RPM expansion depends on equity, security, and reimbursement

Remote patient monitoring (RPM) is one of the fastest growing areas of digital health, with claim volumes seeing a 1300% increase between 2019 and 2023 as providers prescribe everything from continuous glucose monitors (CGMs) to implantable pacemakers to help keep tabs on patients with chronic conditions. 

There is huge potential to use RPM as a way to empower patients, expand access to care, relieve burdens on providers, and reduce avoidable spending by preventing disease exacerbation – but only if the policy landscape is architected in a way that protects patients while adequately reimbursing providers for the efforts involved. 

Currently, RPM technology is moving faster than the administrative framework surrounding it, according to a new report from the Bipartisan Policy Center (BPC). The future of remote monitoring depends on closing those gaps so that the right devices can get into the hands of the patients who need them most. 

“Now is the time for policymakers, payers, and providers to refine their approach to this technology to maximize safe, appropriate adoption for patients who stand to benefit,” the report states. 

Policymakers, providers, payers, and device developers will need to focus on three key areas of regulatory improvement and workflow optimization to ensure that RPM can support better outcomes and lower costs. 

Generating evidence to catalyze reimbursement

To increase adoption of RPM, the industry needs to define appropriate reimbursement for both physical devices and the clinical activities surrounding ongoing patient monitoring. But payers, providers, and developers are stuck in a feedback loop: payers want proof of concept before paying out, but providers and developers don’t have the financial backing to put devices into the field to generate evidence. 

BPC recommends that CMS break the cycle by working with clinical groups to examine existing evidence and develop coverage mechanisms aligned with current and future best practices.   

These efforts should include clarifying current policies around medical necessity and duration of use, adding new billing codes when necessary, and publishing regular reports about the impact of expanded RPM use over time so payers can make informed decisions about reimbursement procedures.  

Prioritizing equitable distribution of devices to all communities

Health equity is a top priority for all stakeholders, but leveraging RPM devices in populations with higher socioeconomic barriers can be a challenge. For example, patients that lack adequate broadband internet access, including 22% of people in rural areas and 27% of Native Americans living on tribal lands, may not be able to use the same devices as their peers. 

Alternative options are available, such as store-and-forward devices that don’t require continuous connections. But a lack of clarity around billing codes for these devices is limiting their use, BPC says.  

“CMS should clarify that it allows store-and-forward technologies for billing codes related to remote monitoring and provide guidance on how often patients should transmit data to providers,” the report states. “This will allow flexibility for patients or providers who do not have access to broadband to benefit from and deliver remote monitoring services.” 

Additionally, the report suggests that Congress should clarify anti-kickback safe harbors for safety-net providers who want to offer devices to patients but lack the resources to cover startup costs. These steps would help ensure that no communities are left behind in the digital health ecosystem. 

Safeguarding privacy and ensuring device security

Medical devices have many cybersecurity risks which need to be addressed in a comprehensive and proactive manner. Policymakers at HHS need to take the lead in creating a strong and secure RPM environment to avoid data breaches and privacy concerns, the report urges. 

HHS should take actions including:  

• Identifying whether existing privacy policies are suitable to protect personal health information transmitted through RPM devices and working with Congress to close any policy gaps 
• Studying the use of cybersecurity safe harbor laws to determine the effectiveness of these regulations 

• Working with the Office of the National Coordinator (ONC) to develop and implement appropriate data standards for interoperability with EHRs and other health IT systems 

 By taking a collaborative approach to refining the policy landscape with these three issues in mind, stakeholders can prime the market for the successful deployment of high-value RPM devices at scale to achieve shared goals of lower costs, better outcomes, and better experiences for people with chronic conditions.  

Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry.  Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system.  She can be reached at jennifer@inklesscreative.com.