Transcript
Marla: All right welcome everyone and thank you for joining us for today's webinar, remote Therapeutic Monitoring and Action Tools, tactics and Results. And I'm Marla Ranieri. I'll be your moderator for today's discussion. And as a former VP of Clinical Excellence and Innovation at a large enterprise organization, I spent a lot of time piloting RTM, evaluating different clinical models.
Different tools and implementing it into over 200 clinics. And so this topic is very near and dear to my heart. In addition to being a provider where we all go the extra mile all the time, we reach out to patients via emails, phone calls, and just check in on them to make sure they're compliant with what we prescribed to make sure they're coming to their sessions.
And that basically means we've been practicing remote therapeutic monitoring all along. We just weren't really reimbursed for it. However, in late 2021, early 2022, right after the Covid pandemic, that really opened up some new opportunities to connect with patients virtually and digitally, and started to make it more formalized with CMS and other insurance companies starting to follow suit, realizing that hybrid models and patient engagement outside of the clinic were necessary in this evolving landscape.
And so that's really where Remote Therapeutic monitoring emerged as a powerful way to enhance patient care and allow clinicians to spend more time monitoring patients outside the clinic as long as that reimbursement followed suit as well, right? So for many R TM still feels a little bit new or complicated, or maybe they tried it and it didn't work out operationally.
And that's really where we're here to talk to you today, raising the questions around implementation, reimbursement, and clinical workflows. So we'd love for you guys to have insight with clinic owners and our panel of experts asking them questions, gaining practical insights and hearing about proven results for those who are making it work.
We're joined by a phenomenal panel of thought leaders and clinic owners who have successfully implemented RTM in their companies. And we'll introduce them in just a few minutes. But before we start a little bit of housekeeping, we do have our chat open and this is gonna be formal and informal and engaging.
So we do wanna hear from you. Feel free to write in the chat and talk amongst each other. But if you do have a question, we have a q and a button at the bottom of the screen. Please feel free to use that button so that we can answer your questions at the end of the session, or we can follow up afterwards and make sure that we do answer your questions if we didn't get to it today.
So with that, I wanna get started. In hearing from you guys, you'll see a little poll pop up that asks what best describes your current RTM journey? So are you using r tm but looking for ways to make it more efficient? Are you piloting it and still exploring the right tools and clinical models? Are you interested in it but really haven't tried it yet?
Or are you, have you tried it and just stop because the tools didn't work for you? All right. Answer that in here as well and make sure that we can see those results. Okay. Looks good. Looks like all of you are engaged in Anto that form, thank you very much. And lots of different perspectives where people are in their journey.
Great. So let's introduce our panel of experts and thought leaders. So first we have Carina Testa. Thank you so much for being here, Carina.
Carina: Thank you.
Marla: And Carina has over 20 years of experience as a clinic owner in Southern California called Aim Sports Medicine and Physical Therapy. She's a strong Medicare population and a forward-thinking approach to innovation.
She began RTM in 2023 after hearing about it at PPS, and she's seen measurable success in both clinical outcomes and operational efficiency. Thank you so much for having you today, Carina. Thank you. Next we have Sharon Shada. Sharon and his wife owned Bounce back physical therapy in Pennsylvania for over 25 years.
Constantly trying to stay on the cutting edge and relevant in the community. They always strive to provide the very best techniques and technology to their client population. Bringing in a patient engagement system eight years ago when it started, and it was a critical part of this innovation, not only did it allow his practice to provide a comprehensive home exercise program, but he incorporated the RTM system as well for accountability and engagement and has been quite successful.
He uses their full information of RTM, including the monthly oversight and billing. On behalf of Bounce Back, thank you for coming today.
Charan: Thanks.
Marla: And we also, Bryan Lang join us. Bryan brings a unique, multidimensional perspective as the president of O-P-T-I-P, a nonprofit organization that supports private practice PTs across the state of Oregon.
He's also a clinic owner of whole Body Health physical therapy in Portland, using RTM as in his own practice and as a provider. He leads an RTM service company that helps supports other clinics in implementing RTM and providing clinicians to, to give that RTM. He brings expertise in operational ex execution, financial impact, and strategic growth.
Pleasure to have you, Bryan.
Bryan: Thanks, Marla. Happy to be here.
Marla: And finally we're joined by Vikram. Vikram is the founder of PT Wired, a custom app platform for home exercise program, RTM, and patient engagement. He's helped hundreds of clinics deploy scalable tech enabled care and has a deep understanding of the tools, codes, and strategies that make R TM successful.
