0 (1s):
Hi, it Dr. Weitz. Thank you so much for joining me for this episode of the private medical practice academy. Today. I want to talk to you about remote patient monitoring. Believe it or not. It's been around since the early 1960s. Now granted, what remote patient monitoring otherwise known as RPM look like in its infancy has little to do with what RPM is. As we know it today, after more than two decades of cultivation from cardiac telemetry to Bluetooth enabled blood pressure cuffs, and now to wearable devices, the technological progress of RPM, finally intersected with other trends in medicine, such as tele-health and the transition to value-based reimbursement.

0 (43s):
And of course COVID, but one of the things limiting adoption of RPM was the fact that CMS didn't provide any form of reimbursement until 2019. And then in January, 2020, CMS added more billing codes. And that has greatly expanded where remote patient monitoring can actually be utilized aside from the fact that you can get paid for RPM. There are other reasons that you should want to add it to your practice first and foremost, it can help you take better care of your patients. This is really the whole premise behind RPM. By continually monitoring patients. We are far more likely to identify problems before they become significant.

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Second RPM can improve patient accountability. Third, it can improve patient satisfaction and fourth, it's going to help your practice with value-based reimbursement criteria. I'll come back to specific examples, but for now let's talk about what RPM is simply put RPM refers to technology and practices that help practitioners track their patients health data remotely, and allows them to design a treatment plan. It's the process of combining remote patient monitoring technology with devices and in turn, enabling the doctor to monitor vitals and other critical data remotely.

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Now, I want to point out that this is very different than a telemedicine visit with a telemedicine visit, either you or your mid-level has a virtual office visit with the patient with RPM. There's no requirement for the physician or mid-level to perform the patient interaction. So how does RPM work? Well, a device transmits patient information, usually through a mobile app, which in turn sends the data to the provider's office. Some of the core requirements for the mobile app include the fact that it needs to be HIPAA compliant and EMR compliant. The provider side of the application must have an analytics component.

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This means that patient measurements are compared with known trends or patterns so that the physicians can assess the risk of unwanted events and modify the treatment plan. There's also a need for a notification module, which does exactly what it sounds like. If the patients are PM measurement shows, signs of danger, the provider is immediately notified either through the app and email or text. For example, if the device is a glucometer and your patient's blood sugar reading is 400, you're going to get notified. Now related to the notification module is the decision support module. This is where you get to set the thresholds so that you can compare the patient's data to your set values.

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So back to that blood sugar example, you can set the values. So you're notified when the blood sugar is, let's say over two 50 or whatever number you choose. This is a way for you to make sure that you're not getting called or notified more often than you want to, but that you are being notified when there is something that you would consider significant. I think this is a great place to talk about patient accountability. Let's say you have a diabetic patient without RPM. You give them a glucometer and meds and tell them, I'll see you in three, three months, the patient could be eating chocolate cake every night, and you would have no way to know or counsel them now with RPM because you're getting multiple readings per month.

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You're going to know that their blood sugar is basically on this roller coaster ride. This data can help you hold that patient accountable. So instead of allowing them to use their sliding scale insulin, to cover up their truck and cake, you can actually intervene and counsel them and get them to change their behavior. Right? And then needless to say, the application needs to have a report module where the data is organized into a report. So you would actually know this information before I continue to talk about the specific mechanics of RPM. I want to circle back and talk to you about why you want to offer RPM to your patients.

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A lot of physicians are under the impression, or I should say that they're worried that RPM is going to increase their workload, because it's going to take more time that the patients are going to call your office more frequently. And the list of concerns just goes on in all actuality, that shouldn't be the case. Quite the contrary, RPM can help identify problems before they get out of hand. As they just described to you, you can set the parameters so that when the patient's values are outside those parameters, your office is notified that way you can proactively intervene before. There's a major issue. As a result, you're going to take better care of your patients because they'll actually be a fewer number of frantic calls to your office.

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There should be fewer trips to the emergency room, as well as a decreased number of hospitalizations. Your patient satisfaction is going to go up as is patient accountable ability, and it should be intuitively obvious to you. The assumption is that by offering RPM to your patients, you're going to help reduce healthcare costs because I just told you you're going to be preventing emergencies, right? So as we transition to value based reimbursement, participating in RPM will only help your opportunities to attain maximum reimbursement as a side note, if you haven't already done. So you may want to listen to my podcast episode on MIP S and how we're being measured in terms of these value criteria.

