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The Centers for Medicare & Medicaid Services (CMS) introduced Remote Therapeutic Monitoring (RTM) in 2022, expanding the use cases for remote digital health technologies. CMS launched its Remote Patient Monitoring (RPM) program in 2019.
Over the last two years, CMS has expanded the RTM program to cover more CPT codes, more conditions, and rural providers.
While RTM can be billed concurrently with certain care management programs, such as Chronic Care Management (CCM), Advanced Primary Care Management, Transitional Care Management, Behavioral Health Integration, and Chronic Pain Management, it cannot be billed at the same time as RPM.
Starting a new program could deliver numerous benefits, depending on your patient population and whether their medical conditions align well with RTM.
RTM can enhance a patient’s adherence to medications and at-home self-care, including:
- Medication regimens
- Treatment protocols
- Rehabilitation exercise routines
- Cognitive behavioral therapy practices
RTM helps patients become more aware of their symptoms, prompting them to use the tools, medications, and strategies recommended by their provider to better manage their condition at home.
RTM offers providers insights into treatment effectiveness and patient adherence to the care plan. Based on the data collected, clinicians can adjust treatment and deploy other care management programs, such as CCM, to provide additional ongoing support.
Conditions covered by Remote Therapeutic Monitoring
Through RTM, Medicare reimburses for collecting, reviewing, and monitoring non-physiological data using medical devices that meet FDA standards.
Currently, the RTM program is restricted to musculoskeletal and respiratory conditions and cognitive behavioral therapy. However, a variety of non-physiological data types may be monitored, enabling providers to tailor tracking to each patient's specific needs.
CPT codes are designated for each of the three conditions, including:
- CPT code 98976 covers device supply with scheduled recordings and/or programmed alert transmissions to monitor respiratory systems each 30 days.
- CPT code 98977 covers device supply with scheduled recordings and/or programmed alerts transmission to monitor musculoskeletal systems each 30 days.
- CPT code 98978 covers device supply with scheduled recordings and/or programmed alerts transmission to monitor cognitive behavior therapy each 30 days.
FDA-approved devices can be used to monitor various non-physiological aspects of treatment, such as:
- Medication intake
- Lifestyle changes
- Therapy compliance
- Physical activity levels
- Range of motion
- Pain levels
- Breathing capabilities
Analysis conducted by Komodo Health and published by the Digital Therapeutics Alliance revealed the number of healthcare providers using RTM across 20 specialties, as shown in Figure 1.
Numerous primary care and specialty providers can use RTM to monitor patients with medical diagnoses, such as:
- Musculoskeletal conditions, including osteoarthritis, rheumatoid arthritis, tendonitis, neurological conditions, post-orthopedic surgery, and bone fractures
- Respiratory conditions, such as asthma, COPD, and COVID-19-related lung issues
- Cognitive behavioral conditions, including anxiety, depression, bipolar disorder, and PTSD
Figure 1: Number of healthcare providers using RTM across 20 specialties. Source.
Starting a Remote Therapeutic Monitoring program
Whether implemented as a stand-alone RTM program or to complement an existing care management program, designing and launching a new RTM service involves several steps.
Step 1: Identify clinical needs
Every provider should begin by identifying a clinical need and specific outcomes the program should achieve. For example, a primary care physician or pulmonologist may treat numerous patients with COPD.
Another example could include primary care or physical rehabilitation providers who see numerous patients after orthopedic surgery. An RTM service could monitor pain levels, medication adherence, and ensure that patients are performing their post-surgical rehab exercises correctly.
By recognizing the need, providers can prioritize resources. They can center the program around desired outcomes. Furthermore, clarifying the program’s purpose can make it easier to gain support from key stakeholders, ensuring initial buy-in and stability.
Step 2: Set program and patient goals
The need identified in the first step informs desired program outcomes.
Consider establishing goals within the following four areas:
- Clinical and patient outcomes
- Patient experience and engagement
- Program revenue and reimbursements
- Provider satisfaction
The objectives for starting an RTM service might include:
- Enhancing medication adherence rates
- Ensuring treatment consistency
- Reducing patient admissions or emergency department visits due to uncontrolled symptoms
An RTM program could help engage patients in self-care at home. This can help avoid costlier care and shorten recovery times.
Financially, the program could support value-based care contracts, enhance shared savings, and provide fee-for-service revenue for new services.
Step 3: Form an RTM team and engage providers
Many programs begin with one care coordinator who works with clinical and administrative staff.
Depending on the number of initial patients enrolled, more than one care coordinator may be necessary. Or, as the program scales, additional staff can be hired.
Under Medicare rules for Remote Therapeutic Monitoring, many qualified healthcare professionals can bill for RTM. This means a provider organization can develop an RTM program using various clinical approaches and clinicians, including:
- Physicians
- Physical therapists
- Occupational therapists
- Speech-language pathologists
- Physician assistants
- Nurse practitioners
- Clinical social workers
In addition to billing clinicians and care managers, the program should have leadership oversight and strategic input. This could come from one leader or several who have complementary experience in population health, data analytics, and digital or virtual health.
