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Remote Patient Monitoring to Increase Revenue Through the Value-Based Care Model

The Remote Patient Monitoring program, introduced by CMS in 2018, allows providers to remotely monitor patients’ physiologic parameters in real-time from data obtained by patients at home. Through this program, a healthcare provider issues a “connected” blood pressure cuff, glucometer, pulse oximeter, or scale to a patient. When the patient obtains data, the data is transmitted automatically to an online dashboard, where the provider can identify abnormalities early and intervene before a critical value – resulting in an ER visit or hospitalization – is reached. This program, through preliminary studies, has been shown to reduce hospitalizations and have a significant impact on the care of multiple chronic conditions. Additionally, the $120-140 per patient per month reimbursement (paid by both Medicare and many commercial payers) can increase practice revenue significantly.

While remote patient monitoring (RPM) is currently touted as a means to both augment patient care and increase reimbursements, the RPM program has an added benefit for the future, when CMS implements the Primary Care First (PCF) model in 2021. PCF, CMS’ initiative for value-based care, will incentivize providers for reducing hospitalizations and will reward them for performance, including quality of care for chronic conditions such as diabetes mellitus and hypertension. As remote patient monitoring has been shown to both reduce hospitalizations and positively impact patient outcomes, the usage of home-based, connected devices is projected to additionally increase CMS reimbursements significantly. This incentive is described on the CMS website as “a performance based adjustment providing an upside of up to 50% of revenue as well as a small downside (10% of revenue) incentive to reduce costs and improve quality, assessed and paid quarterly.”

In 2021, the Direct Contracting model will also be introduced. This program applies to Medicare fee-for-service beneficiaries, specifically ACO’s, Medicare Advantage Plans and Medicare Managed Care Organizations. Similar to the PCF model, groups will be rewarded for providing improved quality of care for patients with chronic conditions. By providing data necessary for early intervention, Remote Patient Monitoring will help to optimize care and outcomes, ultimately increasing revenue for the organization as a portion of anticipated primary care costs or the total cost of care.

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Author: Joshua Baron, MD: EHI Subject Matter Expert

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