Great to have you Vikram.
Vikram: Thank you for having me, Marla.
Marla: Awesome. So really wanna set the stage and find out first, why RTM, what's your why and what is it and why does it matter? I'll start with you Vikram. Can you explain what remote that remote therapeutic monitoring means to you? What it is and why it's such a hot topic right now in the industry?
Vikram: Yeah, so to put it as simple as possible, remote therapeutic monitoring refers to a set of CPT codes that allows, that allow providers to essentially now bill for monitoring patients and engaging with patients in between clinic visits. Like you just mentioned in your intro, a lot of things that people have been doing for years.
Now there is this set of CPT codes for us to actually bill for those services and get paid for it. And, the reason it's become such a hot topic obviously there's a revenue component to it. You can make money for billing these codes. And I think originally when these first came out a couple years back, that was really the main reason people got into RTM, right?
They wanted to with cuts to reimbursement amounts. People wanted to find different ways to get new revenue streams, and this was a new revenue stream. So I think the original angle a lot of people took with it was to boost revenue, and that is still, to some extent, a good angle for it.
But more recently it's become even more of a hot topic because the data that we've seen in terms of how RTM impacts outcomes, how it impacts retention, plan of care length so now it's since it's been a couple years, there are a lot more insights that we have into what implementing RTM can do for our practice.
Marla: Perfect. Absolutely. Said, Vikram. Definitely agree. That's how, it's, how it's evolved for sure. And Bryan, what really made you first start to consider implementing RTM in your practice? What were the specific pain points or key business metrics that you were trying to solve?
Bryan: I think that at a high level, I think it boils down into two main topics or kind of key things.
And the first one was the patient experience, or maybe we can call it like patient value. So I've been in this industry for over a decade now and I feel like it's very consistent that we know we have an industry issue with related to people essentially not finishing their full plan of care, self-selecting out.
Some research says like the fourth or fifth visit is really important for that. And so we thought that part of the reason why that could be is not necessarily 'cause the PT is the problem, but in healthcare we are just like a series of touchpoints. See me this week. I hope you did all your exercises and then see me next week.
And having something like RTM was interesting because I think that would allow for more of a continuum of care throughout that week with check-ins. So that was the first thing of just I like the idea, I like the concept. I think this is something that's needed. And then the second piece is really just increasing our revenue streams, because I, that is something that also in our industry, we are constantly fighting.
And so to have something that's a available where r TM codes are reimbursed, and then on the backend, if we're providing a more valuable service, maybe seeing greater retention, less cancellations and no-shows, it should honestly be a win-win for everybody. So those were the two things that we were looking for.
Marla: Yeah I love that. I love the why of being able to connect with patients and be their coach outside and really help to improve that completion of plan of care and that engagement. Appreciate that insight. And Carina, what about you? What was your why for implementing RTM and how did you communicate that vision to your team?
So they were also bought in as well.
Carina: So my, my my why is very similar to what Bryan said when I first heard about it at PPS, I thought, wow, this is something we actually are already doing, excuse me that we are already doing. Most of my providers were already working on their h the Hs in our downtime and doing the editing and checking in with patients.
And I thought, why not actually, we can now get, actually get paid for this time. And it brought in a more engagement actually with my providers to be more consistent with editing the home exercise program, reaching out to patients via messaging. Checking in with them on their HEPs. And it got better engagement with our patients because now they were also accountable because we could say, Hey, we're gonna look at your, if you're checking off all your boxes and making sure you're doing your exercises each day.
So it, it just brought better engagement between patients and providers. And now we were actually gonna get paid for our expertise and our services, things that we were already doing.
Marla: Yep. Absolutely. Things we were already doing and making sure that we can just focus and do that more formally with a paid revenue stream.
So love, love that. Carina. And Sharon, you were a very early adopter of RTM, so wanted to ask you, how did you get your team bought in to it as well, because sometimes it's an extra thing to do. But we'd love to know just how'd you communicate it to your team that you, your why?
Charan: Yeah just Carina and Bryan, we've been in the community a long time and so for us it's about relationships, right?
More than anything else. When you're in a community, as long as we have been that relationship's pretty powerful, and because we see generational families, it became important. Equally, it became important for the PTs to understand what the relationship meant. And so I would agree with Bryan and Carina that having that revenue stream was a nice touch because we've been doing this forever for free.