Step 4: Design operational workflow, including RTM device management
No matter the size of the RTM team, adding a new service requires planning around how to integrate the program into everyday workflow operationally. The team will need to make decisions on a variety of questions, including:
- Can the current EMR be used to manage enrolled patients, or would a platform explicitly designed for care management programs and billing requirements be better?
What are the operational steps? Including:
- Enrolling a patient and gaining consent
- Setting patients up with devices and receiving readings
- Training staff and clinicians to monitor incoming data and use the data to engage patients and make decisions
- Training billing staff to ensure program requirements are met and reimbursements are timely
- Data analytics needed periodically to review the program’s progress toward goals
A critical part of operational planning is determining whether the organization will lease or buy the RTM devices and the process for getting them into patients' hands.
The decision will largely depend on factors such as the initial program budget, program size, and growth goals.
Leasing RTM devices offers the benefits of a lower upfront cost and the innate flexibility that comes with leasing over owning. Buying RTM devices can be less expensive, avoiding long-term leasing contracts.
Some groups start by leasing devices and purchase their own once RTM revenue merits the switch.
Step 5: Identify and recruit eligible patients
With a program plan in place, it’s time to identify and recruit eligible patients.
Best practices suggest hosting a pilot with a small subset of patients, evaluating the results, and optimizing as needed. As the team works through the initial setup and hones processes, the program can scale to a target patient population size.
The best method for identifying eligible RTM patients is to use the EMR or other software to segment the patient population by several factors, including:
- Patients with medical diagnoses that align with the program’s initial goals and intent
- Patients enrolled in Medicare Part B or a Medicare Advantage plan that reimburses for RTM
Other variables that could indicate that a patient is suitable for RTM include:
- Challenged with sticking with treatment plans or medication adherence
- More open to using at-home technology
- Motivated to improve and attain a higher quality of life
Once a potential patient group is identified, there are three main ways to recruit patients to the program:
In-office: The highest rate of success comes when clinicians personally invite a patient to join the program and share the benefits for this individual. In-office signage and patient materials provided by other staff during essential points of care support clinician conversations.
Outreach campaign: An outreach campaign could include sending a letter to the list of eligible patients explaining the program's value and inviting them to participate.
Phone call: Set time aside to call all eligible patients, explain the program to them, and invite them to participate.
Step 6: Train patients and clinicians
Some patients are more familiar with smartwatches, digital technologies, and Bluetooth and Internet-connected devices. They may more easily adapt to using new at-home technologies with little instruction.
Other patients may require in-office or at-home training.
Once patients grasp how to operate their devices, they must develop a habit of using them and reporting their results. Patients should receive reference materials that guide them in establishing a daily routine for using their devices and sharing data.
When training clinicians on RTM devices, it’s vital to emphasize device use by providing ample training materials, allowing professionals to feel comfortable and confident. Practicing with staff or select patients can facilitate communication and prepare responses to common questions.
Patients may face simple onboarding issues, such as a device not working or not syncing with their mobile devices. Proper training materials developed ahead of time that you can refer patients to or that your staff can use to assist them will set you up for success.
Create “what if” scenarios to help the patient understand appropriate actions based on their readings. Ensure patients know when to reach out for support.
Step 7: Deliver RTM services and measure success
At the outset of your program, track baseline metrics in order to compare results at regular intervals. Regular program performance reviews highlight where the program is meeting goals and identify areas for improvement.
During the first few months of the program, expect to spend more time supporting patients by troubleshooting technical issues. Schedule follow-ups with patients to address any lingering issues or concerns.
Care managers should monitor incoming patient data to ensure the devices and the program are working as intended. Additionally, they should contact patients who are not consistently reporting data, to encourage engagement.
As the program matures, make adjustments as needed based on patient data and feedback from patients, clinicians, and staff.
Key questions answered
How do you start a Remote Therapeutic Monitoring program?
Once you’re familiar with Medicare’s program and billing requirements, we suggest seven steps toward creating a new RTM program. They include:
Step 1: Identify clinical and needs
Step 2: Set program and patient goals
Step 3: Form an RTM team and engage providers
Step 4: Design operational workflow, including RTM device management
Step 5: Identify and recruit eligible patients
Step 6: Train patients and clinicians
Step 7: Deliver RTM services and measure success
What are the benefits of a Remote Therapeutic Monitoring program?
The RTM program currently focuses on using FDA-approved digital technologies to monitor non-physiological data from patients with musculoskeletal and pulmonary conditions or as part of cognitive behavioral therapy.
Collecting, reviewing, and using patient-reported data via RTM devices benefits clinicians and patients in several ways:
- Encouraging care plan and medication adherence
- Improving symptom self-monitoring and disease management
- Enhancing clinical oversight and decision-making
- Avoiding emergency and inpatient care or readmissions
- Lowering the cost of care
- Increasing care access and monitoring between office visits