Latest / Off the Chart: A Business of Medicine Podcast / S1 Ep78: What the 2026 Medicare Physician Fee Schedule means for RPM, with Lucienne Marie Ide, M.D., Ph.D.
Transcript
- Speaker 1 00:00:00 Really hoping that after, you know, five years of stability with RPM can sort of stop thinking about it as this innovative, novel new modality of delivering care. And it can really just become part of how health care is delivered. Speaker 2 00:00:25 Welcome to Off the Chart: A Business of Medicine podcast, featuring lively and informative conversations with health care experts, opinion leaders and practicing physicians about the challenges facing doctors and medical practices. My name is Austin Littrell. I'm the assistant editor over at Medical Economics, and I'd like to thank you for joining us today. This week, we're diving into the fast evolving world of remote patient monitoring, or RPMs. And what changes in the 2026 Medicare physician fee schedule could mean for physicians, practices, and patients? Medical Economics senior editor Richard Payerchin spoke with Dr. Lucienne Ide, founder and CEO of Rimidi, about how proposed billing changes could give practices greater flexibility and what that means for the future of RPM. So with that, thank you again to Dr. Ide for joining us, and now let's get into the episode. Speaker 3 00:01:19 I'm Richard Payerchin reporting for Medical Economics. With me today is Dr. Lucienne Marie Ide, founder and CEO of Rimidi, a company that focuses on solutions in remote patient monitoring and chronic condition management. Dr. Ide, thank you for joining us today. Speaker 1 00:01:37 Glad to be here, Richard. Speaker 3 00:01:40 And recently, you're the author of an analysis that examines some of the different issues in the 2026 Medicare physician fee schedule and some changes that could be coming in, you know, coming in store for remote patient monitoring to begin at the beginning, so to speak. Overall or in a general sense, how would you describe the state of remote patient monitoring in the US health care system right now? Speaker 1 00:02:05 You know, I feel like it is reaching a level of maturity. you know, when the codes were first introduced, CMS made little adjustments here and there, and we've had several years now of stability in those codes and really mainstream adoption of remote patient monitoring. Speaker 3 00:02:22 And just to be clear, for some, terminology, when we talk about RPM or remote patient monitoring, really there are two areas that are involved. Speaker 3 00:02:31 If if again, I'm not an expert on this, but I'm thinking about the distinction between remote physical monitoring and remote therapeutic monitoring. Speaker 1 00:02:40 Correct. So we all sort of interchangeably use remote patient monitoring and remote physiologic monitoring and abbreviate both of them RPM. So that's where you are, you know, as the name implies, monitoring some physiologic parameter of the patient weight, blood pressure blood glucose. Then you have remote therapeutic monitoring, which was introduced a little bit after RPM and is focused really on musculoskeletal and respiratory conditions. And it doesn't have to be specifically their physiologic data. It can be medication adherence type data as well. Speaker 3 00:03:19 For conversational purposes we'll just sort of refer to RPM. And if we need to make those distinctions we certainly can. wanted to double check with you and kind of learn a little bit about some of the current provisions under that code, 99 for 54, and how that might change under the 2026 Medicare physician fee schedule. Can you explain what that is and then maybe how that would change? Speaker 1 00:03:42 Sure. Speaker 1 00:03:42 So there really are two main activities that comprise RPM programs. One is you just referenced is the 99454 activity, which is the connected device and the transmission of data and alerts from that device to the physician or the physician practice. And currently that requires that there's data transmitted 16 out of every 30 days. So that means in practicality, right? If a patient has a blood pressure cuff, they need to be taking their blood pressure. That data needs to be transmitting to their physician practice 16 out of 30 days. This is an exciting area where there's a proposed change in the 2026 physician fee schedule to allow for 2 to 15 days as a separate billable code. And you know, those of us who've worked in the industry for a number of years are excited about this, because 16 was a little bit arbitrary, right, of how they came up with that number originally when they came out with RPM codes. You know, we can all presume it was because it was more than half of the 30 days, right? So they came up with 16, but that may not be medically necessary for every patient. Speaker 1 00:04:51 And so allowing for greater flexibility will allow for more patients to benefit from these programs. Speaker 3 00:04:58 And in your analysis, you also talked about the possibility of a new treatment management service code that is proposed. What would that code do? Speaker 4 00:05:06 So similar to. Speaker 1 00:05:07 The data transmission code there's a code. Well there are two codes 994 579-9458 which are time based codes. And they're measured in 20 minute increments of time spent reviewing that patient's data, communicating with that patient, coordinating care regarding that patient. But there was a similar problem that if the practice didn't meet the 20 minutes, then there was no billable activity. So, for instance, they might have been interacting with that patient, reviewing their data, and accumulated 15 minutes over the course of the month. And they weren't able to build anything for that time. So there's a newly proposed code that would allow for ten minute increments of billing. And