Insights from the OIG’s Recent Report on Remote Patient Monitoring

The Department of Health and Human Services Office of Inspector General’s (OIG) recent report, Additional Oversight of Remote Patient Monitoring in Medicare Is Needed (September 2024, OEI-02-23-00260), highlights the remarkable expansion of Remote Patient Monitoring (RPM) and its potential to serve a wide range of Medicare patients.

At Prescribe FIT, we find this report particularly relevant, as it underscores both the positive momentum in RPM and the need to better understand and optimize its use within Medicare.

Key Takeaways from the Report

1. Dramatic Growth in RPM Utilization and Payments: Between 2019 and 2022, the number of Medicare enrollees using RPM increased more than tenfold, while payments skyrocketed by over 20 times, reaching $300 million by 2022. This growth reflects the effectiveness of RPM in managing chronic conditions and a broader adoption of the full codeset, expanding the scope and payment for these services. At Prescribe FIT, we’ve seen similar momentum, with our own RPM adoption in the orthopedic industry growing 3x last year alone. This surge highlights the increasing value and demand for RPM in patient care.
2. Medicare’s Broad Coverage and Expansion Potential: Medicare currently covers RPM for any chronic or acute condition, providing an incredible opportunity to support patients across a wide spectrum of healthcare needs. This broad coverage allows more patients to benefit from RPM’s capabilities, and there is vast potential for further expansion. As more Medicare beneficiaries take advantage of RPM, understanding who is receiving these services and for what conditions becomes increasingly important. With RPM focused on common chronic conditions like obesity, the potential to enhance patient outcomes and reduce healthcare costs is substantial.
3. RPM Patient Retention and Condition-Specific Usage: In 2022, Medicare enrollees who used RPM services stayed engaged for an average of over five months, with hypertension being the primary focus of over 50% of these cases. At Prescribe FIT, our high patient retention rate—80% of patients stay in our program for at least nine months, during their MSK plan of care to address weight, pain, and mobility issues adequately. Our strong outcomes during their monitored period demonstrate our industry-leading expertise and proves that patients find value in these virtual services.
4. Essential Components of RPM Utilization: RPM consists of three main components—device setup, monitoring device, and treatment management—that together offer a comprehensive approach to managing patient health remotely. The report reveals a gap in the consistent use of all components, with many enrollees not receiving the full suite of services. At Prescribe FIT, we emphasize the importance of using each RPM component to maximize the program’s impact and ensure that RPM services set the patient up for succcess and deliver comprehensive patient management. We lead in patient engagement, with 90% of our patients stepping on the scale the majority of days each month and a high percentage achieving the maximum 80 billable minutes each month, due to our high-touch approach and the evidence-based MSK coaching protocol we’ve developed.
5. Transparency and Provider Information: As the use of RPM grows, it’s essential to maintain transparency in service delivery. Currently, Medicare does not require an explicit order from a healthcare provider to initiate RPM services, leaving room to enhance accountability. We advocate for Medicare to adopt a policy that requires an ordering provider to be documented on RPM claims, enhancing transparency and reducing potential misuse. To support this, we’ve developed our Patient Medical Necessity Determination (PMND) list as part of our Prescribe FIT Protocol, which allows for a virtual prescription and virtual delivery of care to ensure all RPM services are medically justified and properly documented. On top of that, our audit-ready billing reports offer simple identification of CPT codes to bill for each patient and provider. These reports are auto-generated based on the logic from the current AMA Codebook, mock CMS audits, and industry-leading compliance consultation.
6. Provider Education on RPM Billing and Use: To maximize RPM’s potential, it’s essential that healthcare providers understand best practices in billing and service delivery. The OIG report recommends that CMS conduct provider education focused on RPM, which could help standardize billing practices and improve understanding across healthcare providers. At Prescribe FIT, we are committed to advancing this education through FIT Academy, a resource featuring weekly newsletters, a monthly podcast, and a quarterly webinar series on the Future of Orthopedic Care. We also published our RPM Billing Guide to aid in this effort. By empowering providers with up-to-date information and training, we can further optimize RPM for our orthopedic practice partners and patients alike.

The Future of Remote Patient Monitoring
With Medicare’s broad coverage and the strong growth trajectory of RPM, the potential to improve patient outcomes and reduce healthcare costs is more tangible than ever. At Prescribe FIT, we support OIG’s recommendations as part of a broader effort to enhance RPM’s role in Medicare and expand its reach. We are committed to ensuring that every RPM enrollee benefits from a comprehensive approach that maximizes health outcomes and upholds the quality standards envisioned by CMS and OIG.