Upcoming CMS Changes Point to an Impending Merger of RPM and CCM Programs, Streamlining Reimbursement and Enhancing Comprehensive Care
With recent changes to CMS, Remote Patient Monitoring (RPM) and Chronic Care Management (CCM) could be on the brink of becoming one and the same program. In an effort to do more with less and combine two powerful programs, we may see CMS initiate a plan in the coming years which will see RPM and CCM merge into one comprehensive model. This would see the merger of remote monitoring CPT codes 99453, 99454, 99457, and 99458 and CCM CPT codes 99490, 99491, 99487, and 99489 into one monthly reimbursement model. The code associated with both RPM and CCM (CPT 99454, for use of PRM device/device transmission reimbursement) has stayed the same, thus the merging of these two programs seems imminent.
The Addition of Principal Care Management
Principle Care Management (PCM) is a progressive and patient-centered approach that prioritizes comprehensive care coordination and collaboration among healthcare providers. With PCM, the emphasis is placed on building strong relationships between patients and their care teams, promoting open communication and shared decision-making. This proactive model of care aims to address patients' medical, emotional, and social needs holistically, with a focus on preventive measures and early intervention.
In addition to RPM and CCM being combined, Principal Care Management (PCM) could likely be included as well due to overlapping similarities between all three programs and their focus on interventional healthcare. PCM CPT codes 99424, 99425, 99426 & 99427 could very well be folded into the mix. This would see a hybrid model of all three programs merging into one simplified billing system with a new streamlined set of codes that encapsulates all of the services offered.
Increased Need for Interventional Healthcare
There is an increasing demand for interventional healthcare, which seeks to provide a more holistic approach and leverages data-driven care and has brought about a shift from traditional check-ins to more monthly visits (often remote) with patients. As technology advances, so does the ability for doctors to access comprehensive patient data that can help better inform diagnosis and improve treatment decisions.
Utilizing and integrating biometrics from remote patient monitoring into care plans, clinical teams gain a powerful tool to track patient progress, identify behavioral health trends, and make data-driven decisions. By analyzing the collected data, healthcare providers can identify patterns and trends that may indicate positive progress or areas of concern. For example, if a patient's blood pressure consistently decreases over time, it demonstrates the effectiveness of their prescribed medication or lifestyle changes. Conversely, if a patient's glucose levels show a consistent increase, it may indicate the need for additional interventions or adjustments to their treatment plan. This integration of RPM and CCM creates a feedback loop of information, facilitating more personalized and responsive care. Additionally, healthcare providers can now use directional data to make timely adjustments to care plans and proactively address potential complications or worsening conditions. This approach further helps to prevent hospital readmissions, improve patient outcomes, and enhance overall care coordination.
The merging of RPM and CCM into one comprehensive program would mark an exciting transition in healthcare that will bring us closer to providing truly cutting-edge patient care in a cost-effective manner. As the industry transitions to a more unified program, providers, and insurance companies will be able to streamline their services - creating an efficient one-stop shop for healthcare.
Commercial Payers Stand to Benefit
Everyone knows that insurance companies want to satisfy claims and pay out as little possible. By merging the two programs and empowering insurance companies and commercial payers with a data-driven healthcare model, they will ultimately save money by reducing avoidable hospital visits and minimizing administration costs, all while providing patients better care. With current medical constraints and a surge in America’s elderly population, it is only a matter of time before other healthcare efficiencies will have to come into place.
The merging of these two programs also addresses the issue of insufficient staffing in medical facilities. With remote monitoring now part of the equation, medical professionals are able to monitor their patient’s vital signs with less staff and without needing them to come into the office every month - saving both time and money while still ensuring that each patient receives necessary care when needed.
Many Healthcare Workers Can Now Work from Home
The merging of these two programs also addresses the issue of insufficient staffing in medical facilities. With remote monitoring now part of the equation, medical professionals can monitor their patient’s vital signs with less staff and without needing them to come into the office every month - saving both time and money while still ensuring that each patient receives necessary care when required.
According to the AAUW, 77.6% of single parents today are working. Remote monitoring capabilities allow for greater flexibility for many healthcare workers who may work from home and are often lower-income single parents. This issue is compounded by the increased cost of living and historically high inflation rates, creating a demand for healthcare workers to be able to work from home. With CCM and RPM allowing for general supervision incident to and outpatient services by a non-physician practitioner, these programs are ideally suited to the current social-economic climate. They should continue to surge in demand in the coming years.
RPM and CCM have long been fragmented, but since COVID and with CMS’ incentivizing both programs, this is no longer the case. With the merging of these two robust programs comes a vast array of benefits for providers and patients. Now, more than ever, medical professionals have access to comprehensive patient data that can help inform diagnosis and treatment decisions - all while cost-effectively providing quality care from home.
The future of healthcare is likely to involve a more consolidated approach to managing chronic conditions. This merging of services will bring many benefits, including cost savings, improved efficiency and accessibility, greater flexibility, and a proactive care model - all part of improving healthcare. We can expect RPM and CCM to become one unified program as CMS continues to push forward with new initiatives.