Developing an FQHC or RHC Remote Patient Monitoring Program: 10 Things to Know

The 2024 Medicare Doctor Price Schedule (PFS) remaining rule included information of nice curiosity to federally qualified health centers (FQHCs) and rural health clinics (RHCs), with maybe no developments greater than CMS finalizing its coverage to reimburse FQHCs and RHCs for distant affected person monitoring and distant therapeutic monitoring companies. 

FQHCs and RHCs now have the alternative to launch distant affected person monitoring/distant therapeutic monitoring programs that present extra complete distant care administration companies to sufferers and generate important, sustainable, and growable income. Listed below are highlights from the PFS remaining rule. 

For FQHCs and RCHs considering whether or not to proceed with growing distant affected person monitoring (RPM) and distant therapeutic monitoring (RTM) packages, listed below are 10 issues to know. 

1. CMS extends RPM and RTM protection to FQHCs and RHCs

Traditionally, distant affected person monitoring (i.e., distant physiologic monitoring) and distant therapeutic monitoring codes had not been individually billable by FQHCs and FHCs, with CMS contemplating RPM and RTM “included” inside an all-inclusive charge. In 2019, CMS break up persistent care administration (CCM) out from the “all-inclusive” common care administration code (HCPCS G0511), thus permitting FQHCs and RHCs to invoice for CCM below this HCPCS code. But, CMS selected to not break up RPM out on the time (RTM was nonetheless a couple of years away from changing into a clearly outlined and coated service). 

This adjustments with the 2024 PFS final rule, with CMS together with RPM and RTM in HCPCS G0511. The inclusion has been lengthy advocated for, and it is terrific to see it lastly occur. 

2. Checklist of companies coated below HCPCS G0511 expanded additional

When applicable, FQHCs and RHCs can now invoice HCPCS G0511 for distant affected person monitoring, distant therapeutic monitoring, persistent care administration, and the next: 

• Principal care management (PCM) 
• Behavioral well being integration (BHI) 
• Power ache administration (CPM) 
• Group well being integration (CHI) 
• Principal sickness navigation (PIN) 

Notice: The latter two companies are new for 2024, having been finalized within the 2024 PFS remaining rule. Group well being integration (CHI) companies deal with addressing the social determinants of well being (SDOH) wants interfering with analysis or remedy of a affected person’s issues addressed within the CHI initiating go to, whereas principal sickness navigation (PIN) companies might be furnished following an initiating supplier go to to ascertain or affirm a remedy plan for no less than one severe, high-risk situation anticipated to last more than 3 months. 

3. Reimbursement charges lowered, however billing alternatives elevated

For 2024, CMS modified the methodology it makes use of to calculate the cost charge for HCPCS G0511 that takes into consideration the utilization frequency of the assorted companies coated below G0511. The revised methodology used to calculate the reimbursement charge for G0511 resulted in a slight cost discount for 2024, however the lower is lower than what would have resulted from the components usually used to calculate reimbursement changes. Base reimbursement went from about $78 in 2023 to $73 in 2024.  

What does this imply? Federally certified well being facilities and rural well being clinics with pure CCM packages will generate decrease funds per service in 2024 than they did in 2023. Nonetheless, FQHCs and RHCs that develop their packages to incorporate a further service like distant affected person monitoring can generate greater income. The expanded and improved entry for sufferers and elevated billing alternatives helps scale back the sting of the reimbursement lower. 

4. Some FQHC and RHC protection and reimbursement uncertainty stays

The 2024 PFS remaining rule left us with some questions that may hopefully be answered quickly about protection for RPM and RTM. We all know FQHC and RHC billing for the bottom month-to-month RPM service (i.e., distant monitoring and administration of gadget readings) along with month-to-month CCM service (i.e., as much as 60 minutes of medical employees time offering care administration companies) is appropriate.  

