By necessity, the COVID-19 pandemic brought physicians into patients' living rooms virtually. Now, telehealth has evolved to something more – remote therapeutic monitoring.

RTM, which is reimbursable, lets patients connect with their doctors and nurses via care management apps on their smartphones to report non-physiological data, ask questions, watch videos and report outcomes to get better – anytime, day or night.

Given that nearly half of adults in the U.S. are affected by a musculoskeletal condition, which can negatively affect overall physical and mental health, RTM can be especially relevant for people preparing for, and recovering from, ever-more-common knee and hip surgeries.

RTM can empower patients toward better health and reduce extra in-person visits, making it easier and less costly for people, such as those in rural areas, to receive care. It also can reduce unnecessary trips to the emergency room and hospital readmissions that cause healthcare costs to skyrocket.

We interviewed Bronwyn Spira, CEO and cofounder of Force Therapeutics, a vendor of a digital care management platform, to offer a deep dive into RTM and explain how it can improve health outcomes.

Q. Please explain what remote therapeutic monitoring is and how it has come to the fore.

A. The idea that high-quality care can be delivered remotely came into the limelight during the pandemic as patients and providers embraced the concept of virtual care, such as telehealth. Going beyond virtual visits, remote therapeutic monitoring is an important aspect of a virtual care management approach that uses technology to enable a holistic view of patients and their entire care episodes.

Specifically, RTM technology engages patients in their care and captures patient-reported non-physiological data to monitor progress and key metrics, such as patient-reported outcomes, medication adherence, pain, response to therapy, physical activity and more.

It’s different from remote patient monitoring, which collects and monitors physiological data, like blood sugar or heart rate, through medical devices such as glucose monitors or smartwatches. As an enabling technology, RTM has been proven effective for improving patient engagement, satisfaction, care quality and outcomes, as well as reducing costs for both patients and providers.

In 2022, the Centers for Medicare & Medicaid Services leaned into the effectiveness of RTM by introducing new CPT codes that make remote care for respiratory and musculoskeletal (MSK) conditions reimbursable when delivered via a digital care management platform that qualifies with the Federal Drug Administration as software as a medical device (SAMD).

It's important to note that CMS requires more than simply delivering patient education and a to-do list remotely to qualify for reimbursement; both patients and providers must meet specific engagement and interaction thresholds as part of a provider-prescribed care plan.

More specifically, two of the RTM CPT codes require patients to submit patient-reported outcomes for 16 days out of each 30-day period, while the other two codes require 20 minutes of provider monitoring as well as at least one interactive communication.

Achieving these RTM engagement thresholds effectively is challenging, but digital care management platforms offering RTM capabilities with a track record of robust engagement and strong outcomes can make starting a successful RTM program much easier due to the existing digital infrastructure that empowers strong remote patient engagement.

The platform must also provide a measurable, defensible RTM audit trail for all interactions with the care plan as well as outcomes data to support reimbursement.

Q. You report that nearly half of adults in the U.S. are affected by a musculoskeletal condition, which can negatively affect overall physical and mental health. Very specifically, where does RTM come in here, and what can it do for outcomes?

A. It’s true that more than 50% of the adult population has some kind of MSK condition. These conditions are incredibly costly – both in terms of the impact on people’s lives and the cost to the U.S. healthcare system. For people with an MSK condition, there is the daily impact from pain and mobility issues.

Add to that the compounding effects on quality of life, mental health, comorbidities like cardiovascular disease, diabetes, or obesity, the patients' independence, their financial security, and their ability to work. This makes digital care management with RTM particularly relevant, especially as knee and hip conditions become increasingly common, to help people prepare for and recover from surgery or help them delay or avoid surgery when possible.

There are two key facts about the digital care management model that makes it so valuable for MSK patients. First, making care reimbursable using RTM opens the door to making the same high-quality, evidence-based care more easily accessible to underserved and disadvantaged populations.

Delivering care at home for such patients will help them manage their conditions or recover from surgery without the added costs of in-person care while enabling their providers to track and monitor patient-reported outcomes and adapt care pathways to their evolving needs.

Digital care management technology makes patient education, physical therapy, communication, etc., more readily accessible, overcoming barriers related to internet access, language, learning styles and schedules in ways that are impossible with in-person care.

Second, RTM incentivizes a holistic approach to care that connects patients with their care teams throughout their care journeys, enabling timely intervention that prevents ED visits and readmissions. Every patient has different needs, comorbidities and support structures at home, so the provider can individualize diagnosis, surgery and follow-up care information.

