Earlier this year, the Centers for Medicare and Medicaid Services released a new set of reimbursement codes that have the potential to take digital health solutions for musculoskeletal (MSK) and respiratory care to the next level.
Providers can now use the Remote Therapy Monitoring Code (RTM) to bill payers for digital MSK or respiratory services related to the cost, setup and monitoring of software and devices that measure patient adherence and response to therapy. For providers affected by pandemic-related burnout and staffing shortages, these norms now provide financial structures and incentives to expand digital therapy and treatment for their patients with MSK or respiratory conditions.MSK’s condition alone is a huge driver of U.S. health care spending and disability 1 in 2 people affected by MSKrelated question.
As we all know, the pandemic has caused health systems, clinics, physicians and consumers to increasingly rely on digital health to improve the quality and access to healthcare. Even before the pandemic, digital health was on the rise, reflected in increased patient use, a trend supported by CMS, which in 2019 issued a reimbursement code for remote patient monitoring for collecting digital data. These codes have been tried and tested in the midst of the pandemic as commercial payers have proliferated to cover RPM. However, RPM was limited to physiological data more in line with primary care and cardiovascular health, and MSK and respiratory care were excluded from the initial list of billable services.
That changed in January with the release of CMS’ much-anticipated RTM code, which addresses gaps in care for these two very common health conditions. But to truly close the gap and improve the codes for access and care, commercial payers need to adopt them.
What’s good for providers is also good for patients
Covid leads to shortage of supplier resources: chief among them care Staff shortages related to changes in the domestic situation or burn out. in a 2022 Survey, One-third of nurses report they plan to quit their jobs by the end of the year, with 44% of them citing burnout as the number one reason. The reduction of active clinicians and support staff may jeopardize the quality and safety of patient care.
Additionally, consumers remain reluctant to visit clinics, whether related to the pandemic, taking time out of their schedules, geographic distance, or, most recently, the high cost of gas.Same Consumers are satisfied with digital healththey expect more diversified services from digital health service providers, especially when it is convenient and fast.
In addition to helping suppliers meet consumer expectations, RTM can be used to increase and reduce overburdened practices, while also opening up new revenue streams. Knowing that more digital services are reimbursable, providers may be more inclined to partner with digital health platforms to create lucrative partnerships and expand healthcare options for those in need.
RTM codes provide flexibility for providers and patients and motivate practitioners to interact with patients during their care. Addressing overall health in a digitally flexible manner is especially important for people with MSK disorders who have mobility impairments and can benefit from ongoing engagement to encourage necessary behavioral changes that are key to better outcomes. While what’s good for providers is good for patients, RTM creates more options and lowers costs for value-based solutions.
Shift payers to value-based care
Payers have long expressed interest in moving to value-based care, but have struggled to do so due to the legacy infrastructure of more traditional fee-for-service (FFS) models. RTM brings needles closer to an outcome-based payment model. While still FFS in nature, it allows more resource utilization to be focused on those with greater needs rather than on patients who are doing well without additional resources.
By using value-driven technologies, providers can better address patients’ physical, emotional and psychological needs and the economic and downstream costs associated with them. With these norms, providers can stop being gatekeepers to in-office healthcare, only be allowed to provide services in face-to-face contact, and can transition to more of a coaching role.As guides rather than gatekeepers, providers have been shown to increase patient self-efficacy and accountability A better experience with great results.
Typically, payers and providers wait 6-12 months after CMS releases new codes before adopting them to see how they perform. However, for RTM code, there is no reason to wait for adoption. Since the release of remote patient monitoring (RPM) codes prior to 2019, precedents for such codes have been established. The RTM code builds on an ongoing effort to create a reimbursement system better suited to the new age of telehealth. These latest codes fill the reimbursement gap that was not available in the first code iteration. So there is already a tried and tested path that uses RPM as an example.
Telehealth is here to stay. There is no point in sticking to the tried and true face-to-face FFS model. The real power of telemedicine lies in its ability to facilitate connection with consumers. RTM codes ultimately make providers financially viable and more accessible to healthcare consumers. For payers and providers, RTM codes are now being used. Please don’t wait.
Photo: nito100, Getty Images