again, that may be appropriate for a good number of patients and will allow those patients to participate in these programs and allow practices to sustain RPM programs for a broader base of patience. Speaker 3 00:05:59 One of the things that you had mentioned in your analysis was talking about how the new codes, and you've already touched on this, even in conversation here, but you had talked a little bit about how the new codes and changes could offer increased flexibility for RPM programs, and based on that theme of flexibility and medical necessity. Could you elaborate a little bit more on that? Why is that important? Speaker 1 00:06:20 Sure. I mean, I think it's important for us all to remember that, you know, foundationally, the purpose of RPM is to improve outcomes for patients, right? That's why CMS pays for this activities, because they believe that proactively monitoring and managing patients outside of the clinic will improve their outcomes and, you know, ultimately reduce cost. and so, you know, if you think about a population of patients, they don't all need the same intervention, right? Not every medical condition is the same and requires the same amount of monitoring. Speaker 4 00:06:56 So you could compare. Speaker 1 00:06:57 For instance, diabetes for. Maybe it's appropriate that a patient needs to check their blood glucose every day to, you know, weight loss where they don't necessarily, you know, need to weigh themselves every single day. Speaker 1 00:07:11 And so having this flexibility in the number of days of readings or in the amount of time spent, allows for clinical judgment on the part of the provider of what kind of intervention does this patient need? it allows practices to sort of triage patients and be a little bit more strategic with the time that their clinical team is using to engage their population and really provide appropriate level of care to each patient who's in the program. Speaker 3 00:07:42 Maybe to continue with that train of thought with added flexibility. Do you think that that will become a characteristic, say, or a facet that may be more appealing to physicians who have thought about implementing an RPM program, but haven't taken that step yet? Speaker 1 00:07:58 You know, as I've spoken with physicians about this, I do think there's an aspect where it gives them some downside risk protection. And what I mean by that is, you know, the practice is providing these devices to the patients as part of the RPM program. And that's really what that 99454 code is, you know, reimbursing the practice for, for, you know, giving a blood pressure cuff to the patient and having a system that transmits the data in the current system. Speaker 1 00:08:27 If that patient doesn't reach 16 days, the practice doesn't get reimbursed anything that month. And so having this flexibility where they could be reimbursed, the patient goes on vacation. They forget to take their blood pressure cuff with them. You know, things happen in life that get in the way of, you know, every single day doing exactly what your physician asked you to do. and so I do think it makes, the programs a bit more appealing to some physicians who worry that there's a real cost to those devices and they could end up losing money on the program. You know, everyone should be doing this because they believe it will benefit their patients, but it also has to be financially sustainable model. Speaker 3 00:09:08 Absolutely. And that's something that for our physician audience, we like to emphasize and make sure that they I mean, you're a doctor. I don't have to tell you how hard the market is out there sometimes. but especially for smaller and medium sized independent practices, they have a tough road to hoe. So it's and not enough hours in the day. Speaker 3 00:09:25 So it's one of those things that, maximizing both time and the financial finances along with patient benefits is super important. Speaker 1 00:09:33 Absolutely. Speaker 3 00:09:35 And this is something that, of course, makes headlines. We've written about umpteen times. And we'll continue to and that's regarding actual physician reimbursement. Are there any hints or predictions on what could happen to RPM reimbursement rates for 2026? Speaker 1 00:09:54 Yeah, this was another exciting part of the draft physician fee schedule. Is that CMS is saying they want to, you know, hold the RPM rates where they've been. And I think there had been a recommendation by some parties to decrease the reimbursement rates around RPM, and they have signaled that they're not going to do that. And I believe overall that there's going to be a rate increase to physicians. But that's really good to see specifically in RPM that the CMS came out and said there's not enough evidence to say that there should be a rate decrease. And so they plan to hold it steady and continue to review the data. and again, I think that's important. Speaker 1 00:10:32 There's there's a slim margin in the RPM business. These code changes will help because as we've discussed it gives practices some downside risk protection. Right. You get 18 minutes not 20. You can still bill for something. You get 14 days of reading not 16. You can still bill for something. So I think the combination of holding the rate steady and providing this flexibility where it's not all or nothing. It's really impactful to practices. Speaker 5 00:11:04 Say, Keith, this is all well and good, but what if someone is looking for more clinical information? Speaker 6 00:11:10 Oh, then they want to check out our sister site, Patient Care Online. Com the leading clinical resource for primary care physicians. Again that's patient care online. Com. Speaker 3 00:11:23 And one of the things that you wrote about yourself and we've met we've covered on different occasions dealing