The state of remote patient monitoring: developments for 2024

State of RPM: ©Metamorworks - stock.adobe.com

Advocates hope remote patient monitoring will continue evolving in 2024 with developments in policy and technology aligning to improve patient health.

Physicians are gathering evidence that integrating technology to track patient conditions outside the doctor’s office can lead to health improvements. Data from devices can signal potential maladies early on, which in turn can lead to treatments that are effective and potentially far less expensive than visits to the emergency department or an urgent care center, or readmission to a hospital.

That goal has not changed for physicians and patients using remote monitoring (RM) programs. But there are developments on the horizon and physicians and technology experts shared their thoughts about the state of RM, what to expect in 2024 and how physicians might integrate it into their practices.

Medicare support

U.S. Centers for Medicare & Medicaid Services (CMS) reimbursement policies are influential across American health care, and experts said two developments in 2023 indicated Medicare regulators will continue supporting RM or at least not pull the plug on it this year.

In February 2023, a Medicare Multi-jurisdictional Contractor Advisory Committee met online “to examine the quality and strength of the clinical evidence related to remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM) for non-implantable devices.”

Physicians from across the country were unanimous in describing benefits of RPM and RTM for a variety of conditions: physical therapy after injury or knee surgery; ulceration and neuropathy of feet of diabetic patients; medication adherence for substance use disorder; managing hypertension, diabetes, congestive heart failure, sleep apnea, asthma, chronic obstructive pulmonary disease; serving rural patients; engaging Black and Latino patients; monitoring youths in families using Medicaid or infants out of neonatal intensive care with chronic conditions.

The physician speakers cited current evidence about RM effectiveness and predicted much more to come in studies happening now. The committee opted not to make any recommendations that would lessen or restrict reimbursement for remote monitoring.

Later in the year, CMS’ 2024 Medicare Physician Fee Schedule included policies for reimbursing RPM and RTM for federally qualified health centers and rural health clinics, creating potential for new remote monitoring in rural and underserved areas.

Code changes on horizon?

The American Medical Association’s (AMA) Current Procedural Terminology (CPT) billing codes for remote physiologic monitoring came online in 2019, followed by remote therapeutic monitoring codes in 2022.

Those are still relatively new, but the codes could be modified in the future. In February, the AMA’s CPT Editorial Panel had an agenda item possibly deleting current RPM and RTM codes and replacing them with a combination CPT code set for both, but that proposal was withdrawn from consideration. The applicant is revising its proposal for the May meeting of the CPT Editorial Panel, according to AMA spokesman R.J. Mills.

Any changes would apply to the 2026 CPT code set, Mills said.

If enacted, Medicare and private payers likely would follow the changes, said Daniel Tashnek, co-founder and CEO of Prevounce, a health care software firm.

“It may create some initial headache as providers familiarize themselves with the changes unless they have a vendor who handles that sort of thing for them,” Tashnek said. “However, it’s a clear net positive because coverage is expanding. Providers’ and the AMA’s definitions of ‘simplify’ may be different, but theoretically coding for RPM should be more straightforward for providers under the proposed structure.”

Technology will get better

In fall 2023, the University of Arizona’s Gutruf Lab unveiled a development in biosymbiotic electronics: an armband made with waterproof sensors embedded in 3D-printed nonadhesive silicone mesh, with wireless charging and ability to transmit data up to 15 miles, far beyond signal strength of Wi-Fi or Bluetooth. It’s as accurate as a bedside monitor using stick-on sensors to measure heart rate, blood oxygen saturation and temperature, and as portable as a brick-and-strap smartwatch, with no need for cellular tower connections.

“The whole device is fully encapsulated so you can go to the shower with it,” said Philipp Gutruf, lab leader and assistant professor of biomedical engineering. “You can keep it on literally 24/7. There’s no reason to take it off.”

That device is not approved for medical use yet, but there could be innovations in ones that are.

In October 2023, the U.S. Food and Drug Administration offered guidance that it no longer would review advances in approved noninvasive monitoring devices if changes did not create undue risks to patients. That could allow improved devices to come to market faster, said Kyle Faget, a Boston-based health care and life sciences lawyer who co-authors her firm’s health care blog.

“I think that RTM and RPM are only gaining traction out in the marketplace now, and there’s a lot of innovation in this space,” Faget said. “So clearly FDA is thinking about the appropriate amount of regulation or regulatory oversight it needs to extend for these devices to ensure safety and effectiveness.”

Health care apps for remote monitoring likely will become easier to develop, said Matthew Smuck, MD, a spine physiatrist and director of the Wearable Health Lab at Stanford Medicine. He compared current app development to website design in the early days of the internet — challenging in the beginning but getting easier over time.

“That same thing is happening with apps,” he said. “The ability to develop apps isn’t as robust as the ability to develop websites, but it’s heading in that direction.”

Patients are starting to like RPM

In a 2023 survey of physicians and executives, 67% of respondents said RPM had a high impact on patient satisfaction. Patients consider it a “concierge service” that engages them with their health, said Kyle Williams, CEO of MD Revolution, a remote care management firm based in San Diego.

The technological barriers of 20 or 10 years ago will continue eroding because patients are not necessarily intimidated by technology, especially when it’s easy to use, said Williams.

“There’s a real disconnect here between what physicians think patients want and can do and what they actually are capable of doing,” Williams said. “Seniors especially are happy to use technology if it’s simple and effective and it gets them better care. We see physicians sort of underestimating their patients, if you will. People are used to having cellphones, they’re used to texting, they’re used to asynchronously talking or chatting.”