RPM use in Medicare booming, but policy changes needed

Though a small percentage of Medicare beneficiaries use remote patient monitoring (RPM) services overall, the utilization has grown exponentially in recent years, necessitating policy changes and new payment incentives, according to a new Peterson Center on Healthcare report.

The report is based on three evaluations of digital health tools by the Peterson Health Technology Institute (PHTI) and an analysis of Medicare billing trends. The prior assessments revealed that digital health tools, many of which rely on RPM, have mixed benefits for patients with chronic conditions. For instance, the institute found that tools targeting type 2 diabetes that use RPM and behavior and lifestyle modification approaches did not provide meaningful clinical benefits; however, some types of hypertension-related digital health tools effectively controlled blood pressure.

The new report charts the significant rise in RPM use among Medicare patients between 2019 and 2023. It shows a 10-fold increase in traditional Medicare patients using RPM services from 44,500 in 2019 to 451,000 in 2023. Among Medicare Advantage patients, RPM use increased from 20,441 in 2019 to 160,137 in 2021.

RPM utilization was highest among older, non-white and more medically complex beneficiaries, including those dually eligible for Medicare and Medicaid, the report states.

In conjunction with utilization, spending on RPM services has grown, with traditional Medicare claim payments for RPM totaling $194.5 million in 2023, up from $6.8 million in 2019. Spending on RPM services per traditional Medicare beneficiary increased from $154 in 2019 to $431 in 2023.

The most common primary diagnoses among traditional Medicare patients using RPM for more than one month were hypertension (57%), diabetes (13%) and sleep-wake disorders (6%). RPM for hypertension lasted an average of 6.6 months, while RPM for sleep-wake disorders lasted 3.1 months.

The data shows that RPM utilization and spending within Medicare are growing rapidly, underscoring the need for new policies to drive value. The Peterson Center on Healthcare made three policy recommendations:

• Align coverage and reimbursement to clinical benefits by developing condition-specific RPM duration limits and tying reimbursement rates to condition-specific clinical effectiveness.
• Ensure RPM access by evaluating strategies to increase utilization, especially in rural areas.
• Improve RPM data collection by requiring more specificity on remote monitoring claims.

"As we adopt exciting, new technologies that extend care beyond the walls of the doctor's office, we need to design payment models that align with clinical benefits for patients," said Caroline Pearson, executive director of the Peterson Center on Healthcare, in a news release. "That means ending 'forever codes' that incentivize long-term billing of ineffective care and instead designing payments that reimburse providers for the periods of time they should be actively monitoring and managing their patients' diseases."

Additionally, as policymakers consider the above recommendations, they must be wary of potential fraud. A September 2024 HHS-Office of the Inspector General report found that 43% of Medicare enrollees who received RPM in 2022 did not receive at least one of the three components of RPM: education and setup, device supply and treatment management.

The HHS-OIG noted that this raises concerns about whether RPM services are being used as intended.

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.