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Next, I want to transition and talk about the types of remote monitoring devices that have been approved by the FDA. So you can start to think about how they actually integrate into your current practice. So some of these devices are electronic stethoscopes, blood pressure, monitors, glucometers audiometers, oximetry, spirals, emitters, apnea, monitors, breathing, frequency, monitors, cardiac monitors, scales, electronic thermometers, EKG, GS, and even EEG. So if you're listening to this list, you should be thinking to yourself, wow, there are so many areas of medicine where this can actually be applied.

0 (7m 11s):
Right? Okay. That's the point? No. Before I talked to you about RPM and how it actually works, let me talk about reimbursement for a second. Medicare reimburses for RPM, and I'll walk you through the codes for that shortly. On the other hand, you need to know that only some of the commercial insurers cover RPM codes, regardless of whether it's Medicare or commercial insurer, you also need to know that the patient is of course still subject to their deductible and their co-pay or co-insurance. And while I'm sure you're thinking to yourself, no, duh, you're going to need to take this into consideration when you're coming up with your financial projections for RPM, but more of that in a little bit.

0 (7m 59s):
Now let's talk about how RPM actually works. First. You identify the patient. You believe is going to benefit from remote patient monitoring. For example, maybe you're a pulmonologist who wants to monitor a patient with severe COPD. You're going to write an order for remote patient monitoring you're then going to have the patient sign, a consent form to participate in remote patient monitoring. After you've written the order and obtained the patient's consent, the rest of what I'm going to tell you about it, doesn't actually have to be done by you or a mid-level. It can be done by anyone on your team that you assigned it to.

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The key is that you're going to have to train that person. But think about this for a second. You can actually utilize, let's say a medical assistant or somebody else, somebody that normally does not generate any revenue for you. So this is a way of extending your practice, increasing your revenue and taking care of patients better than you had before and getting paid for it. So now I'll continue. The patient can either be given the device, sold the device by the practice, or they can buy the device on their own. If you provide the device, then you can bill a monthly use fee using CPT code 9, 9, 4, 5, 4.

0 (9m 21s):
On the other hand, if you sell the device to the patient or they buy one on their own, you can't bill that code regardless. What you can bill for is 9 9 4 5 3, which is for the setup of RPM on the device and patient education. I do want to point out to you that this is a one-time charge. Then once the patient has the device, the patient has to submit 16 readings or data points per month. I'll come back and talk about RPM vendors in a minute, but basically the software should track that your office is getting the transmissions.

0 (10m 1s):
Now you may be wondering what happens if you don't get those 16 data points, because as we all know, patients, aren't always compliant. So reaching out to the patient to remind them, to transmit the data point and documenting that you did so actually counts towards those 16 transmissions. One of the things you're going to want to look for in an RPM software platform is that it provides your staff with the data points and notifies them when they're not getting the data points so that they can reach out to that patient. You can't bill the base CPT code for RPM, unless you have those 16 data points per month. The other component of what you need to build that base code is to provide 20 minutes of RPM services per calendar month.

0 (10m 47s):
And that CPT code is 9, 9 4 5 7. Now, I want to stress to you again that this can be performed by your staff. So for example, you train your medical assistant to review the transmitted data points. This takes them some amount of time. Then in turn, they contact the patient either by video or by phone and discuss the data points. Maybe they tell them, Hey, your numbers look great, keep up the plan. Or maybe your staff comes to you and says, Hey, these data points tell me that there is an issue here and you in turn, tell the staff, tell the patient X, Y, and Z. As long as you spend at least 20 minutes per calendar month, you can get paid for 9, 9, 4, 5 7.

0 (11m 33s):
Now let's say that you or your staff actually spends more than 20 minutes per month. Maybe back to my example of the chocolate, eating diabetic, they're noncompliant their blood sugars out of control. In this case, maybe the staff spends more than 20 minutes counseling that patient. So the good news that you can, bill 9, 9, 4, 5 8 for an additional 20 minutes, if you spend between 20 and 40 and another 9, 9, 4, 5 8 for up to 60 minutes. So set another way. The first 20 minutes and 16 data points, you build 9, 9, 4, 5, 7 additional 20 minutes, 9 9 4 5 8.

