Remote Therapeutic Monitoring: Here to Stay

Back in the day, rehab therapists had to wait until they saw their patients in person again to assess their progress. However, thanks to technology-based healthcare delivery, like remote therapeutic monitoring (RTM), it’s now possible to assess patients’ adherence outside of the clinic. 

As a therapist, this means you can influence your patient’s behavior and help them reach their goals between visits. Plus, this framework aligns with value-based care and technological adoption, which is being influenced by the Centers for Disease Control and Prevention (CMS). 

Remote therapeutic monitoring can provide tremendous value to both patients and rehab providers. Yet, many people, therapists and patients alike, are still uncertain about what it is, how it’s used now, and where it seems to be going in the future. Let’s dive into what we can expect from remote therapeutic monitoring so you can determine how it best fits into your practice. 

What Is Remote Therapeutic Monitoring?

Remote therapeutic monitoring is the use of digital medical devices to collect and monitor data between visits. RTM gathers non-physiological data related to therapeutic treatments, such as patient respiratory or musculoskeletal (MSK) system data. 

This technology lets providers electronically retrieve treatment adherence and therapy response data using an RTM medical device. As a result, rehab professionals can assess medication adherence, exercise compliance, and even pain management without the patient physically coming into the clinic. 

The Different Types of RTM

If you’re thinking about integrating RTM with your patient care, make sure you’re aware of the various types that are available. 

• Intermittent Monitoring: This involves the periodic collection of data from patients. It’s ideal for those who don’t have severe symptoms or who experience them less frequently. This information may be collected via questionnaires, virtual appointments, or self-reported symptoms.  
• Proactive Monitoring: This form of RTM is best for high-risk patients, as it utilizes machine learning and predictive algorithms to spot potential health problems. Rehab providers could be alerted before the situation advances so they can intervene as needed. 
• Continuous Monitoring: Rehab professionals can monitor patients in real time with this type of RTM, making it useful for patients with more complex MSK conditions. 

How Does RTM Differ from Remote Patient Monitoring? 

When most people hear about RTM, they think of remote patient monitoring, or RPM. However, while their titles share a couple of the same words, these are two different frameworks. 

The main thing these two have in common is that they both require the use of a medical device. In addition, RTM codes were built based on the RPM code template. In fact, CMS states that RTM coding was developed to allow practitioners who typically could not bill for RPM codes to furnish and bill for services that appear similar to those of RPM. 

Now, let’s dive into how they differ from each other.

• Who Can Bill: RPM includes physicians and non-physician providers, such as physician assistants and nurse practitioners. However, RTM codes are considered general medicine codes. This allows physical therapists, occupational therapists, sleep-language pathologists, and physicians to bill for RTM services. 
• Type of Data Collected: RPM captures physiological data (e.g., heart rate, blood glucose) while RTM collects non-physiological data. 
• How Data Is Collected: RPM requires that collected data is automatically transmitted, while RTM can capture both that automatically transmitted and patient-reported data. 
• Conditions/Systems Monitored: RPM focuses on post-acute and chronic diseases. RTM, on the other hand, involves the musculoskeletal and respiratory systems, among others. 

Remote Therapeutic Monitoring: A History

We can’t really discuss the evolution of RTM without first looking at RPM. After all, RTM exists essentially as an extension of RPM. So, let’s buckle down on a bit of history. 

The Evolution: 1800s to the Early 2000s

RPM is a form of telehealth that dates all the way back to the late 1800s. One of the first instances of remote patient monitoring comes from an 1887 article published in the Lancet, where a doctor asked that a patient be placed on telephonic communication. By 1957, the Holter monitor was discovered, which recorded electrocardiographic signals from an individual going about their daily activities. 

Fast-forward to the 2000s, and telehealth saw exponential growth. In fact, telehealth use grew by 52% year over year between 2005 and 2017. However, interestingly, this technological innovation was still considered uncommon in 2017. In 2019, though, CMS launched the RPM program. This allowed providers to be reimbursed for using technology to monitor patients with chronic conditions between visits. 

The Introduction of RTM in the 2020s

In early 2020, a research team realized that there were significant gaps in care for respiratory and musculoskeletal patients. MSK alone resulted in $380.9 billion in healthcare spending in 2017 and also caused substantial productivity losses. Plus, statistics show that nearly 1 in 2 individuals over age 18 will experience an MSK injury in their lifetime, so something had to be done. 

Later that year, in October 2020, the Current Procedural Terminology (CPT) Editorial Panel created and submitted remote therapeutic monitoring codes to CMS and the American Medical Association (AMA) to combat this gap in care. The Relative Value Units (RVU) Update Committee assigned values to them at a January 2021 meeting, and RTM codes officially went live in 2022. 

In 2023, more and more providers adopted RTM, especially in the physical therapy and rehabilitation fields. Business leaders recognized that RTM offers a much more comprehensive approach to patient care. This framework has the ability to not only improve health outcomes but also generate additional revenue.

As of 2024, CMS announced that physical and occupational therapists can bill RTM for assistants under general supervision. With general supervision, the licensed therapist just has to be reachable by telecommunication when the assistant performs services. 

Previously, Medicare regulations required that physical therapists and occupational therapists in private practice only bill when assistants were under direct supervision. This required the licensed therapist to be on-site when the assistant performed services, but not necessarily in the treatment room. 