For instance, a affected person with two or extra persistent circumstances, like hypertension and weight problems, may very well be enrolled in a “twin” RPM and CCM program. The FQHC or RHC might present the affected person with an at-home blood pressure monitor, create a complete care plan, and supply ongoing care administration help. If no less than 16 gadget readings are collected and no less than 20 minutes of employees time is spent serving to sufferers obtain care plan objectives, the FQHC or RHC might invoice HCPCS G0511 twice for that affected person every month. Whenever you mix the $73 in reimbursement for the RPM gadget readings and $73 in reimbursement for CCM, it equals $146 in anticipated month-to-month reimbursement, as represented within the following graphic: 

A key excellent query is whether or not FQHCs and RHCs will be capable of invoice HCPCS G0511 a 3rd time for preliminary enrollment right into a distant affected person monitoring program. Underneath CPT code guidelines, practices can invoice a one-time code tied to organising the affected person with their RPM gadget for the primary month they gather 16 readings. Have been the identical logic to use to FQHCs and RHCs, a well being middle might invoice G0511 thrice for a single affected person within the first month: gadget setup, 16 readings, and 20-plus minutes of care administration. This could whole $219 in reimbursement, as represented by the graphic that follows. G0511 can be billed twice in months thereafter. 

We count on CMS to supply clarification as as to if preliminary gadget setup is individually billable or whether or not they think about it to be bundled with the 16 gadget readings. In both state of affairs, a twin RPM and CCM program can supply significant, recurring income. 

5. RPM and RTM is of great worth for FQHC and RHC sufferers

Whereas sufferers nationwide are benefiting from distant affected person monitoring and distant therapeutic monitoring, increasing entry to those companies by means of FQHCs and RHCs is a giant win for affected person care. We all know that FQHC and RHC affected person demographics embrace greater prevalence of persistent circumstances, with people dealing with entrenched boundaries to affected person care, corresponding to low mobility, the necessity to journey longer distances to obtain care, and better ranges of indigency. 

FQHCs and RHCs are notably properly suited to care administration due to their built-in care mannequin and excessive deal with social determinants of well being (SDOH). Affected person engagement and buy-in is essential for the success of RPM and RTM, and FQHCs and RHCs are likely to excel in these areas. 

6. Delivering RPM and RTM companies is pretty easy

The core Medicare guidelines FQHCs and RHCs might want to adjust to once they launch distant affected person monitoring and distant therapeutic monitoring packages are simple to comply with. Medicare provides suppliers nice flexibility in selecting which circumstances and affected person cohorts make the most of RPM. An FQHC or RHC would want to determine the situation(s) they want to handle remotely and launch this system to supply the service to its sufferers. Medicare RTM protection is analogous however is restricted to particular situation sorts or modalities (e.g., respiratory system standing, remedy response). 

Following enrollment in both program, a affected person will must be supplied with a tool to gather the physiological or therapeutic information. RPM and RTM gadgets have to be electronically related. Relying on an FQHCs and RHC’s device vendor companion, it might be potential to have gadgets mailed on to sufferers. FQHCs and RHCs may also select to have sufferers decide up their RPM or RTM gadgets on the group’s bodily location. 

As soon as the gadget is ready up, well being information is captured by the gadget and transmitted from affected person to FQHC or RHC electronically. The FQHC or RHC then analyzes this information and offers the affected person well being and wellness steering and interventions primarily based upon the outcomes. 

7. Frequent examples of distant affected person monitoring functions

Distant affected person monitoring can be utilized to help sufferers with numerous persistent circumstances. A number of the commonest affected person functions for RPM embrace: 

• Hypertension administration  
• Weight measurement for congestive coronary heart failure  
• Weight measurement for weight problems 
• Power obstructive pulmonary illness (COPD) administration  
• Bronchial asthma administration  
• Glucose monitoring/steady glucose monitoring (CGM) 

8. Many selections of RPM gadgets, with necessary connectivity issues

FQHCs and RHCs have selections for what RPM gadgets they supply to sufferers to gather well being information. The most typical RPM gadgets are blood stress displays, weight scales, blood glucose meters, and spirometers, with different gadget sorts seeing elevated use together with pulse oximeters and ECG machines. 

