RPM use soars by more than 1,300% within Medicaid population

Remote physiologic monitoring (RPM) use among Medicaid patients increased by more than 1,300 percent from 2019 to 2021, driven primarily by a small proportion of healthcare providers, and female and chronic disease patients, new research shows.

Published in Health Affairs, the study examined the uptake of RPM by Medicaid beneficiaries. RPM involves using tools like wearable devices and mobile applications to transmit patient data, such as heart rate, blood pressure, and blood oxygen levels, to healthcare providers.

The study authors note that in 2019, the Centers for Medicare and Medicaid Services (CMS) adopted new billing codes to support reimbursement for RPM. During the COVID-19 pandemic, public and private healthcare payers expanded RPM coverage and reimbursement. After the public health emergency (PHE) declaration expired last year, lawmakers are considering new RPM reimbursement policies.

Thus, researchers from the CMS and Manatt Health Strategies set out to investigate RPM use data within the Medicaid population to inform this policy decision-making. They used Transformed Medicaid Statistical Information System Analytic Files data to gather claims, encounters, and enrollment information for Medicaid beneficiaries between January 1, 2019, and December 31, 2021.

The number of RPM recipients per 100,000 Medicaid beneficiaries increased from 2.1 in January 2019 to 29.6 in December 2021 — representing a 1,300 percent jump during the study period.

However, RPM use varied widely across state lines. In 2021, it ranged from 0 recipients per 100,000 beneficiaries in Vermont to 217.7 recipients per 100,000 beneficiaries in New Jersey. Additionally, the rate of RPM use in 2021 was more than 30 percent higher among states with documented RPM reimbursement policies than those without.

The researchers identified more than 5,600 distinct providers who billed RPM claims for Medicaid beneficiaries in 2021. However, more than half of all the RPM claims were attributable to 5 percent of providers, representing 283 individuals. Internal medicine, general practice, and family practice physicians were the most common types of providers to bill RPM claims.

Further, the study shows that rates of RPM use were highest among older beneficiaries, those who identified as female, and people diagnosed with diabetes and hypertension. The rate of RPM use per 100,000 beneficiaries among Medicaid patients older than 65 was 381.4; among those identifying as female, it was 77.6; among those with diabetes, it was 545.2; and among those with hypertension, it was 715.7.

RPM use was also high among Medicaid patients residing in metropolitan areas and enrollees in limited benefit managed care plans.

“The growing interest in and increasing reimbursement for remote physiologic monitoring services offer promising opportunities for improving chronic disease management and patient outcomes, particularly among the Medicaid population, which comprises the most vulnerable and underserved populations in the United States,” the researchers concluded.

The new research aligns with previously released data showing that adoption of RPM skyrocketed during the COVID-19 pandemic.

A 2023 report from data analytics company Definitive Healthcare reveals that RPM claim volume increased 1,294 percent from January 2019 to November 2022. This report also shows that hypertension and diabetes account for the highest proportion of claims, with essential hypertension accounting for 51 percent of RPM-related claims and diabetes mellitus with complications accounting for 10.4 percent.

However, a study published last November found that though RPM helped improve outcomes for Medicare patients with hypertension, it increased outpatient visits and net healthcare spending. For the study, researchers compared outcomes data for 192 practices where 25 percent or more hypertension patients received RPM (high-RPM practices) to 942 control practices where less than 2.5 percent received RPM (low-RPM practices).

They found that between 2019 and 2021, hypertension patients at high-RPM practices experienced a 3.3 percent relative increase in hypertension medication fills and a 1.3 percent increase in the number of unique hypertension medications received compared with patients at low-RPM practices. Additionally, high-RPM practices’ net hypertension-related spending saw a relative increase of $274 per patient.