How Is Remote Therapeutic Monitoring Being Used Now?

If you own a physical therapy clinic and don’t currently utilize RTM, we’re sure it would help to know how other practices use it. Let’s shift gears and discuss what you can expect today from physical therapy RTM. 

As a rehab therapist, you likely already prescribe home exercise programs to your patients. Therefore, half the work is already done. The next step is making sure you utilize the right ‘medical device’ to receive Medicare reimbursements. 

When it comes to RTM, software can qualify as a medical device, which the FDA defines as “software intended to be used for one or more medical purposes that perform these purposes without being part of a hardware medical device.”

Examples of RTM Physical Therapy 

Once you’ve selected a qualified medical device for your practice, here are some examples of CMS-approved ways you can utilize remote therapeutic monitoring and what CPT codes apply: 

• Call or message a patient and discuss how their home exercise program is going. Code 98980 covers 20 minutes of this form of RTM services each month. 
• Perform five to 20-minute patient consultations via phone or video. This helps to hold the patient accountable for the work they’re doing, and as long as the patient is benefitting from these consulatations, code 98981 covers each additional 20-minute RTM treatment management service that took place during the month. 
• Analyz3 and interpret the data from patient’s treatment programs, such as checking a patient’s log-in history and therapy adherence in the applicable medical device, for 30 minutes. You can use code 98977 for this and bill once per month. 
• Have rehab assistants aid with the initial setup of the device. They can educate the patient on how to use the medical device, too. This can be billed one time per patient with code 98975. 
• Give the patient an exercise program and have them log task completion, difficulty level, duration, symptoms, and more. You can bill for the patient having access to the software as long as the software transmits data for 16 days in a 30-day period with code 98977. 

The Future of Remote Therapeutic Monitoring

Having just properly entered the scene in 2022, RTM still has a long journey ahead. However, the future of this technology is bright. Given its ability to improve access to care, address longstanding adherence issues, and boost patient outcomes, we anticipate seeing more opportunities. It’s also a feasible option for patients who want to avoid contact with germs, and this approach doesn’t cause rehab practices to lose revenue in the process. 

Here are some of the changes we anticipate moving forward with RTM. 

Advanced Technological Integration

Currently, the application of artificial intelligence (AI) in RPM is being explored, as it can potentially decrease costs through early detection. AI with RPM may also aid clinical decision-making by analyzing health data points and generating alerts. However, the FDA is still trying to determine how to best create policies regulating AI as medical device software. 

Because RTM is basically an extension of RPM, it’s reasonable to assume that what’s happening with RPM will likely eventually happen to RTM. Therefore, we anticipate AI integration into RTM platforms as well. Applying machine learning to RTM tools may enable the increased use of predictive analytics, the development of customized care plans, and more. 

Greater RTM and Electronic Health Records (EHR) interoperability also seems to be on the horizon. This will enhance treatment planning efficiency and allow for better care coordination. 

Increased Adoption across Specialties

RTM physical therapy has proven to be incredibly beneficial and profitable. As a result, it’s now being considered for other specialties. For instance, one study assessed how rheumatologists could use RTM to better monitor their patient’s disease activity and flares between visits. 

As other clinicians become informed about the benefits of RTM, participation rates will likely increase. Additional private payers may also join in and mirror Medicare’s coverage of RTM. 

A Greater Shift to Value-Based Care Models for Profit Sustainability

Investing in value-based care is becoming crucial for clinics wanting to stand out in the healthcare marketplace. With this approach, providers are rewarded for better results related to outcome measures, quality of care, and cost. 

RTM devices and proper use of RTM CPT codes can help physical therapists shift to value-based care. For example, let’s look at the Merit-Based Incentive Program (MIPS). This is a program that physical therapy practices may participate in that connects Medicare payments to provider performance and focuses on value-based care. 

MIPS is voluntary for some practices and a requirement for others, but we foresee more practices participating due to RTM. One’s quality of performance dictates whether they receive a payment penalty, no payment adjustment, or a payment bonus. Those who do well may count on outcome reimbursement models to sustain profitability. RTM can help collect data and report to MIPS, the first large-scale value-based payment model to affect physical therapists (PTs). 

Potential Changes to Reimbursement and Regulations

With increased RTM adoption among providers, we expect to see some changes to the CPT codes eventually. Billing guidelines may be updated to demonstrate the various applications of RTM. Following that, we’ll likely witness updates on provider reimbursements, too. 

As CPT codes change, so too will regulations. RTM physical therapy may have stricter compliance conditions, which might entail specific documentation requirements. This is usually done to ensure program efficacy. 

Better Outcomes & Increased Profitability With RTM

It’s clear that the future of healthcare includes technology. Gone are the days of paper records and simply waiting until you saw your patient in person again to get an update. Telehealth initiatives combined with the power of RTM have entirely changed the game. 

From improved outcomes and care accessibility to greater patient engagement and profitability, this is the future of healthcare. While it may seem daunting to implement today, those who don’t get on board may be left behind tomorrow. 

If you’re interested in offering remote therapeutic services at your practice or want to learn more about the latest technological advancements in physical therapy, let’s talk! Net Health provides specialized software that can help grow your business and enhance patient care while also remaining compliant.