Some of the important selections FQHCs and RHCs might want to make regarding gadgets is whether or not the gadgets offered to their sufferers use mobile or Bluetooth expertise. A mobile gadget — with an embedded mobile modem — is often easy to arrange and use, solely requiring sufferers to insert batteries, flip the gadget on, after which comply with the instructions for tips on how to function the gadget to seize readings (e.g., stepping on a scale). A Bluetooth gadget requires the completion of extra steps, which can embrace downloading and putting in a smartphone app, connecting the gadget to the smartphone, and making certain the smartphone can entry Wi-Fi.  

Utilizing Bluetooth gadgets could also be tougher for FQHC and RHCs sufferers who lack entry to or can’t afford broadband web or who’re unable to afford newer smartphone fashions that could be required to run some gadget apps. Notice: Study extra concerning the variations between cellular and Bluetooth RPM devices here. 

9. Affected person schooling is important

To make sure the short- and long-term viability of a distant affected person monitoring or distant therapeutic monitoring program, FQHCs and RHCs will want sufferers to initially agree with a suggestion that they start to make use of an RPM or RTM gadget (i.e., consent to receiving RPM/RTM companies) after which stay engaged and proceed to make use of the gadget over time. There are a couple of steps federally certified well being facilities and rural well being clinics can take to assist with affected person schooling and engagement, together with: 

• Defining RPM or RTM so sufferers perceive the service  
• Describing how RPM or RTM works 
• Explaining the well being, wellness, and monetary worth/advantages of RPM or RTM 
• Offering directions on gadget setup and ongoing utilization 
• Delivering schooling utilizing the communication channels sufferers choose (e.g., textual content messaging, cellphone calls, affected person portal, in-person) 
• Reengaging with RPM or RTM program individuals to reply any questions and guarantee they really feel regularly supported 
• Strengthening schooling and engagement efforts by studying from affected person experiences (e.g., surveys of energetic program individuals, evaluating why sufferers stopped taking part, getting suggestions from supporting employees) 

10. Do not underestimate the significance of selecting a distant affected person monitoring system

FQHCs and RHCs have choices for the distant affected person monitoring and distant therapeutic monitoring system — comprised of software program and related affected person gadgets — they need to use. Making an knowledgeable resolution on which system to put money into could show the distinction between an RPM or RTM program that meets affected person and program wants or turns into one the group regrets. 

Among the many qualities FQHCs and RHCs ought to prioritize in an RPM/RTM system embrace the next: 

• Capability to help the tools that may gather and interpret their most pertinent affected person information 
• Capability to scale as an RPM or RTM program grows 
• Ease of system setup and utilization, customization choices, and availability of coaching and help offered by the system’s vendor 
• Capability for the system to efficiently combine with current expertise, corresponding to an digital well being information (EHR) platform 

• System issues, together with necessities to make use of a vendor’s gadgets or “carry your personal” offered by a special vendor; means to have gadgets shipped on to sufferers; whether or not the seller supplies help for affected person setup and use of the tools; and talent to make use of cellularly related gadgets, Bluetooth gadgets, or a mix of each  
• Help for coding and billing of RPM and RTM companies, together with how the system helps streamline these processes and higher ensures clear claims that result in well timed, correct reimbursements 
• Precedence on safety and compliance, that are important for long-term program viability 

Prevounce: The Full Distant Affected person Monitoring System

With a greater understanding of distant affected person monitoring and distant therapeutic monitoring, together with their substantial worth for sufferers and suppliers, FQHCs and RHCs can take the following step in launching their RPM and RTM packages with confidence. Prevounce is the developer of some of the trusted, complete remote patient monitoring platforms that features software program and optionally available related gadgets.  

Day-after-day, Prevounce helps organizations, together with FQHCs and RHCs, develop affected person care exterior their partitions, bringing the worth of distant care administration to extra individuals who will profit from the companies. To learn the way Prevounce will help your FQHC and RHC set up and construct a thriving RPM or RTM program, book a meeting with us here.