with especially documentation and audits and kind of emphasizing that. How would you describe the importance of documentation in RPM programs? Speaker 1 00:11:40 Well, kind of tying back to that previous question around, you know, reimbursement rates, you know, documentation is all of our friend because it's really demonstrating what patients are being enrolled, you know, what benefit they are gaining from the program, what kind of device they're using. Speaker 1 00:11:59 And, you know, as you know, last fall we saw a report come out of OIG, talking about RPM programs and sort of their assessment and some concerns they had. And I think a lot of those concerns can be addressed through documentation. And, you know, nobody loves documentation. I know my, you know, physician colleagues won't made out like that. I'm saying that. But, you know, the more data that's captured and reported to CMS, the better job we can do on analyzing that data and demonstrating the impact of the program. And so I think, you know, data such as what diagnosis, what kind of device and what was the outcome is really important to build the case long term for these modalities of care to continue to be reimbursed. Speaker 3 00:12:43 You know what in not to belabor that point, but you got the wheels turning for me here because I'm thinking about not just, well, sort of maybe two related elements, if I may, and I'm kind of winging it here. So bear with me for just a moment, but, Regarding that importance of the documentation, and especially given the current administration's attempts to tackle waste, fraud and abuse in health care, how will that come into play? Would you anticipate? Speaker 1 00:13:12 you know, they're in any market. Speaker 1 00:13:14 Health care. Non health care. There are always bad actors right. And so I think many of us welcome the scrutiny. because we don't want a few bad actors to ruin the market for everyone who's running these programs appropriately and enrolling the right patients. And so that's sort of how I think of it. As, you know, we welcome the scrutiny to say, you know, are the right patients getting enrolled? Are they receiving the right level of care, and weed out the folks who are trying to, you know, take advantage of the system, if you will. Speaker 3 00:13:45 And, you know, we've talked a little bit about actually, we've talked quite a bit about here about some of the different financial elements that will affect remote patient monitoring in the 2026 Medicare physician fee schedule. One thing I definitely wanted to ask about, though, is that with RPM programs, that does allow, you know, physicians and assisting companies to compile a lot of patient data about the actual patient medical care, their health care, their health. Speaker 3 00:14:10 Are you aware of any maybe scientific studies or, research going on right now that looks at those results and is pointing to some success stories, or maybe some areas that need improvement? Speaker 1 00:14:21 You know, I think we are amassing a body of evidence to support the benefit of this kind of proactive management within the sort of general concept of remote monitoring. Right? There are all sorts of different use cases. And by that I mean within the patient journey. Right? So immediately post discharge after starting a new medication after getting a new diagnosis. And I think that level of granular data is what's going to be very interesting to look at over the coming years as these programs grow and scale. And we can start to sort of subsegment patient populations and say, where are these programs really most beneficial both clinically and financially? so that's what I anticipate we'll see down the road, because I think we've seen the general impact on improvement in blood pressure improvement and glycemic control, you know, reduction and readmission for heart failure. Now, the question is, are there certain patients who are even more likely to benefit than others, and how do we target them? you know, with specific interventions. Speaker 3 00:15:28 This is something that has come up, and I'm going to be curious to hear your thoughts about sort of an intersection on what we just talked about, both with patient data and what I like to call the AI question that comes up now in every interview in the last few years, artificial intelligence and large language models have become potentially revolutionary technology in healthcare and in other fields. How do you anticipate AI will change remote patient monitoring. Speaker 1 00:15:55 You know, I think more than anything it will bring efficiency to it, right? That, I, you know, computers in general are better than human beings, often at seeing patterns and data. At least they do it more efficiently than we do. And so I think the ability to serve up insights to the, you know, learned intermediary, the the nurse, the physician, the pharmacist that might not otherwise be apparent to them will be extremely helpful. and, you know, back to the physician fee schedule aspect of it. I think we're going to have to, at the same time, think through, how do we compensate for, you know, I assisted technologies because, as you know, many of the sort of the basis for the CPT system is time and complexity. Speaker 1 00:16:45 And so if we improve efficiency by using AI and that decreases the amount of time, does the physician then get paid less for that intervention, even though the complexity may be the same. So there's a lot to work through there, and I know there are groups currently looking into that and working on that as we speak. Probably not for 2026, but I think for 2027. Speaker 3 00:17:06 Wow. That's going to be an interesting element to see in the future. you know, obviously, from a from a patient's perspective, of course, the better the healthcare, hopefully