Ever since CMS released the new CPT codes for remote therapeutic monitoring last year, health systems have been eager to use them, but unsure of the criteria. Providers are acknowledged for the time they spend connecting with patients outside of the office.

With the new CPT codes, providers can get reimbursed for:

• Educating patients on how to use a remote care-management platform.

• Monitoring a platform's alerts and patients' use of remote education.

• Direct patient/provider messaging within the platform.

• Data collection via the platform, i.e., collecting patient feedback on pain levels, activity and motion.

To qualify for reimbursable RTM, providers need to use software deemed a medical device by the FDA. Force Therapeutics, vendor of a digital care-management platform, just received such a designation for its software.

We interviewed Bronwyn Spira, CEO and cofounder of Force Therapeutics, to dig into RTM and the CPT codes to help healthcare-provider organization CIOs and other health IT leaders understand this new way of getting reimbursed for care.

Q. Providers now can get reimbursed for educating patients on how to use remote care management platforms. How do healthcare provider organizations go about this education?

A. One trend that is enduring beyond the pandemic is that healthcare providers and payers are finally embracing remote care. By issuing new CPT codes for remote therapeutic monitoring, CMS is attempting to drive the behavior changes it wants to see.

The ability to manage evidence-based, outcomes-driven care at home while enabling individualized and adaptable care journeys for each patient – rather than a one-size-fits-all approach – is a game changer for providers and patients.

And it makes high-quality, evidence-based care more accessible to all patients, including populations that have been historically underserved due to barriers to care, such as income, insurance, language, mobility, transportation and others.

When it comes to patient education and using musculoskeletal (MSK) care as an example, the traditional way of delivering patient education for the entire care episode, especially post-surgery care, is highly fragmented.

Typically, the care team walks through the instructions and gives the patient a large, printed packet. At discharge, patients may be medicated, overwhelmed and anxious – not ideal for absorbing complex information. Now that remote care-management technology is an accepted and reimbursable modality, healthcare providers have more tools at their disposal to effectively educate patients and monitor their progress.

Using a digital care-management platform that not only qualifies as software as a medical device (SAMD), but also provides continuous patient engagement and flexible care-management capabilities, is critical to effective and efficient patient education.

This allows patients to access the resources prescribed for them by their providers, anytime, anywhere and as many times as they want. Educational content can be presented in multiple ways to suit different learning styles and preferences, making information digestible, understandable and easily shared with a spouse or other care partner at home.

Delivering education in bite-sized pieces, employing gamification techniques and integrating quizzes all help patients absorb the information needed to fully engage in their own care plans and achieve the best outcomes.

Q. Monitoring a platform's alerts and patients' use of remote education also are in the cards now. How do healthcare provider organizations go about this monitoring?

A. An important foundational point is that, from CMS' point of view, it's not enough to just deliver education and a to-do list to the patient using a technology platform. It's critical that the platform engages the patient in a care plan prescribed by their provider such that it helps the patient achieve the same or better outcomes at home than they would with traditional in-person care.

Hence there must be a measurable, defensible audit trail for all interactions with the care plan. Medicare and other payers will require that evidence, both for tracking outcomes data, as well as preventing misuse of the new reimbursement codes.

The other key factor is that managing care using the technology platform shouldn't create additional work for providers – it needs to be well integrated into their workflows. Traditionally, remote monitoring was done with phone calls and in-person visits.

In a virtual care process, interactions still need to be meaningful, measurable and well-documented. With the parameters for meaningful touchpoints identified by CMS, providers can work with their platforms to configure efficient workflows and even incorporate automation for manual tasks.

From the patient perspective, the digital care-management platform should be easy and convenient to use as it tracks and measures patient engagement. When the patient logs in, the platform should automatically track the time they spend, the activities they engage in, the tasks and exercises they complete, and their responses to questions about pain, activity level, range of motion, etc.

As data flows back to providers, they can be alerted if the patient is off course or reports pain or other symptoms that need attention. All these elements are coordinated to drive better patient outcomes and higher patient satisfaction.

The virtual care approach has been proven in multiple studies to achieve similar – or better – care outcomes. For example, a one-year retrospective analysis by one health system that implemented a full-suite MSK digital care-management platform showed that readmission rates for all total joint arthroplasty surgeries, independent of surgeon variability, dropped more than 26% compared to the prior year.

Q. Up for reimbursement: direct patient/provider messaging within a platform. How do provider organizations handle this messaging?

A. There are two important things when it comes to patient-provider messaging. First, all messaging must be between the patient and their own care team. Health information can't be generic, out-of-the-box or outsourced to a call center.

Every patient has different needs, different comorbidities and different support structures at home, so messaging related to diagnosis, surgery and follow-up care needs to be individualized to each patient by their provider.

Second, messaging activities must fit within the provider workflow. In today's environment with labor shortages and clinician burnout, providers simply cannot be expected to find additional time for new activity.

Instead, we need to scale care delivery, making it easier and more streamlined for clinicians. A digital care-management platform needs to make communicating with patients efficient and effective, so each member of the care team contributes appropriately to guiding patients toward the best outcomes.

For example, a platform can be configurable to fit the workflows for different clinicians, such as physicians, physical therapists, nurses, care navigators, etc. The platform can intelligently alert the appropriate care team member if patients need intervention, such as if they report unexpected pain or symptoms of infection.

In addition, by delivering preemptive patient education, patients have more clarity about what to expect during their recovery and when to contact their providers if things are not proceeding normally. This level of ongoing interaction benefits patients and providers alike in achieving the desired outcomes.

Q. Data collection via a platform – collecting patient feedback on pain levels, activity and motion – also is reimbursable. How do provider organizations manage this kind of collection?

A. As I mentioned, to qualify for reimbursement for RTM, the platform used by the provider must be deemed a SAMD by the Food and Drug Administration. Given the numerous devices commonly used today for remote patient monitoring, such as watches and fitness trackers, it's not practical to expect all patients to have the same device or to have providers access multiple portals to see patient data based on the device they are using.

Therefore, a digital care-management platform needs to bring all the pertinent data points (activity, pain, sentiment, functional outcomes) together to create a holistic view of patients and their care episodes.

A digital patient engagement and care management platform has to employ an omnichannel approach, gathering information from email, secured messages, text messages, interactive voice response calls, in order to be effective.

Digital care instructions need to be accessible to all patients, irrespective of their device or access to computers so they can actively engage in the recovery process by reporting their progress and completing patient-reported outcomes assessments, creating a clear understanding of their activity levels, pain, medication use, swelling and potential complications.

Clinicians can use real-time status updates to monitor patients' therapeutic progress and identify patients in need of intervention or support. In addition, digital care-management platforms provide the means for patients to interact directly with their care team instead of seeking care elsewhere or heading to the emergency room.

Coupling a wealth of patient data with ongoing interaction creates a continual feedback loop, so care teams can adapt a care plan to meet the patient's needs every step of the way. Some patients will require very little personal assistance, making time available for patients who may need more help.

As we move into this new year, the ability to be reimbursed for elements of remote care delivery will incentivize the use of digital care-management technology. Providers will be able to deliver individualized care to a wider range of patient populations, and more patients will have access to the care they need to improve their health.

Follow Bill's HIT coverage on LinkedIn: Bill Siwicki
Email the writer: bsiwicki@himss.org
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