But more than that, it was the ability to stay engaged with the patient, not just when they were a patient, but even when they're gone. And so I think what my staff originally felt was important for us as a company to, I'm sorry, there's noise in the background. I apologize. Was to understand that the relationship was broader than just.
Them, it became the engagement of the patient and the pt, not just during the plan of care, but really what does that look like over the lifespan of the relationship. And once we talked about that, it was a buy-in which was a, which is a nice one, and I know we'll get into this a little bit later.
What were some of the challenges and whatnot? Buy-in was a challenge initially, but more we practiced with Vikram and his team. The more, the more buy-in we had.
Marla: Yeah. Continuing that therapeutic alliance outside of the clinic and being able to extend that care, so love that.
And love you recognizing the challenges and that we will definitely get more into that for sure. So let's get into the, how Vikram, can you give us some details and walk us through how R TM works, including which billing codes should be used, and really what we should, which billing codes we should be obtaining if done correctly.
Vikram: Yeah. I'll start by saying there's not a one size fit, all fit, fits all approach to RTM. As we'll get into the way Corina has implemented it, it's very different from how Sharon has implemented it with his team. And that's just based on differences in the clinic. And, that's probably a separate conversation with somebody on RM to figure out what may be the right implementation for you.
But as far as just the how generally to do RTM, you have to supply a. Digital device or a device to a patient to remotely monitor them from. The vast majority of people in PT in this space, they use digital devices such as a home exercise program app to basically monitor the patient. And we have to be able to collect data from the patient in between clinic visits and what counts as data could be something like home exercise program completion, it like adherence data outcome report feedback report messages being sent from the patient on how they're progressing, step activity count data.
There's lots of different things that can be count as like data for that purpose, but we have to be able to collect data from the patient for it to really be RTM. So that's the key piece is whatever you're thinking about doing for RTM, you gotta obviously make sure that it's some type of a device that will comply with the requirements and be able to collect the data that you need to fulfill the requirements.
As far as the code specifics. There are two sets. There are four main codes that apply to pt and there are two codes that are more based on the patient's engagement with the device, the amount that they will use the app, like if we're assuming it's an app, the amount that they'll use the app, and we're the amount that we're able to collect data from the patient on the app.
And then there's two codes that are based on the provider's time monitoring the patient. So based on the amount of minutes per calendar month that the provider spends monitoring the patient having. Calls in between visits with the patient, reviewing the data, the improvements all of that time also is accumulated towards those codes.
So in terms of the how and the strategy, we have some clinics that they only bill some of the codes. We have some clinics that bill all four codes. So it really does depend on what your main goals are with RTM as well as your availability as well as what your workflows are like in the practice.
What may be the best decision for you? I know, we'll get into how some of the owners on this call have done it, and I know Bryan has lots of opinions on different strategies depending on how the clinic is structured. But yeah, that, that's a short overview of the how to implement RTM.
Marla: Great. Thank you. And if you wanna put the codes in the chat, I think that'll be really helpful for our, for listeners. And then Carina, I know that Vikram just said there's different ways to implement it and you have one certain model, so would love to know how is it working in your company?
What's being monitored, who's doing the monitoring, and how does it fit into your provider's daily workflow?
Carina: So we do all of our RTM monitoring ourselves, and we do all our billing ourselves. We use RTM on all our Medicare and Medicare Advantage patients. And we for context, I have 4.5 FTEs and 40% of our visits are Medicare.
The treating provider is in charge of all the monitoring the home exercise program set up, any editing of the home exercise program, and all the messaging. I handle all the RTM detail monitoring, so I do spend some time each week. Going through and making sure that that the PTs have done their live interactions, that they're accumulating their minutes.
And I did all this, I set this up on Google Sheets because I started this so long ago before PT Wired had set up their RTM dashboard. I started with Google Sheets and that's where I've stayed, but it's a way for me to track the minutes that each patient has under each provider.
Hey, are we just, just shy of a few minutes to get to our next code? Did everybody get their live interactions this month? How many data points do we have for certain patients? And then towards the end of the month, I can let all the PTs know, Hey, this patient, when they come in at the end of the month needs, here's all the codes that you need to bill, just to streamline it and make it a little bit separate from regular billing.
And if someone does not have a patient does not have a visit at the end of the month, then we set up a an RTM dummy case in prompt, and I do the billing for the codes at the end of the month through that. It's our goal is always to have a minimum of 40 minutes of monitoring minutes per month per patient, which for us, we we see our Medicare patients one-on-one.
