Late last year, the Centers for Medicare & Medicaid Services (better known as CMS or, simply, Medicare) made some changes to the way it covers remote patient monitoring programs like myNurse.
The most significant change for myNurse members was Medicare’s new requirement that we collect a minimum of 16 days’ worth of measurements each month from members in our remote monitoring program, which is an increase from previous requirements.
Here we take a look at some of the details of these new requirements, the reasoning behind them and how more readings can help as you tackle health issues like high blood pressure or diabetes.
The 16-day minimum requirement
According to the 2021 Medicare Physician Fee Schedule, remote patient monitoring programs must collect and transmit information like a patient’s blood pressure or weight on at least 16 days for every 30-day period in order for Medicare to cover two key billing codes: CPT 99453 (which covers time spent setting up devices like blood pressure monitors and teaching patients how to use them) and CPT 99454 (which covers the cost of the devices themselves). Or, as the fee schedule’s final rule puts it, Medicare will only cover these services “once per patient, per 30-day period, and only when at least 16 days of data have been collected.”
Unless you’re a doctor or medical billing specialist, this may all sound like gibberish. CPT? Fee schedule? Final rule?
The long and short of it is that Medicare will no longer cover the key services patients need to meaningfully participate in a remote health monitoring program – getting set up with devices, regularly measuring their vitals and sending that information to their care team – unless the program collects readings from patients on at least 16 days out of the month.
The why behind the rule
Now, you may be wondering: Why 16 days?
The short answer is that in order to track progress and ultimately have a positive impact on a person’s health, remote monitoring programs need to consistently collect readings from their members, and Medicare has decided that 16 days’ worth of readings per 30-day period is the minimum amount needed to meet that goal.
After all, there’s not much point in a doctor setting up a remote monitoring program and sending patients a blood pressure monitor, but then never collecting or reviewing any blood pressure readings.
Without consistent insight into the ups and downs of a person’s blood pressure, weight or other relevant health information, doctors and nurses are left in the dark on how patients are managing their health between clinic visits and won’t be able to intervene proactively to help with ineffective medication or side effects. They also lack the information they need to offer personalized care and advice that can help patients improve their health long term.
That’s why Medicare decided the 16-day requirement was needed to ensure that remote monitoring programs have a chance to make a real difference in the health of patients and that patients are able to build a meaningful relationship with their care team.
Benefits of more readings
All that aside, if you’re trying to tackle high blood pressure, manage your weight or keep your blood sugar in check, the important thing to know is that taking regular readings will almost always get you closer to reaching your health goals.
For example, if you’re trying to control your weight and wondering how often to weigh yourself, researchers have consistently found that weighing yourself daily was even more effective at managing weight than weighing only a few times per week. Not only that, but weighing more frequently has also been shown to help people lose more weight over time.
The same goes for blood pressure. Studies have shown that measuring more often can make a big difference in how well patients are able to manage high blood pressure. Indeed, one study on the impact of home blood pressure telemonitoring found that remote monitoring of blood pressure, combined with support from a case manager, helped patients achieve better control over their blood pressure not only during the 12 months in which they were part of the monitoring program, but also for six months after the program ended.
In an article about that study, Dr. Deepak Bhatt, Executive Director of Interventional Cardiovascular Programs and a professor at Harvard Medical School noted how more frequent measurements, coupled with monitoring, can help doctors intervene more effectively: “More frequent blood pressure monitoring allows more opportunities to detect blood pressure that is higher than the desired range. That may trigger more intensive treatment of elevated blood pressure.” Or, as the article notes from the patient’s perspective, “if you stay on top of it, you’ll do a better job of treating it.”
There’s nothing magical about taking a reading 16 days out of the month, but doing so should help you to be more engaged and accountable. That’s because this sort of “self-monitoring” creates a natural feedback loop, where you track your blood pressure or weight, see how your numbers change and use that feedback as a source of motivation. You start to think to yourself, “I really can see changes if I follow my plan.”
So while weighing yourself or taking your blood pressure 16 days out of the month may be the minimum required to be in line with Medicare’s rules for remote monitoring, when it comes to health measurements like these the truth of the matter is simply: the more often, the better.