the better for the patient. I mean, that's, you know, that's that's the ultimate goal. I'll be very curious to see how that develops, though. I really like that point because nobody's quite really articulated articulated it like that in our in my conversations at least. So. Very cool. You know, this was something, maybe a little bit off from the Medicare physician fee schedule, but I'm curious about your thoughts on this one. HHS Secretary Robert F Kennedy, Jr has expressed some enthusiasm for use of wearable medical devices as a way to improve individual patient health. Speaker 3 00:17:52 How would you describe sort of the overlap or interaction between wearable consumer health devices and more formal RPM programs? Speaker 1 00:18:02 sure. This you know, this has been a topic for a while. And, before this current administration, even of, you know, conversations of should wearables be part of RPM programs? And, you know, I think that you really have to think about what's the the medical necessity or the evidence. Right? Because I am all for health and wellness and, you know, self-efficacy by patients. I don't know that we are ready to bridge that yet for that to be part of sort of the mainstream medical, you know. Does your doctor want to know how many steps you took today? And, you know, figuring out that intersection between consumer health and, you know, health care you receive from your physician is something that we really haven't quite bridged yet outside of maybe concierge medicine practices, and we're integrative medicine practices, but we really haven't seen that come over into mainstream medicine. so I don't know, I today, moment in time, I don't believe that putting a wearable on every wrist is going to solve our chronic disease problem. Speaker 1 00:19:10 I think it will, you know, improve the general health of our population. But I think it's an aunt, not an or. Right. I'd love it if everybody had a better understanding of the importance of nutrition and activity and their life and their health, but at the same time, we need to support those individuals who do have a chronic condition that they're managing, like diabetes or hypertension. And a wearable alone is not going to solve that. Speaker 7 00:19:44 Hey there, Keith Reynolds here, and welcome to the P2 Management Minute. In just 60s, we deliver proven real world tactics you can plug into your practice today, whether that means speeding up check in, lifting staff morale, or nudging patient satisfaction north. No theory, no fluff, just the kind of guidance that fits between appointments and moves the needle before launch. But the best ideas don't all come from our newsroom. They come from you got a clever workflow hack and employee engagement win, or a lesson learned the hard way. I want to feature it. Speaker 7 00:20:13 Shoot me an email at Kay reynolds@lifesciences.com with your topic, quick outline, or even a smartphone clip. We'll handle the rest and get your insights in front of your peers nationwide. Let's make every minute count together. Thanks for watching and I'll see you in the next P2 management minute. Speaker 8 00:20:33 You know what? Speaker 3 00:20:34 This was something that I didn't really have down on my list of questions, but it is something else that we cover quite a bit, you know, involving healthcare technology, not just RPM, but the notion of cybersecurity and patient data, you know, privacy and data security in healthcare. Anything on the horizon, anything currently happening say that would indicate any vulnerabilities for RPM programs in terms of a cybersecurity perspective. Speaker 1 00:21:05 You know, certainly our experience at remedy is that we are being asked to more and more tightly integrate to the clinical workflow and the electronic health record, right. So as soon as we are touching that patient's health record, in addition to all the patient generated data from their RPM device, you know, we have an obligation to protect, you know, that data and take all of the measures we can. Speaker 1 00:21:29 So, you know, we have our SOC two certification and our high trust certification. And a lot of, you know, investment in infrastructure in order to protect patient data. I think the industry is finally getting there. I think, you know, with a lot of the expansion of RPM happening during the, you know, 21, 22 time period coming out of the pandemic when there were sort of we were, you know, a little bit in crisis mode there. Coming out of the pandemic. People weren't as focused on it probably as they should be. but absolutely, you know, if you look at healthcare data breaches, they are very often through a third party vendor. And so I think, you know, health systems who are implementing these programs need to treat it just like they do any other IT system that they interface with and hold people to, you know, those high standards of cybersecurity and data protection. Speaker 3 00:22:24 Excellent. And one of the things that as we speak here today, it's the end of July. Speaker 3 00:22:31 And technically we're still in the public comment period, as I understand it, for the the 2026 Medicare physician fee schedule, which is, as of right now, actually a draft form. And I just didn't know if out in the industry, you know, whether it be, technology companies or at a policy level in government. Has there been any rumblings about, a lot of protests about the changes, at least according or at least regarding remote patient monitoring? Speaker 1 00:23:04 I don't think there's been a lot of protest. I mean, this was signalled, over a year ago that they anticipated introducing these two new codes in RPM. So I think that gave people really time to think about it, debate it before this draft physician fee schedule came out for 2026. So that part of it