Trends in utilization of remote monitoring in the United States

Abstract

Remote monitoring can help clinicians provide timely services and enable patients to engage in managing their medical conditions. Unfortunately, little is known about the national utilization of remote monitoring across the United States. Using 2019-2023 Medicare data encompassing 100% of professional services billed to and reimbursed by Medicare, we conducted a national analysis of remote-monitoring utilization. A total of 13 529 594 remote-monitoring services (remote patient monitoring and remote therapeutic monitoring), corresponding to $664 518 754, occurred between 2019 and 2023. Remote patient monitoring was most frequently delivered by primary care clinicians, accounting for 6 377 468 (48%) of all services, whereas remote therapeutic monitoring was most frequently delivered by other specialists, accounting for 173 621 (51%) services. With respect to place of service, most remote patient monitoring occurred in physician offices (12 135 569; 92%) compared with at home (540 219; 4%), or other care sites (515 302; 4%). Most remote therapeutic monitoring occurred in physician offices (322 156; 95%) compared with at home (12 560; 4%), or other care sites (3788; 1%). Our study results highlight the salient use of remote monitoring across clinical specialties and the need to address adoption barriers in certain care sites to further enhance utilization.

Introduction

Remote monitoring can play a role in improving care by enabling clinicians to provide more timely services and encouraging patients to engage more directly in their care management. Over the last half decade, Medicare has been a national leader in encouraging remote monitoring by reimbursing clinicians for 2 types of remote-monitoring services: remote patient monitoring (RPM), which involves collection of physiologic data (eg, blood pressure, blood glucose levels, weight, oxygen saturation levels, heart rhythm) essential for managing conditions such as hypertension, diabetes, and heart failure, and remote therapeutic monitoring (RTM), which involves collection of nonphysiologic data (eg, pain levels, patient symptoms, therapy adherence/response) related to treatment of conditions such as arthritis, asthma, and chronic obstructive pulmonary disease.^1-4

Indeed, early studies in limited settings suggest that remote monitoring (RPM and RTM) can be associated with reduced hospital readmissions, improved medication adherence, and stronger patient–clinician communication.^5-9 Additionally, studies have shown substantial growth in the use of RPM in 2020 and 2021 during COVID-19.^10-13 To achieve its potential promise, remote monitoring must move beyond local uptake toward broader, sustained adoption across the United States. However, less is known about longer-term trends in the utilization of remote monitoring—in particular, therapeutic monitoring—spanning from before to after the pandemic. Furthermore, little is known about how remote monitoring is utilized nationally across the different post-acute and ambulatory settings. We sought to address knowledge gaps in remote monitoring by conducting a national analysis of utilization of both RPM and RTM services between 2019 and 2023.

Data and methods

We used 2019-2023 Medicare data encompassing 100% of professional services billed to and reimbursed by Medicare. Because Medicare began reimbursing clinicians for RPM and RTM at different times—beginning in 2019 for RPM and in 2022 for RTM—we used Current Procedural Terminology codes to capture RPM services (99091, 99453, 99454, 99457, 99458) from 2019 to 2023 and RTM services (98975, 98976, 98977, 98980, 98981) from 2022 to 2023.

We first calculated annual sums of RPM and RTM services and corresponding reimbursements. Then, we compared services by clinical specialty, grouped into primary care (eg, internal medicine, family medicine, and general practice), medical subspecialty (eg, cardiology, oncology, nephrology), and other specialty (eg, otolaryngology, general surgery, therapists) types. We also stratified use by place of service, classified as home, physician offices, or other settings (eg, nursing facilities, assisted-living facilities, off-campus outpatient hospital).

We used Kruskal-Wallis tests to compare overall differences between the cumulative sum of service counts by clinical specialty and place of service. Statistical tests were 2-tailed and considered significant at an α = .05. Given the publicly available nature of all study data, the University of Texas Southwestern Medical Center Institutional Review Board waived approval per institutional policy. Our analysis followed Consolidated Health Economic Evaluation Reporting Standards reporting guidelines where applicable.

Results

Between 2019 and 2023, a total of 13 529 594 remote-monitoring (RPM + RTM) services occurred, corresponding to payments of $664 430 143.

RPM use and payments

Remote patient monitoring increased annually from 160 595 services and $8 548 950 in 2019 to 5 515 442 services and $255 379 855 in 2023. Between 2019 and 2023, RPM services increased by over 3334% and RPM payments increased by 2887%.

Between 2019 and 2023, RPM services were most frequently delivered by primary care clinicians, who accounted for nearly half (48%; 6 377 468) of all services (Figure 1). In comparison, medical subspecialists accounted for over one-third of services (38%; 4 953 012), while other specialists provided the balance (14%; 1 858 683) (P = .249).

Figure 1.

Remote patient monitoring (RPM) and remote therapeutic monitoring (RTM) use and payments by clinical specialty.

