Remote Patient Monitoring (RPM) and Chronic Care Management (CCM) are two different approaches that clinicians and healthcare providers might utilize – but these are two distinct medical monitoring solutions and have variances for both practitioners and patients.
In short, both RPM and CCM are value-based healthcare services intended to augment the quality of care delivered to the patient while supporting cost and time efficiencies for clinicians and providers.
However, the contrast is that CCM is all about comprehensive chronic condition management and establishing informed care planning. RPM is centered around real-time tracking of patient measurements to swiftly identify any changes in their condition and take preventative action to avoid deteriorations in patient well-being and prevent hospitalizations and readmissions.
Remote Patient Monitoring vs CCM Explained
For those outside of the medical profession, RPM and CCM may sound fairly similar. Physicians and clinicians must explain how these services compare and differ if they offer both options for patients.
From a healthcare provider’s perspective, there are also considerations around the cost, scalability, and suitability of RPM and CCM depending on patient demographics and cohorts, the capacity and scope of the service, and which options will best meet the needs of the target patient group.
Chronic Care Management (CCM)
CCM, as the name suggests, is designed for patients with two or more chronic illnesses. Chronic conditions require long-term management and oversight, with CCM often introduced as a way to maintain communications between in-person appointments.
A physician with a CCM patient care program might make regular calls to their patients or schedule video calls, as well as offering educational resources and target setting to help patients contribute to their own care management.
Read more: RPM for chronic pain management
Remote Patient Monitoring (RPM)
RPM equally involves regular interactive consultations, normally via video chat – however, the service monitors patient health remotely, using FDA-approved data collection devices. The patient will take their readings as prescribed – perhaps blood pressure, blood oxygen, and weight – with data transmitted automatically to the practitioner for analysis and review.
Clinicians and patients can access the same real-time measurements and how these have changed over time. The healthcare service uses this data collection process to adjust medications, care plans, lifestyle recommendations, and treatment protocols. Read more about the benefits of remote patient monitoring here.
While some elements of CCM are remote, RPM is ideal for patients with barriers to access, such as being a long distance from a healthcare facility, having limited mobility, or other factors that make it challenging or impossible to attend regular face-to-face appointments.
Key Differences Between CCM and RPM
As our summary explains, the primary difference between these two services is that RPM provides remote healthcare monitoring, whereas CCM provides ongoing patient support between visits.
Both modern healthcare services can benefit patients and practitioners, but the right solution depends on the patient groups and prevalent conditions being managed and monitored by the provider.
CCM is often a good option for:
Services treating patients with complex or serious chronic diseases.
Patients needing regular support and guidance with multiple chronic conditions.
Patients who require ongoing communication between visits.
RPM is particularly well suited to:
Patients already following a care plan or taking medications who require regular tracking to supervise their condition or overall welfare.
Healthcare providers managing patient groups in rural areas or where most patients find it difficult to attend regular appointments.
Preventing hospitalizations, readmissions, and medical complications, especially for patients with chronic conditions such as diabetes, heart failure, and COPD.
Both services have been shown to lead to improvements in patient outcomes, better experiences and satisfaction with the healthcare provided, and enhanced revenues and efficiencies for healthcare services.
It is possible to combine CCM and RPM to maximize the advantages, such as when using CCM for a patient with a chronic condition, while using RPM to monitor the symptoms of that condition and intervene when measurements indicate a potential medical emergency or cause for concern.
Understanding the Medicare Billing Codes for CCM and RPM Services
The Medicare Fee Schedule uses CPT code 99490 for CCM services. This complex care CPT code becomes claimable with an initial 20 minutes of time contributed by a physician, clinical staff under the supervision of a physician, or another appropriately qualified medical professional.
CPT 99490 is claimable once per calendar month and once per patient during each billing cycle. Healthcare providers can submit CPT 99490 claims when a patient has two or more chronic diseases or conditions that are anticipated to last at least one year or for the patient's lifetime.
Providers can claim the code for care coordination services, patient management and communications, care planning, and providing educational information. Care plans must be created by a physician with specific objectives or medical goals.
RPM services have multiple billable CPT codes, split into:
CPT 99453 – for setting up an RPM device and patient education about taking readings.
CPT 99454 – billable monthly for remote monitoring and assessing readings submitted.
CPT 99457 – claimable once per month for patient management and treatment.
CPT 99458 – an additional CPT code where care services exceed the 20-minute threshold applied to CPT 99457 claims.
Some RPM CPT codes are reimbursed only once, such as when a provider submits a claim for the supply of a device. Others are claimable once per 30-day billing cycle or multiple times per month where there is a demonstrable need for a higher degree of patient interaction. You can read more about RPM billing requirements here.
Alternative Ways to Deliver Virtual Patient Care
RPM and CCM are among the most widely used forms of virtual care management, responding to patient needs and making professional medical care and supervision more accessible and viable financially for the service provider.
The key objective should always be to respond to the needs of the patient and to offer services that are most beneficial to the provider and service users, whether to maximize the use of resources, ensure the provider can support growing numbers of patients, or manage a higher prevalence of chronic diseases without a corresponding reduction in care quality.
For more information about remote patient monitoring solutions and CCM, introducing virtual patient care within your healthcare service, or comparing turnkey solutions for expedited implementation, please get in touch with the Wanda Health team at any time.