has felt pretty stable to me. one question I have is it is proposed that the new 2 to 15 days of readings would be reimbursed at the same level as the 16 days of readings. I think that's a really interesting aspect, and I look forward to reading the public comment on that of whether people agree or disagree with that. Speaker 1 00:23:45 as well as the comment on, you know, the ten minutes, you know, should ten minutes be reimbursed at half the rate of 20 minutes. Right? So the actual reimbursement rates, I think will get, you know, a lot of commentary and input from the market. But I don't think that there's anything about sort of this expansion of RPM that has been very, you know, disruptive. I think people saw it coming. Speaker 3 00:24:13 Excellent. Okay. And I'll tell you what I was going to say. We covered a heck of a lot of ground in a short amount of time. It's been a great introduction to some of these proposed changes. And, you know, one question I always like to throw out there as well. Our main audience is primary care physicians. What would you like to say to them or what would you like them to know? Speaker 1 00:24:32 Yeah, I think sort of back to where we started the conversation of really hoping that folks, after, you know, five years of stability with RPM, can sort of stop thinking about it as this innovative, novel new modality of delivering care. Speaker 1 00:24:48 And it can really just become part of how health care is delivered, because there are so many patients who can benefit from the follow up. outside of the clinic. And there are so many practices who can benefit from the financial support this program gives, which sometimes I remind them the alternative is a lot of uncompensated care, right? Games of phone tag with patients between the nurse and the patient, and portal messages, an activity that the practice probably isn't getting compensated for. So sometimes I think folks don't think through it that way of, you know, by by enrolling your more complex patients into a program like this, you can not only deliver a better outcome, but you can also get compensated for time that you might very well be spending today and just not getting paid for it. Speaker 3 00:25:35 You know what, doctor, if I may, this was something that we didn't touch on that I probably should have thrown out there because and I think that we may have talked in the past and, and, you know, some other industry experts have mentioned about patient reaction and response when their physician suggests a program like this. Speaker 3 00:25:51 I'm sure that there are some patients who think, oh, brother, this is just one more thing for me to do in my already busy day. But there are also some patients, it sounds like, who may respond really well and become maybe a little bit more excited about their health care. And can you talk a little bit about what's been your experience with patient response? Speaker 1 00:26:09 yeah, that's a great question. And I think gets to sort of patient selection is a really important aspect of these programs. You know, it's not going to be for everybody that, you know, if that patient is not enthusiastic about, you know, measuring their blood pressure at home, you may need to do additional work with them before you enroll them in a program like this. You know, if you truly believe they'll benefit. So I think it's about really helping the patient understand what's in it for them. And a lot of times that's convenience, right? It's hard to get time off of work. Get to the doctor. Speaker 1 00:26:43 Maybe you need to get a ride from, you know, a caregiver or spouse or child. So, you know, I think the patient response, you know, by and large is really positive. Once they understand what's in it for them, in that way, it doesn't feel like, oh, I'm just being asked to do something else. Right. So that that has really been one key aspect. We still do hear about friction from copays. And again, you know, we really encourage all of our practices. You know, make sure that you understand for the different plans that your patients are on, what their copay structure is going to be. Make sure that the patient understands that because nobody likes surprises. and generally we find patients, if they see value in the program, they're not going to push back on the copay. Speaker 3 00:27:33 I'll tell you what, doctor. It's been a great conversation here about remote patient monitoring and some changes that may be coming up next year. If I have follow up questions, I'll certainly reach out via email, but I just appreciate you taking the time. Speaker 1 00:27:45 Yeah. Great to see you, Richard, as always. Speaker 3 00:27:47 Oh, you as well. Thank you so much. And otherwise just have a great rest of the day and rest of the week here. Speaker 1 00:27:51 Thanks. You too. Speaker 9 00:27:52 Thank you. Bye bye. Speaker 2 00:28:00 Once again, that was a conversation between Medical Economics senior editor Richard Payerchin and Dr. Lucienne Ide, CEO of Rimidi. My name is Austin Littrell, and on behalf of the whole medical economics and physicians practice teams, I'd like to thank you for listening to the show and ask that you please subscribe so you don't miss the next episode. You can find us by searching off the chart wherever you get your podcasts. Also, if you'd like the best stories that Medical Economics and physicians practice publish delivered straight to your emails six days of the week, subscribe to our newsletters at Medical Economics comm and Physicians Practice Comm. Off the chart A Business of Medicine podcast is executive produced by Chris Mazzolini and Keith Reynolds and produced by Austin Littrell. Medical economics, Physicians Practice, and Patient Care Online are all members of the RM Life Sciences family. Speaker 2 00:28:43 Thank you.