The recent decision by the Centers of Medicare & Medicaid Services to include some reimbursement in 2015 for remote monitoring is being hailed as a "revolutionary step" for mHealth. While limited in scope, it pushes the bar away from face-to-face visits – the hallmark of a fee-for-service system – and closer to outcomes-based medicine.
"I think they finally realize that it's the future," said Samir Damani, a cardiologist at Scripps Healthcare in San Diego and founder of the digital health startup MD Revolution. "But the first step is to incentivize. You've got to get the carrot before the stick."
"CMS has finally realized that the old model of face-to-face visits isn't working," added Bill Smith, president of ALR Technologies, which markets a digital chronic care management solution for physicians. "They're recognizing that physicians need some specific reimbursement for" care coordination via digital health.
According to CMS' 2105 Physician Fee Schedule, physicians can bill Medicare for "non-face-to-face" chronic care management, to the tune of $46.20 per patient per month for 20 minutes of care. The reimbursement is included in the new schedule as CPT code 99490.
“This Halloween, Medicare beneficiaries got an important treat for home care of chronic care management, remote patient monitoring of chronic conditions and other services when provided via telehealth,” Jonathan Linkous, CEO of the American Telemedicine Association, said in a press release trumpeting the new rules – for which the ATA has been lobbying CMS for more than five years. “It has been a long time coming, but this rulemaking signals a clear and bold step in the right direction for Medicare. This allows providers to use telemedicine technology to improve the cost and quality of healthcare delivery.”
While Smith points out the new code simply enables physicians "to get paid for what they're already doing," Damani called it just a first step toward a system that incentivizes outcomes. Whether physicians move from this to a larger care coordination platform remains to be seen.
"Remote monitoring plus care coordination is an ideal model for chronic care," Smith said. "What comes next is reimbursement for remote monitoring above and beyond care coordination."
ALR is currently working with the Kansas City Metropolitan Physicians Association on a program to monitor diabetic patients that will enable physicians to benefit from this new code. It's estimated that one out of every three dollars spent on healthcare in the United States is tied to diabetes, with an annual bill of approximately $245 billion.
"CMS policymakers are being very farsighted in reimbursing physicians for the use of remote monitoring technologies that hold the promise of assisting busy physicians in managing more patients more effectively," Sidney Chan, ALR's founder and CEO, said in a press release. "Medicare is embracing these new technologies and, if history is any guide, private sector plans may follow as Medicare is often a trendsetter in reimbursement policies."
Damani says healthcare now has to prove that digital health works. Once we start seeing successful examples of remote monitoring and coordinated care, he said, CMS and others will be more likely to incentivize.
"The promise of it has not been fulfilled," he said. "We need to see some use cases."