Whether in a Fee-for Service (FFS) and more so in a value-based/capitated reimbursement model program costs are critical. Typically, we see competitive promotions orclients share how Remote Patient Monitoring (RPM) is described to them –surprisingly it’s all about the maximum revenue opportunity - make $198 perpatient per month (PPPM) – as easy as that. While possible, it’s not probable.
While the top line revenue is always compelling,it’s the net profits that tell the story. Before continuing, let’s be clear - the RPM objective is to ensure the patient has a maximum opportunity to achieve a greater state of wellness. This insight is hoping to educate adopters howbest to maximize financial performance while delivering upon the clinical objective(s).
There are two major cost elements that heavilyimpacts the financials:
Let’s dive into each of these points.
While a provider does need to demonstrate a financial investment associated with the medical device, there are three options toconsider as to how to acquire these devices:
Let’s assume that the device MSRP of a cellular bloodpressure device cost is $120 (inclusive of the first-year cellular costs) and comes with a 1-year warranty. When achieving the 16-day measure (CPT 99454), the average reimbursement is $50/month – within 2.5-months, the cost of this device is covered. However, more often new clients tell us theyare currently leasing the same medical device for $25/month for the duration ofthe program; given the life of the device extends 3-plus years. Over the projected life of the device, the cost of the device will be $900. There are alternatives within a launch methodology that mitigates this cost.
An equally critical consideration, when building your RPM program, is to ensure that the patient engagement element maximizes the opportunity to achieve the 16-day measure compliance. Having an ongoing cost of $25/month for adevice and not having reimbursement revenue further impacts overall operational cash flow. As outlined, the credibility of earning $198 PPPM, requires further due diligence.
The concept of device leasing was outlined above – the best approach is to pay for the devices upfront. If this is not possible, establish an iterative rollout; work within your budget and expand as funds from current profits can fund the next iterative growth phase. Ultimately, one should avoid paying 750% more for a device.
Also, ensure you are not paying a flat rate per patient per month regardless of achieving targeted performance criteria. In the end, no performance means no payment –it doesn’t matter if you are operating in an FFS or a value-based program.