Reinstating Co-Pays for Remote Patient Monitoring: A Barrier to Equitable Healthcare

Updated on September 1, 2023

Remote patient monitoring is a relatively new and insurance-reimbursable medical service that can complement telehealth. Patients utilizing a physiologic biosensor device and/or a software app monitoring vital signs can share data with their healthcare team to reduce emergent care and be proactive with health problems. In other words, remote monitoring enables healthcare providers to see how patients are doing outside of clinical settings, such as at home or in a remote area, increasing access to care and with the potential to decrease healthcare delivery costs. Since the start of the pandemic, the out-of-pocket responsibility for patients was waived as part of the Public Health Emergency (PHE) provisions. Unfortunately, the termination of the PHE on May 11, 2023, reinstated patient co-pays for two types of services, Remote Physiologic Monitoring (RPM) and Remote Therapeutic Monitoring (RTM), creating a significant setback for accessible, innovative healthcare. As our nation establishes a new normal post-pandemic, discontinuing the co-pay waiver appears not just out of step with modern healthcare but an affront to those in need.

Let’s start with the fact that healthcare in the United States is often difficult to access, particularly for those in rural areas and with limited incomes.A health system built on equity should ensure every citizen has access to the healthcare services they need, regardless of geography, ability, or wealth. The expanded availability of telehealth and digital health services like RPM and RTM, coupled with eliminating the RPM/RTM co-pay during the 3-year Public Health Emergency, was a big step toward achieving that ideal.

Commercial insurance often mimics coverage decisions made by the Centers for Medicare & Medicaid Services (CMS). With the co-pay reinstated by CMS, commercially insured people will now incur an annual cost of up to $240 or more yearly for remote monitoring. Compared to typical out-of-pocket costs for in-person office appointments of three or four visits per year (i.e., $80/year), remote monitoring co-pays are now expensive for patients, potentially compromising their access to RPM/RTM services. Such policy shift creates a significant barrier for people most needing care. Because of the new out-of-pocket requirements, many patients are declining their physician’s remote monitoring offer. For example, in a large national network of rheumatology practices that were routinely enrolling an average of 50 patients each week into remote monitoring services from the five highest performing doctor’s offices before May 11, now it is not unusual to enroll no more than one or two per week in the same time frame. In today’s economy, where patients scrutinize every dollar spent, many people may forego valuable service RPM/RTM services that can improve patient care. For most, it’s a choice between necessities and health, a choice no one should make.

Furthermore, most low-income earners are hourly wage workers, which makes taking time off to visit a doctor’s office extremely difficult during regular working hours.RPM and RTM provide a much-needed lifeline, allowing such individuals better access to their healthcare provider and care team between office visits without losing wages or risking their jobs. But with the co-pay now reinstated, many low-income patients are back to choosing what healthcare services they must sacrifice.

Unfortunately, this dilemma isn’t just a socio-economic problem; it’s a racial and ethnic one as well. Health disparities across racial lines in the U.S. are well-documented.Often, it’s communities of color that disproportionately work hourly jobs, live in low-income households, and face transportation issues. By disincentivizing the use of remote monitoring, we exacerbate these disparities, pushing people who are already marginalized even further to the fringes of healthcare access.

Even if one ignores ethical considerations, the fiscal impact alone is concerning. Patients who can’t afford regular monitoring or routine visits end up in emergency departments when their conditions worsen, which costs the healthcare system more than preventive or routine care. The entire remote monitoring program was intended to save money and increase access. Reinstating the RPM/RTM co-pay violates the prime tenets of the program when it discourages adoption. It’s a penny-wise, pound-foolish approach that only burdens our already stressed healthcare system.

In times of adversity, we’ve seen the immense value that telehealth and remote monitoring services can bring. Such services bridge gaps, make healthcare more equitable and save lives. The reinstated out-of-pocket requirement is not just a barrier to patient access but a barrier to our nation’s progress in healthcare. When people delay or avoid preventive care because of costs, they often pay the price with their health, and our nation pays the price in the long run with lower work productivity and rising healthcare costs.

We are at an inflection point. We can uphold policies reinforcing disparities or commit to a healthcare system that makes access more equitable. It’s not just a matter of economics or public health; it’s a question of our national character. Let’s make the right choice. CMS and commercial insurance companies must acknowledge these ramifications. They should permanently waive co-pays on RPM/RTM services, ensuring every American has equal access to proactive and preventive healthcare services regardless of zip code or paycheck.

BEN zoom pic new2023 edit copy
Benjamin Nowell

W. Benjamin Nowell, Ph.D., M.S.W., is Director, Patient-Centered Research, at the Global Healthy Living Foundation, a patient advocacy organization, and its associated CreakyJoints® online patient community. As Principal Investigator of the ArthritisPower™ registry, Ben oversees research activities conducted by GHLF/CreakyJoints. An accomplished patient-centered research scientist with over 10 years of experience consulting on and leading studies with academic institutions, clinical sites/registries, patient organizations, and biomedical/pharmaceutical companies, he designs and leads real-world studies using innovative digital health technologies, notably wearables and mobile apps.

DSC01184 copy
Robert Popovian
Robert Popovian, PharmD, MS, Chief Science Policy Officer, GHLF; Senior Health Policy Fellow, PPI and Visiting Health Policy Fellow, Pioneer Institute - photo attached