For care teams, communicating with patients is efficient and effective, so each member of the team contributes appropriately as they guide patients toward the best outcomes, while avoiding adverse events. Throughout the process, patient-reported outcomes evaluate the utilization, pain, function, clinical benefit, mental health, well-being and patient experience.

All that patient data coupled with ongoing interaction creates a continual feedback loop so at every step in the patient’s care plan, care teams can adapt to meet the patient’s needs. Some patients will require very little personal assistance, so care teams have more time available for those who need more help.

The impacts are far-reaching. When providers only see patients in the clinic, it’s a tiny window into their lives. The digital care management approach, now made reimbursable with RTM, captures holistic, contextual data, creating a more meaningful, measurable and even predictive view for better patient care and outcomes.

Q. You say RTM empowers patients toward better health and reduces extra in-person visits. Please elaborate how.

A. For patients in rural areas or patients who are uninsured or underinsured, the direct and indirect costs of in-person visits can be a significant barrier. A litany of things makes patient monitoring via in-person visits difficult – getting time off work, arranging childcare, finding transportation, paying for gas, traveling long distances, etc. The cost, inconvenience and stress required to see a doctor for five minutes cause many people not to follow through.

Many of these issues can be overcome using digital care management technology, alleviating challenges like access, language and healthcare education disparities. The ability to manage evidence-based, outcomes-driven care at home while enabling individualized and adaptable care journeys for each patient is a game changer for providers and patients.

With active, ongoing monitoring using RTM technology, care teams are alerted and can intervene quickly when a patient is concerned or isn’t progressing as expected. Early action prevents potential complications from escalating and avoids unnecessary ED visits and readmissions.

As I mentioned, digital care management technology makes key steps in the care journey, such as patient education, physical therapy and care team communication, more accessible. For example, instead of disjointed, paper-based patient education, patients can access educational content in multiple ways that cater to different learning styles.

A patient’s active participation in their care plan can be gamified to help them absorb important information and stay committed to progress toward achieving the best possible outcomes. Virtual care designed to deliver evidence-based, outcomes-focused care by the provider organization overcomes many of the care access barriers that exist today.

Q. How can RTM reduce unnecessary trips to the emergency room and hospital readmissions?

A. The cost for musculoskeletal care is the top driver of healthcare spending in the U.S., totaling around $600 billion annually. Avoiding the high cost of ED visits and readmissions has a significant impact on both costs and outcomes.

With a digital care management approach that supports RTM, patients actively engage in the recovery process, reporting their progress and completing patient-reported outcomes, giving their providers a clear understanding of their activity levels, pain, medication use, swelling and potential complications. The care team monitors progress and identifies patients needing intervention or support.

An example we often hear is how providers can deliver care quickly and effectively when a patient is concerned. Case in point, one of our providers, an orthopedic surgeon, recently shared this typical example. He had a patient contact his care team through the digital care platform to say the patient was concerned and heading to the ED.

The care team responded immediately, talked with the patient and requested photos to make a thorough assessment. Instead of an ED visit, the provider discussed the next steps with the patient to keep his recovery on track. This avoided both the stress and the thousands of dollars in costs of an ED visit – and gave their patient better outcomes and much better, more personal care experience.

Delivering that level of personalized care so quickly, anytime day or night, improves outcomes and reduces costs for patients, providers and payers alike – and this example is just one of thousands like it.

The virtual care approach has been proven in multiple studies to achieve similar – or better – care outcomes. Looking ahead, providers must be prepared for the increasingly rigorous requirements surrounding care quality and outcomes.

As CMS continues to transition the U.S. healthcare system from fee-for-service to value-based care models, it is expanding incentives for providers to adopt more comprehensive care strategies that consider both surgical and non-surgical approaches. In 2025, it will become mandatory for hospitals under the Hospital Inpatient Quality Reporting (IQR) program to collect and report patient-reported outcomes, risk variables, matching variables and patient-reported outcomes-related variables for at least one-half of eligible total hip and total knee patients.

With digital care management technology, data collection is a byproduct of smart care delivery. A report just released by our company encompassing data from nearly 55,000 patients from four nationally recognized provider organizations demonstrated that virtual care management produces clinically significant improvements.

For example, across all patients in the study, the average length of stay for knee, hip, shoulder and spine surgery was only 1.1 days. At one year post surgery, 82% of hip patients met the HOOS Jr. minimal clinically important difference (MCID) threshold of 18, and 74% of knee patients met the KOOS Jr. MCID of 15.1.

Empowering patients to drive their own recoveries and connect with their providers and care teams directly to report data, ask questions, educate themselves and report outcomes – anytime, day or night – is proven effective – and soon it will increasingly dictate successful reimbursement.

Follow Bill's HIT coverage on LinkedIn: Bill Siwicki
Email him: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.