0 (12m 17s):
And if you really have somebody that needs a lot of counseling and it's an hour, you can build a second 9, 9, 4, 5, 8. Okay? So now you know why you should offer RPM and that it's reimbursed, but I'll bet. You're still wondering how to make the mechanics of RPM work because no matter how great this sounds, I'm sure you're thinking to yourself. I just don't really need anything else. That's going to increase my workload. The first step here is choosing the right RPM vendor. And there are lots of them. Let me start by telling you that there are products that are essentially turnkey, where there's a predesigned remote patient monitoring device and software platform.

0 (13m 2s):
There are others where you can custom design it and everything in between some of the vendors support only Medicare billing, others support commercial payers. You need to understand these new ones differences. Here's some of the things that you're definitely going to want to think about first, will you provide the device to the patient? Are you selling them the device? Are you allowing them to buy it on their own? One of the considerations here is that when the patient provides their own device, there's less control over how accurate the device is. This is certainly an issue, but probably not the biggest issue.

0 (13m 43s):
One of the things I want you to think about in terms of what do I do with this whole device thing is how much effort is it going to take? And what's the reimbursement about it. Obviously, if the patient provides their own device, there's no inventory that you have to keep, but there's also less upside potential. Since you can't charge them either a monthly fee for providing the device, nor can you mark up a device that you're selling to them. And you may still have the hassle of helping the patient with the technology. On the other hand, if you provide the device, you need to understand the process. Do you have to maintain an inventory? In other words, do you have to purchase the device and then store it in your office?

0 (14m 27s):
Depending on the vendor you choose to partner with, you mean, deed have to maintain an actual inventory. In some cases, the vendor will drop ship the device to your patient and provide instruction on how to use the device. Having the vendor drop, ship the device and provide the instruction will simplify the entire process for you. In any case, you definitely want look at how easy the device is to use. And it should be obvious. If a device is easy to use, it's going to increase patient compliance and decrease the number of calls to your office. You can bill for RPM without using an RPM system, but this can be quite labor intensive.

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Since you have to dot all of the I's and cross all of the T's in order to qualify for each code. That's why there are so many vendors now out there that are offering RPM services, some offer a software platform,

1 (15m 25s):
Some offer

0 (15m 26s):
Software and device. And then there are others that are totally turnkey, where all you have to do is write the order. And then the vendor will do all of the rest. But as with everything else, there's no such thing as free lunch. All of these companies charge for their services. So depending on which vendor you use, what services they offer, how turnkey it is, how much staff you need, in addition to what you already have to carry out RPM. All of these things go into understanding the costs. Needless to say, staff costs you money. So if you need more staff, but you pay less for the RPM service, is that the same or different than if you paid more for the RPM turnkey services and needed less staff, you need to understand the compensation model.

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How many patients are you going to enroll in RPM? What codes are you going to use? Are you going to have only the 20 minute code or for how many patients do you think you're going to have additional codes. You need this information in order to come up with your financial projections, then you also need to understand your staffing requirements. And of course, how much you're going to pay the vendor for the services. They provide. Some vendors charge, a monthly fee and a per patient fee. And then you bill and you collect the money. Other vendors just charge a per patient fee. There are some that are basically turnkey, where they do all of the billing.

0 (17m 2s):
They do absolutely everything. And then they just send you a check. There is some that do fee splitting, and then there's everything in between. Long story short, you need to understand both the revenue model and the overhead component in order to come up with financial projections, for how much your practice can generate from offering RPM. Another thing you're going to want to consider when choosing a vendor is their customer service. You want to make sure to get references from other providers using that particular vendor. In reality, the vendor has to customers, you that provider and your patient, the vendor really needs to be responsive to both the key takeaways.

0 (17m 46s):
Remote patient monitoring provides many benefits for you and your patients. There are many conditions that can be monitored and a variety of devices to assess them. However, in order for RPM to be successful, it requires the patient to be compliant with transmitting their data points. That means that everything about RPM needs to be easy for that patient, or they're going to drop out. This should be your first and foremost consideration when choosing both the device and any vendor. Why? Because these are the two keys to making RPM successful in your practice.

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Thanks for joining me. Be sure to sign up for my newsletter below, and I'll be sending you tips on how to start your practice best run your practice, grow the practice, and then ultimately be able to leverage your medical practice into multiple other businesses. I hope to see you soon.