Use CasesJune 22, 2022

Improve patient outcomes through Remote Therapeutic Monitoring

Brad Thorson

Remote Therapeutic Monitoring (RTM) is a set of practices and billing codes for the implementation of passive patient-data collection. Unlike Remote Patient Monitoring (RPM), RTM does not require the use of specialty hardware like a blood pressure cuff.

The Centers for Medicare & Medicaid Services (CMS) specifically identifies four types of data collection for RTM: 

  1. Respiratory system status

  2. Musculoskeletal system status

  3. Therapy adherence

  4. Therapy response 

RTM can be as simple as having the patient record whether they took their daily medication, or asking them a question about any potential side effects.

Both RTM and RPM require patients to complete some data collection action at least 16 out of 30 days in order to be billable. In addition to billing for patient data collection, there are billing codes for the implementation of an RTM or RPM program (one time) as well as billing codes for 20 or 40 minutes of patient/provider consultation (once a month).

Why is RTM important?

It’s simple: Increased data and revenue.

In no other industry, is the promise of big data larger than in healthcare. Our American paradigm of once-yearly physical checkups is largely driven by the logistical barriers of in-person healthcare. But digital health, and RTM more specifically, brings the opportunity to personalize the frequency of encounters based on a myriad of signals.

Equally important, RTM establishes an economic incentive to introduce telehealth implementations at primary care practices that were previously focused on in-person care. In fact, effective RTM programs could increase the revenue per patient by $1,200 or more a year, while drastically reducing long-term healthcare costs.

How can RTM lower healthcare costs?

Across diseases, up to 63% of patients don’t adhere to their care plans. Additionally, three out of four patients are non-adherent to their medications (that’s on top of one-third that never fill their script in the first place), which leads to over $100 billion a year in excess hospitalizations.

Study after study has shown that simply reminding patients to take their medication dramatically increases adherence. Why, then, doesn’t every provider writing a daily script for more than 16 doses deploy an RTM program to increase their practice’s revenue?

It’s simple. EHRs haven’t been built for patient-centric experiences that allow for frictionless data collection.

Setting up an RTM program in Capable 

Capable Health provides a suite of digital health tools and interfaces to launch and scale HIPAA-compliant digital health solutions. Core to our system design are care plans, a structured set of goals, tasks, and surveys that can be combined in our no-code workflow builder to automate patient experiences.

Let’s say I’m running a practice focused on HIV prevention and I prescribe a class of drugs called Pre-Exposure Prophylaxis (PrEP) that, when taken daily, are 99.9% effective at preventing HIV. CDC research has found that 20-50% of PrEP patients are non-adherent to their medication. Not only would an RTM program tracking adherence be good for my bottom line; it would also dramatically reduce the chance of HIV infection among non-adherent patients.

First, I would create a care plan, something I’m going to assign to my patients that will improve their health outcomes. In this case, we can call it Daily PrEP. A care plan needs at least one goal which is straightforward in this case: Take Medication Daily. In order to achieve that goal, care plans can include repeatable tasks such as monthly, weekly or daily. For my Take Medication Daily goal, I’ll create two tasks: Log Dose Time and Record Any Issues.

Care plan created!

rtm image 2

As a practitioner, I just need to assign this care plan to the appropriate patients and if they’re using one of our pre-built experiences, they’ll see action items every day. You can extend this workflow further to automate actions like quarterly lab testing and video visits.

Making RTM work for you

You’ve made it easier for your patients to be adherent and you’re collecting the data needed to bill insurance for your RTM program. But is it worth it?

CMS guidance suggests that compliant RTM programs could generate over $1,200 per patient per year. As you consider your digital health opportunities, RTM can be both great for your patients and your practice.

It’s important to note that patients must collect data at least 16 of 30 days and providers must spend at least 20 minutes reviewing that data to be eligible for RTM reimbursement. With Capable, providers can schedule and conduct video visits from any web browser or native app while also documenting notes in our encounter feature. It’s easy to track encounter durations and support any billing questions with notes natively embedded in the patient record.

CDC-approved interventions like PrEPMate have shown a 15% increase in patient retention, while PrEPMate and LifeSteps have shown a 15% and 21% improvement in daily medication adherence respectively. Both interventions can be easily implemented using Capable’s care plans.

Get started in automating your RTM programs with Capable

Capable Health empowers healthcare innovators to provide affordable, personalized, quality care at scale. We’ve developed the all-in-one care delivery and management platform enabling providers to launch and scale their own HIPAA-compliant digital health solution — with 80% less time, money and code. 

Capable Health helps you use data to improve patient outcomes by standing up your Remote Therapeutic Monitoring program in days, not months. Book a demo today.

As a footnote, it’s helpful to know CMS’ billing codes for RTM and how Capable can help you manage your Revenue Cycle Management (RCM).

Here’s a table with RTM billing codes, their description, and an estimated reimbursement:

RTM CPT codes

*While not explicit in code description, CMS specifically called out medication adherence as a use case already in practice among providers in its proposal of the 2022 RTM codes.