Exploring new policy needs as RPM gets more popular in Medicare

From relatively light touches via smart blood pressure monitors and scales to the full-blown technology suites that transform the home into a hospital-grade environment, remote patient monitoring (RPM) has become a promising strategy for improving the quality, coordination, and convenience of care, especially among Medicare beneficiaries who are seeking digitally enabled strategies for aging at home. 

The popularity of RPM is growing rapidly, according to the latest industry data – and so are the associated costs for Medicare, leading policymakers to consider how to support the growth of remote care without blowing the budget.  

In a new report from the Peterson Center on Healthcare, researchers explore how RPM (and its close relative, remote therapeutic monitoring (RTM)) is being used in the current Medicare environment, particularly under fee-for-service (FFS) reimbursement models, and what new policies might be required to ensure that beneficiaries and taxpayers are getting measurable value from the influx of remote tools into the home. 

RPM is being used more often for longer periods of time

The rise of RPM has been swift and is getting swifter as AI-enabled technologies get more sophisticated, more affordable, and more intelligent. For example, traditional FFS Medicare expenditures on RPM have increased from $6.8 million in 2019 to $194.5 million in 2023, the report notes, with monitoring for diabetes and hypertension representing 73% of total RPM spending in 2023 and musculoskeletal disorders comprising 59% of RTM expenses during the same time period.  

COVID-19 likely supercharged the growth trajectory after CMS eased restrictions on reimbursement for remote care to expand access during the social distancing period, but its popularity has remained in the post-pandemic period after providers and patients both saw positive impacts from adopting the strategy. 

Not only can RPM help patients achieve measurable clinical improvements without overcrowding the daily schedule, but remote care also offers a new revenue stream for providers – potentially more than $1,100 per patient per year, the report says – to supplement the financial sustainability of beleaguered practices. 

It’s no wonder, then, that providers are encouraging patients to use RPM tools more often and for longer. In 2019, only 4% of RPM episodes lasted more than nine months. But in 2023, that number increased to 22% of episodes. In addition, spending for RPM services per FFS Medicare beneficiary who received RPM increased from $154 in 2019 to $431 in 2023.  

Currently, Medicare has no limits on how long a provider can bill for RPM services, which may be contributing to the significant increase in duration of reimbursable RPM use.  

However, the rise in utilization isn’t just about milking the system. Encouragingly, providers appear to be recommending RPM tools to the people who can truly use the extra support: during the period under observation, RPM use was highest for older, nonwhite, and more medically complex beneficiaries, including those dually eligible for Medicare and Medicaid. This indicates that providers are genuinely acting on RPM’s potential to address disparities for traditionally underserved populations and deploying technologies strategically to achieve important goals around equity and outcomes. 

Policy recommendations to support responsible, sustainable growth of RPM

To continue shepherding RPM and RTM in the right direction while reducing any opportunities for abuse of reimbursement structures, the Peterson Center recommends several potential actions for policymakers.  

• Develop evidence-based, condition-specific limits to the duration for reimbursement: Providers should only be reimbursed for RPM when it is being actively used to address a clinical situation, the report recommends. Reimbursement for the episode should end once a patient is on a stable and sustainable regimen for the condition under monitoring. 

• Evaluate strategies to improve RPM access in rural and underserved communities: The report found that rural regions are slightly less likely to have access to RPM when compared to more urban environments. CMS should reconsider how to compensate for regional variations in reimbursement that might be limiting RPM deployment in remote, rural communities.  

• Improve data collection to better understand how, when, and why RPM is being used: The authors suggest that CMS and state Medicaid programs require more specificity in claims and encounter submissions to illuminate around what digital solutions are being used, what clinical or physiological data is being collected, and who is ordering the service.  This will help payers better develop policies and programs to encourage appropriate RPM use.

By ensuring that policies remain aligned with the growth and expansion of the RPM ecosystem, policymakers, providers, payers, and patients can foster effective utilization of these important technologies and ensure that all individuals in need can get access to digital tools that support better health at home. 

Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry.  Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system.  She can be reached at [email protected].