Telehealth Advocacy Groups Raise RPM Coverage Decision Concerns

The American Telemedicine Association and Alliance for Connected Care have expressed concerns regarding a Contractor Advisory Committee (CAC) Meeting on remote physiologic monitoring (RPM) and remote therapeutic monitoring (RTM) for non-implantable devices slated to take place on Feb. 28.

The meeting, hosted by multiple Medicare Administrative Contractors (MACs), will seek advice on the strength of published evidence related to RPM and RTM for non-implantable devices and other relevant data to determine "meaningful and measurable patient outcomes (e.g., decreases in emergency room visit and hospitalizations) for our Medicare beneficiaries," a press release notes.

MACs are private health insurers that have been awarded a geographic jurisdiction to process Medicare Part A and Part B medical claims or Durable Medical Equipment (DME) claims for Medicare Fee-For-Service (FFS) beneficiaries. MACs make Local Coverage Determinations (LCDs) on whether to cover a particular item or service in its jurisdiction or region. These determinations are based on whether that item or service is deemed reasonable and necessary.

In a Feb. 21 letter to Novitas Solutions and First Coast Service Options — the MACs hosting the meeting — the telehealth advocacy groups raised several concerns. These include the absence of noteworthy studies from the bibliography, the short time allotted for discussion, combining discussions on RPM and RTM into one meeting, and certain clinical conditions and disease states being omitted from consideration.

"We are concerned that advice rendered by the CAC in this instance will not be the result of a full scientific inquiry, nor will it help ensure unbiased or contemporary consideration of state of the art technology and science," the groups wrote in the letter.

They noted that at least 45 credible studies were missing from the bibliography, including some from well-known physicians using RPM, and urged a more comprehensive literature review.

Further, they emphasized that RPM and RTM are very different services, but the meeting leaders have allotted only 75 minutes on the agenda for discussion, "which is not enough time for meaningful evidentiary presentation and deliberation."

In addition, the groups requested that meeting leaders widen the evidence being considered to include more conditions RPM/RTM can help treat.

"There is a broad range of chronic conditions for which utilizing RPM and RTM are appropriate, and limiting the evidentiary review indicates you are considering limiting an LCD to only the conditions considered," the groups wrote. "This would leave clinicians currently using RPM outside of cardiology with no feasible way to continue."

The concerns regarding the meeting come as healthcare providers increasingly adopt RPM.

Last September, the American Medical Association released survey results showing that the proportion of physicians using tools that support remote monitoring for efficiency — defined in this analysis as smart versions of common devices such as thermometers and blood pressure cuffs — jumped from 12 percent in 2016 to 30 percent in 2022.

Further, the percentage of physicians using remote monitoring and management tools to improve care, including applications and devices for vital sign monitoring of chronic care patients, increased from 13 percent to 34 percent between 2016 and 2022.

Not only that, but 75 percent of physicians polled in 2022 said being able to offer remote care was an important reason to use digital health tools.