Among primary care clinicians, the utilization of RPM increased by 3035%, from 79 797 services in 2019 to 2 501 631 services in 2023, with a concurrent payment increase of 2617%, from $4 348 826 to $118 137 766. Among medical subspecialists, RPM increased by 4819%, from 46 199 services in 2019 to 2 272 412 services in 2023, corresponding to a 4169% increase in payments from $2 504 771 to $106 928 383. Among other specialists, RPM increased by 2054%, from 34 409 services in 2019 to 741 311 services in 2023, accounting for a 1699% increase in payments from $1 684 756 to $30 309 765.

With respect to place of service (Figure 2), between 2019 and 2023 most RPM services occurred in physician offices (12 135 569; 92%) as compared with at home (540 219; 4%), or other care sites (515 302; 4%) (P = .037). Remote patient monitoring delivered in physician offices increased from 140 781 in 2019 to 5 118 772 services in 2023. There were also increases in RPM at home (from 13 611 to 180 915 services) and other settings (6203 to 215 755 services) over the same time period.

Figure 2.

Remote patient monitoring (RPM) and remote therapeutic monitoring (RTM) use by place of service.

RTM use and payments

Remote therapeutic monitoring use increased from 59 040 services and $2 657 195 in 2022 to 279 464 services and $13 256 696 in 2023. Remote therapeutic monitoring services and payments grew by 373% and 399%, respectively, between these 2 years.

Between 2022 and 2023, RTM services were most frequently delivered by other specialists, who accounted for 173 621 (51%) services, compared with primary care clinicians with 150 556 (45%) services and medical subspecialists with 14 327 (4%) services (P = .156). Among other specialists, RTM increased by 291%, from 35 392 in 2022 to 138 229 services in 2023, accounting for a 280% increase in payments from $1 541 865 to $5 863 099. Among primary care clinicians, RTM increased by 604%, from 18 720 in 2022 to 131 836 services in 2023, with a concurrent 693% increase in payments from $877 601 to $6 959 262. Among medical subspecialists, RTM use increased from 4928 to 9376 services (91% increase) while payments increased from $237 729 to $434 334 (83% increase) between 2022 and 2023.

Between 2022 and 2023 most RTM services occurred in physician offices (322 156; 95%) as compared with at home (12 560; 4%) or other care sites (3788; 1%) (P = .102). Remote therapeutic monitoring delivered in physician offices increased from 54 028 in 2022 to 268 128 services in 2023. There were also increases in RTM services delivered at home (4237 to 8323 services) and other settings (775 to 3013 services) over the same time period.

Discussion

Across the United States, utilization of RPM and RTM has grown rapidly—over 3334% and 373%, respectively—since Medicare began reimbursing clinicians providing these services. Similarly, payment for RPM and RTM has also grown significantly—over 2887% for RPM (corresponding to $255 379 855 in 2023) and over 399% for RTM (corresponding to $13 256 696 in 2023), respectively. Remote patient monitoring was mostly delivered by primary care clinicians in physician offices, whereas RTM was mostly delivered by other specialists within physician offices. Our results are notable for several reasons.

First, the results highlight the salience of remote-monitoring use across a range of clinical specialties, as shown by substantial RPM use among medical subspecialists (eg, cardiologists, gastroenterologists) and RTM use by other specialists (eg, anesthesiologists, orthopedic surgeons). These results highlight the potential for broader use of remote monitoring by a wider range of clinicians compared with other services that are oriented around care management and reimbursed by Medicare (where use occurs predominantly among primary care clinicians).^14,15 As the health care community gains experience with providing and billing for remote monitoring in the post-pandemic period, future work could assess the overlap or complementary effects of remote monitoring with other care management services in optimizing patient care processes or affecting outcomes.

Second, this analysis reveals that, while a broad range of clinicians have adopted remote-monitoring services, these services have occurred predominantly in physician offices rather than other sites of care. Over our study period, only approximately 10% of services occurred in non-physician office settings, such as homes, nursing facilities, or outpatient hospitals. Considering the aim of remote monitoring to enable clinicians to facilitate proactive care in a range of settings, our findings suggest opportunities to understand adoption barriers in certain sites of care, such as patient homes, and scale up the utilization there. Care models such as Hospital at Home, which also saw increased adoption during the pandemic and enables patients to receive acute level care within their homes, also represent opportunities for remote monitoring to be complementary in such settings.¹⁶

Study limitations included the descriptive design and data limitations, which precluded geographic- and patient-level results. Future work should build on our analysis—which provides important new insight about national utilization trends—and evaluate implementation and adoption facilitators and barriers, as well as the impact of remote monitoring on patient care processes and outcomes.

Supplementary material

Supplementary material is available at Health Affairs Scholar online.

Author contributions

Concept and design (J.H.J., J.M.L.); data collection (Y.T.), analysis (Y.T.), and interpretation (J.H.J., N.L., Y.T., D.S.B., B.A., J.M.L.); drafting (J.H.J., N.L., J.M.L.) and critical revision (J.H.J., N.L., Y.T., D.S.B., B.A., J.M.L.) of the manuscript; supervision (J.M.L.); agreement with submission of final manuscript (J.H.J., N.L., Y.T., D.S.B., B.A., J.M.L.).

Funding

None