Remote Therapeutic Monitoring: Implications for Physical Therapy Operators

Written by Clark Wilson, CVA; Greg Begun; and Ash Midyett, CFA

In the broadest sense, remote monitoring refers to a physician assessing a patient’s health through the use of a medical device or software while physically away from the patient. There are two main types of remote monitoring: remote patient monitoring (RPM) and remote therapeutic monitoring (RTM). RPM focuses on gathering physiological data from medical devices attached to the patient’s body, while RTM focuses on non-physiological data that is generally self-reported.  

As it relates to physical therapy, RTM can be used to treat and monitor a wide range of conditions, including musculoskeletal conditions, respiratory conditions, geriatric conditions like osteoporosis, and others. Given the broad range of RTM services, there is a growing list of software providers targeting specific and use cases. Some of these entrants include Medsien, Owlytics Healthcare, and Zimmer Biomet, all of which have proprietary RTM software platforms.  

Clinical Consideration

The clinical advantages of RTM include improved adherence to treatment plans, enhanced recovery speeds, reduced re-injury rates, and increased patient satisfaction and engagement.  Reducing the chance of reinjury and the number of post-injury visits may increase member satisfaction while enhancing data collection to improve treatment and outcomes.  Practices may also see increased patient volumes through improved patient access to care and diagnostics, while minimizing the need for unnecessary in-person appointments. 

As a new method of patient engagement, research on the efficacy of RTM remains limited. While research often considers remote monitoring as an effective method of treatment for many conditions, limited research specific to RTM exists for physical therapy applications. Additionally, critics often cite data privacy concerns as a primary headwind for further industry adoption.  

Billing

In response to the growing adoption of RPM and RTM, the Centers for Medicare & Medicaid Services (CMS) first introduced CPT codes for RPM in 2018 and for RTM in 2021. Since the CPTs were first introduced, CMS has amended billing rules multiple times in response to the pandemic. As of the 2024 Final Rule, CMS allows for billing “incident to” under the direct supervision of a qualified provider (physical therapists, occupational therapists, and speech-language pathologists). RTM and RPM must also be delivered via an approved medical device (which may include software) as certified by the FDA. 

The care lifecycle for RTM can generally be characterized by an initial diagnosis, in person or via a telehealth visit, followed by periodic monitoring of the condition, telehealth check ins, or exercise appointments. A provider must monitor a patient for at least 16 days of a 30-day period. As the typical physical therapy course of treatment can range from a few weeks to a couple months, it is easy to understand how RTM may be worked into the treatment life cycle. 

RTM is newer than RPM, and payers have been slower to adopt coverage for RTM services as a result. Approved codes are relatively narrow in the scope of conditions covered. Medicaid coverage varies by state, and many states do not have a clear policy around reimbursement. Similarly, commercial payers have been slow to adopt coverage and are generally less likely to cover RTM than RPM.

RTM presents a unique opportunity for physical therapy practices to add an additional revenue stream without significant, up-front investment of time or capital and may broaden the practice’s eligible market for care. With the nearly ubiquitous adoption of mobile phones and growing popularization of fitness wearables, the cost of care for physical therapy RPM and RTM is primarily driven by the cost of software to administer the service ($15–$40 per month) and clinician time.

Industry Outlook

The RTM industry is in the early stage of the industry lifecycle, characterized by fragmentation, high margins, and a robust growth outlook. Current estimates by the Bipartisan Party Center suggest RPM adoption has been limited but is growing quickly, with 594 monthly claims per 100,000 Medicare enrollees as of 2021, which represents a six-fold increase since 2018. It is too early to say whether RTM will follow a similar growth trajectory. Statistics on usage and efficacy remain limited given the novelty of the technology and the fragmentation of its end market. For instance, there are over 37,000 outpatient rehabilitation clinics in the United States with the largest provider only controlling approximately 5% of the market.  

In recent years, the adoption of RPM and RTM has been catalyzed by three primary headwinds: technological progress and the proliferation of mobile devices, an industry-wide shift toward value-based care, and the COVID-19 pandemic. For years, insurance payers, regulators, and thought leaders have heralded the adoption of value-based care initiatives to better align the cost of care with improved patient outcomes. RPM and RTM facilitate data collection and may improve patient outcomes while reducing costs through enhanced recovery speed, improved adherence to treatment plans, reduction in re-injury rates, and improved patient satisfaction and engagement. As value-based care continues to gain market share, RTM technology will likely benefit. The confluence of expanded coverage, patient demand, clinical research, and value-based care advocacy will likely bolster RTM adoption among physical therapy providers. While growth projections remain limited, Global Market Estimates predicts annual RTM market growth in the high teens over the coming years. Physical therapy business operators will likely continue to adopt RTM.

Sources

Physical therapy and remote patient monitoring. (2022). Telehealth.HHS.gov.   https://telehealth.hhs.gov/providers/best-practice-guides/telehealth-for-physical-therapy/physical-therapy-and-remote-patient-monitoring 

Saag, JL & Danila, MI. (2022). Remote Management of Osteoporosis. Curr Treatm Opt Rheumatol. DOI: 10.1007/s40674-022-00195-4. Epub 2022 Sep 2. PMID: 36068838; PMCID: PMC9438367. 

ROI of RPM CCM and RTM. (n.d.). Humhealth. https://www.humhealth.com/blog/roi-of-rpm-ccm-and-rtm/ 

Remote Patient Monitoring (RPM) CPT Code Billing Summary. (n.d.). Healthsnap. https://healthsnap.io/resources/rpm-billing-overview/#:~:text=CPT%20Code%20Billing%20Summary&text=In%202018%2C%20CMS%20began%20providing,reimbursement%20associated%20with%20these%20codes. 

Centers for Medicare & Medicaid Services (CMS). (2022). CMS Manual System. CMS. https://www.cms.gov/files/document/r11118cp.pdf 

CMS.gov. Calendar Year (CY) 2024 Medicare Physician Fee Schedule Final Rule. (2023). CMS. https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-medicare-physician-fee-schedule-final-rule 

Thomas, JJ. (2022). How long is physical therapy session? Primal Physical Therapy. https://primalphysicaltherapy.com/how-long-is-physical-therapy-session/ 

Curtis, J., et. al. (2024). The Future of Remote Patient Monitoring. Bipartisan Policy Center. https://bipartisanpolicy.org/report/future-of-remote-patient-monitoring/ 

U.S. Physical Therapy (USPh). (2024). USPh IR Presentation Q1 2024. U.S. Physical Therapy. https://www.usph.com/wp-content/uploads/2024/05/USPH_IR_Presentation_Q1_2024_FINAL.pdf 

Global Market Estimates (GME). (2024). Global Remote Therapeutic Monitoring Market Size. Global Market Estimates. https://www.globalmarketestimates.com/market-report/remote-therapeutic-monitoring-market-3954#:~:text=The%20global%20remote%20therapeutic%20monitoring,getting%20infected%20by%20the%20virus