With the right legal and policy backdrop, digital health tools will play a bigger and bigger role in healthcare. They offer a huge opportunity to improve patient care, reduce hospitalizations, avoid complications, and improve patient engagement—all while reducing costs. The Connected Health Initiative (CHI) is continually looking for ways to ensure that patients and providers can use all the digital tools available to them. For that to happen, we need Congress to recognize the importance of digital medicine and telehealth tools and address provisions that hinder their use. This is part of a series outlining key priorities for the 118th Congress in legislating on digital health.
Remote patient monitoring (RPM) tools are key to helping doctors understand what their patients are going through and how their prescribed interventions are helping. These tools are usually asynchronous, meaning that data is collected at one time (or over a period of time) then reviewed by a caregiver later. Until recently, the Centers for Medicare & Medicaid Services (CMS) did not have adequate Current Procedural Terminology (CPT) code families for remote patient monitoring, which made it difficult for doctors to bill for these services—and impeded their use. Fortunately, CMS has made significant progress in supporting asynchronous RPM services, including its decisions to provide unbundled support for both RPM and remote therapeutic monitoring (RTM) CPT code families. However, significant barriers remain that prevent realizing the potential of remote monitoring tools and services that are demonstrated to markedly improve both prevention and treatment of acute and chronic conditions. We recommend that the 118th Congress include a provision removing the requirement for providers to charge patients a 20 percent copay for asynchronous remote patient monitoring services. In the 117th Congress, H.R. 4755, the Seniors’ Chronic Care Management Improvement Act of 2021, proposed ananalogous allowance for providers billing for chronic care management (CCM) codes.
While RPM use is growing, mandatory cost-sharing requirements on Medicare patients discourage socioeconomically disadvantaged populations from benefiting from these services. CHI Steering Committee member University of Mississippi Medical Center (UMMC) notes that 45 percent of the patients enrolled in its hypertension RPM project report an income below $30,000, and 25 percent reside in federally designated rural areas. Clinically, UMMC’s program shows substantial improvements in blood pressure control, which leads to reduced risk for future cardiovascular events. Copays of $10 to $20 per month associated with RPM codes can result in patients making difficult choices between paying for medications, transportation, groceries, housing, or other essential expenditures. Congress can increase equity in healthcare by reducing the cost of copays for these essential treatments.
In addition, we recommend that the 118th Congress direct CMS to provide unbundled billing codes for remote monitoring services at federally qualified health centers (FQHCs) and rural health centers (RHCs). CMS has historically refused to issue digital health billing codes for use at FQHCs and RHCs, arguing that the payments for such services are covered by existing prospective payment service processes (in the case of FQHCs) or flat fee structures (in the case of RHCs). Without additional funding to invest capital in remote patient monitoring systems, FQHCs and RHCs are, in practice, unable to offer such services to their patients. In addition, FQHCs and RHCs serve patients who are more likely to live in rural areas, have low socioeconomic status, and lack access to other vital healthcare services. Restricting these centers from best serving the needs of their patients is a health equity problem. Congress should make sure that all citizens can access high-quality, cost-effective digital health services, no matter where they live.
We know that Members of Congress want to ensure their constituents get the best value and have the best options in their healthcare. That means ensuring any who need them can access remote monitoring services, and that doctors can bill appropriately for them. CHI is here to help identify the ways Congress can improve the legal and regulatory environment for digital health companies, doctors, patients, and for the country.