Data and Telemedicine: MACRA, MIPS, and Your Data

MACRA, The Medicare Access, and CHIP Reauthorization Act of 2015 changed the way that Medicare rewards clinicians for value over volume.  It supports multiple quality programs under the new Merit-Based Incentive Payments System (MIPS)
and gives bonus payments for participation in eligible alternative payment models (APMs).  In general, it moves payment from a fee-for-service payment model to a value-based system that encourages quality and more efficient/effective patient care.  This system also is tailor-made for the incorporation of telemedicine into a value-based payment system.  Each year, we move closer to a value-based system and away from a fee for service system.  How can you dip your toe in the water of a value-based system to try it out? The Center for Medicare/Medicaid Services (CMS) gave us the answer as of January 2018.

Medicine doctor working with modern tablet computer and virtual

CPT code 99091:  Remote Patient Monitoring allows patient-collected physiologic health data that is digitally stored and/or transmitted by the patient to be securely sent to the provider.  This involves patient-collected heart rate, blood pressure, weight, glucose readings, CPAP usage, EKG readings, and pulse oximetry readings to be shared directly with the provider for monthly review.  This must be transmitted using a HIPAA-compliant, secure system like Housecall Telemedicine and cannot be transmitted by insecure mechanisms like email or text. It pays an average of $59 per patient per month nationally. Not only has remote patient monitoring been shown to improve outcomes and access to care, it also has been shown to improve cost-effectiveness and reduce hospital readmission rates.  This study from 2015 showed in COPD and CHF patients that 30-day readmission rates were reduced 50% and showed a 13-19% reduction in 180-day readmission rates. This finding was made even more impressive given that the study population consisted of underserved patients and included many who had no insurance.  Indeed there are numerous studies that show telemedicine, remote patient monitoring, and transitional care programs along with care management programs can drastically reduce 30-day readmission rates by as much as 50%.

Remote Patient Monitoring can also be used with Chronic Care Management (CCM) services (CPT codes 99490 and 99487).  These codes were introduced in 2015 to compensate providers for the routine care of complex chronic conditions that providers have delivered for years without compensation.  CCM Patients must have multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, and chronic conditions that place the patient at significant risk of death, acute exacerbation, decompensation, or functional decline.  This includes (but is not limited to) conditions such as Alzheimer’s disease and related dementia, Arthritis (osteoarthritis and rheumatoid), Asthma, Atrial fibrillation, Autism spectrum disorders, Cancer, Cardiovascular Disease, Chronic Obstructive Pulmonary Disease, Depression, Diabetes,  Hypertension and infectious diseases such as HIV/AIDS.   CCM requires at least a visit in-person yearly that can be billed separately.  It also requires a formal care plan for each individual patient that is reviewed and revised as needed.  CMS even loosened its prior restriction on telemedicine to allow Chronic Care Management Care Planning to be done directly with the patient by a care manager via an unrestricted telemedicine conference (CPT G0506) as of January 1, 2018.

Chronic Care Management for “non-complex” cases (CPT 99490) pays an average of $49 monthly nationally.

Chronic Care Management for “complex” cases (CPT 99487) pays an average of $86 monthly.

Chronic Care Management Care Planning (CPT G0506) pays an average of $59 monthly and can be done via telemedicine between a care coordinator and the patient.

Remote Patient Monitoring (CPT 99091) pays an average of $59 monthly.

A complex patient enrolled in both CCM and RPM generates an average revenue of $204 per patient per month or $2448 per patient per year to a practice.  This is in addition to in-person visits with the provider that are charged separately.

Reimbursement Update on Remote Patient Monitoring, and Chronic Care Management Codes for 2018

CMS Fact Sheet on Chronic Care Management Services

Frequently Asked Questions About Chronic Care Management

Housecall Telemedicine is a data platform that allows you to connect patient data to a direct telemedicine visit.  From the very beginning of the company, the idea of connecting patient-collected personalized data to a provider has been “THE IDEA” behind the company.  That idea was fairly out there in 2014.  Now in 2018, it is becoming mainstream.  Now that the CMS has come around with recent CPT codes that support the data connection between patient and provider, the expansion of telemedicine has clearly begun.  Good ideas from the CHRONIC ACT that were recently incorporated into law with the latest budget act passed in February 2018,  make the use of telemedicine in Medicare patients even easier.  These new rules expand the use of telemedicine in end-stage renal patients, and for tele-stroke.  It also greatly expands the use of telemedicine for use in Medicare Advantage plans and ACOs.  The use of the Next Generation ACO telehealth waiver allows ACOs to waive the geographic restriction for telemedicine use in Medicare and allows the patient to be anywhere to make a telemedicine connection to a provider.  The use of telemedicine for Chronic Care Management care planning in an unrestricted fashion continues to expand the use of telemedicine and provides improved access to care for our patients and that care is more consistently delivered.  It seems like CMS finally Cares Enough To Care and has finally begun to really answer the question Why Telemedicine?