Many state Medicaid programs have established RPM coverage policies similar to Medicare, with 41 states providing at least some type of RPM reimbursement based on CCHP’s research reflected in our policy trend maps. In terms of private payer RPM coverage, it is noted that RPM reimbursement across commercial insurers is not well-known, but some payers have adopted more narrow policies which limit the set of conditions eligible for RPM reimbursement.
The authors draw on the clinical benefit information gathered through the Peterson Health Technology Institute (PHTI) evaluations of digital health tools to treat the primary conditions associated with Medicare/Medicaid utilization of remote monitoring services: hypertension, diabetes, and musculoskeletal disorders. Additionally, there is some analysis of RPM duration of use by defining periods of continuous use as episodes to determine shifts in length of RPM use by condition. Overall, the analysis found that clinical effectiveness and duration of benefit vary by condition and product, and that remote monitoring is currently used by a very small percentage of Medicare/Medicaid populations. However, RPM utilization, as well as its duration of use, are quickly growing. Findings include:
- Hypertension is the primary diagnosis for 57% of all Medicare beneficiaries with an RPM episode; musculoskeletal disorder is the primary diagnosis for almost 60% of beneficiaries with an RTM episode.
- The average RPM episode for hypertension lasts 6.6 months; the average RTM episode for a musculoskeletal disorder lasts 1.7 months.
- RPM blood pressure monitoring during periods of active medication management allows providers to quickly adjust patients’ hypertension medications, resulting in rapid improvements in blood pressure outcomes.
- Physical therapy RTM patients experience greater improvements in pain and function than those who receive only in-person physical therapy.
- RPM for diabetes may be most effective when targeting patients with the highest starting HbA1c levels and those who are at critical transition points in their care plan.
- One percent of Medicare beneficiaries use RPM today; they tend to be older, nonwhite, urban, more medically complex, and dually eligible for Medicare and Medicaid.
- Less than 0.2% of Medicare beneficiaries received RTM services in 2023; they tend to be older, white, women, and live in urban areas.
- In 2023, 451,000 patients in Medicare used RPM services, versus 44,500 in 2019.
- On average, the duration of continuous RPM use in Medicare rose from 1.7 to 5.2 months between 2019 and 2023.
Based on these findings, the report recommends that policymakers consider:
- Better aligning RPM coverage policies to the conditions/durations found to have the most clinical benefit.
- Improving access to high-impact remote monitoring tools.
- Requiring more specificity on RPM billing claims to improve data collection.
The report makes an interesting suggestion in regard to the second recommendation, ensuring availability of high-impact remote monitoring tools. The evaluation found that most beneficiaries utilizing RPM were primarily located in urban areas. Therefore, to improve RPM access specifically in rural areas, which have higher rates of chronic disease and traditional access issues, it is suggested that CMS reassess its current geographic variations used for Medicare reimbursement. The authors acknowledge that the geographic variation seeks to align payment with local costs of living, but also highlight that it may limit national companies from offering digital health tools in more rural and low-cost regions.
In regard to the first recommendation, aligning policies with clinical evidence, the report notes that there currently is no Medicare limit on the conditions for which RPM may be used, as well as no limit on the duration of reimbursement. Nevertheless, the findings seem to show that current RPM condition/duration rates are already consistent with the clinical evidence in this area. For instance, the clinical evidence review found that RPM use in patients with hypertension is most valuable within the first six months, when active management of medications for blood pressure occurs. Meanwhile, Medicare utilization data found that an average RPM episode for hypertension lasts 6.6 months. In addition, the evidence shows that RTM improves outcomes for people with musculoskeletal conditions during targeted physical therapy episodes that last 2–4 months, while the average RTM episode for a musculoskeletal disorder was found to last 1.7 months.
The last recommendation relating to data collection also highlights that currently Medicare does not require RPM claims to explicitly report information related to the condition being treated and device being used, therefore the data and evidence available is not yet entirely clear.
As coverage of remote monitoring services and the devices used are still relatively new, it may be best for policymakers to first focus on strategies to increase both RPM access and data collection to form a more thorough evidence base before considering further refinements to RPM policies. RPM billing rules are already quite complex, and additional limitations may decrease both provider participation in utilizing RPM technologies in their practice, as well as patient access to the clinical benefits RPM provides. |
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