $96 per patient per month. Providers are more likely to offer the services in these areas where they can get paid more. In densely populated areas like Seattle and New York City, the same service is reimbursed at $113 and $110, respectively.
The bill would use the national average as a floor for remote monitoring payment so rural providers are paid enough to justify offering the services, which require a connected device and regular monitoring of patient data.
Provider organizations Ascension, LifePoint Health, SSM Health and Marshfield Clinic support the legislation. Associations representing rural health clinics, patients, providers and RPM companies like the National Rural Health Association, the Alliance for Connected Care, the American Association of Nurse Practitioners, the Health Information Management Systems Society and the American Telemedicine Association are lobbying for the legislation in Congress.
“Ascension is committed to caring for all persons, with special attention to vulnerable communities like rural seniors,” Eduardo Conrado, president of Ascension, said in a statement. “The Rural Patient Monitoring Act would help strengthen the delivery of care for patients with conditions that put them at risk of rehospitalization—keeping them healthier, allowing them to remain at home, and lowering costs to Medicare.”
The RPM Access Act also commissions a study on the cost savings of RPM for the Medicare program through the expanded access to rural areas the bill would create.
“Medicare beneficiaries in rural and underserved areas often face serious barriers to health care, and they deserve better,” Blackburn said in a press release. “The Rural Patient Monitoring Access Act would ensure Tennessee Medicare patients have access to high-quality remote physiologic monitoring services to manage chronic conditions and help patients eliminate unnecessary hospital visits.”
“Too often, patients are struggling to receive the medical care they need because of how difficult it is to see a doctor in person,” Warner said in a statement. “Remote monitoring services offer a life-saving solution, expanding care options and allowing individuals to regularly receive the medical consultations they need, all while lowering costs and hospital admissions. I’m proud to introduce the Rural Patient Monitoring Access Act to improve health care services for our seniors.”
An advocate working to pass the bill said they hope to get it included in a broader rural healthcare package in the Ways and Means committee.
However, the remote monitoring billing codes have been facing scrutiny, which could hamper progress in Congress.
The Peterson Center report found 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.
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.
Audits of remote monitoring services also increased in 2024, according to two lawyers that spoke with Fierce Healthcare and have represented companies undergoing audits by Medicare Administrative Contractors and health systems.
President Joe Biden’s inspector general of the Department of Health and Human Services, Christi Grimm, raised a yellow flag on remote monitoring in September 2024, pointing out billing inconsistencies. While stakeholders said the claims were overblown, lawyers have admitted that many providers make mistakes when billing for RPM because the codes are relatively new.
“No one's completely squeaky clean,” Thomas Ferrante, partner at law firm Foley & Lardner, said last month. “It's just so complicated. There's always some error rate of mistakes. So, not surprisingly, things come up in those audits. Sometimes it's not worrisome. Sometimes it's, 'What the heck has been going on?'”
Both lawyers and the Peterson Center expressed concern about third-party RPM companies that are marketing the service as a revenue driver for provider groups. The group has recommended stricter billing criteria to policymakers, which includes a limit on the duration the codes can be billed.