They're scheduled for a full hour. So for those that say there's not enough time to do our tm we bill for timed units, which ends up somewhere between 53 and 55 minutes. We use the other five minutes as part of our RTM minutes because there's for sure some time in there that we talked about the home exercise program.
We edited the home exercise program. And so if you see a patient on average two times a week for four weeks, you've got eight visits. Eight times five minutes is right there as your 40 minutes already. So that's how easy it can be. Now obviously we also do my PTs also know to do their RTM monitoring and downtime.
Patient cancels. Perhaps that's when they're calling to check in or messaging a patient, or maybe that's when they spend, if there's a major edit on home exercise program that's gonna take 'em 10 or 15 minutes to update everything, that's when they'll do that and track their time that way.
Marla: That's a great model.
I love that you use the PTs. You are able to do it in your clinic and support it through your Medicare population. I wanna move to Sharon 'cause you do a completely different model. You don't use your own internal PTs and so you've set it up quite differently. So I'd love to hear from you how you are utilizing RTM in your practice.
Charan: Sure. We, early on when Vikram rolled this out, he and I had quite a few conversations about the struggles we were having with being able to have the time for the clinicians to work on this. And he and I had talked about how do we make this work in a way where we can implement this and have some success?
And so our model was actually quite drastically different than Carina's, where we were really hands off in Vikram's. So what we came up with was we had a remote, PTA that would do the job for us, making the phone calls monitoring the system, keeping in touch with the patients. Updating us as PTs on a weekly and sometimes even a daily basis, letting us know, Hey, this person's engaged, this person's not engaged.
We should probably update their exercises. And so you had this communication going back and forth with, again a member of our team that was more remote, but still a part of our team, which is really great. And so that was one of the biggest hurdles that we were able to get past in terms of time efficiency because we just didn't have the time to do that.
We're a very busy practice. And so trying to find the time to be able to do what Corina was talking about, what just wasn't gonna work for us in terms of time efficiency, which led to the second problem that Vikram and I were able to solve. And that was, okay, fine, we're doing the RTM, but how are we billing for it?
And that was a real challenge for us because ultimately I. The coding is so challenging because everything is based on minutes. And if you're not tracking that not only can you not get paid for, but you get audited for it. And if you're not showing that you're keeping the minutes and you're not keeping the documentation, you've got an audit problem.
And so the second problem that, that Vikram and I were able to come up with was that they would bill for us. And so because we're a prompt client and because they work within Prompt, what would happen is every month we would save up our rtms. And then Stephanie, in this case, the, our remote PTA would which by the way, she's been fantastic was also sending the claims out with the RTM codes because she was not only able to justify the documentation, but then she was able to execute on the billing side.
And that has been a fantastic way for our practice to, to flow with that's worked out really well for us. Vikram, I don't know if you wanna talk about your side of that, but we really worked hard on implementing 'cause we didn't wanna give up on it. I was very close to giving up on it and Vikram said, don't do that yet.
'cause we had, we've had a relationship for the last eight years. He said, let me come up with another solution. And we did. And it's been brilliant.
Marla: Yeah. And I've seen that, the PTA, the outsourcing obviously there's a modifier when you use A PTA, but absolutely still able to get those reimbursed codes and really be able to make it work for your practice.
So love, love that model. And for busier clinics, that's a great model to work through as well. And Bryan, I wanna ask you, because you actually provide the RTM for many different clinics, so on your end would love to hear what other types of patients are you enrolling besides Medicare and which ones are being covered?
I know it's different in every state, but can you give us some examples since you're doing it in multiple areas?
Bryan: Sure. That is a loaded question, but I love to try to answer it. 'Cause it's it is one of the hurdles that we're still experiencing and I think giving a little bit of context of where it started and where it is now might help a bit.
I've been in this game since the beginning and when the CMS centers of Medicare and Medicaid services came out with the framework and it was like the wild west to be honest with you. We knew that Medicare, traditional Medicare was covering it and. That was it. Like we, there were no commercial insurances covering it.
They didn't even know what it was. And then as the years have gone on, we've started to see more and more adoption from commercial insurances to start reimbursing those RTM codes. So we always know Medicare's reimbursed, but now we're seeing commercial payers like UHC Aetna, even some Blue Cross Blue Shield plans starting to cover these services.
Cigna still has some blanket statement that they're not covering R TM codes right now, nationwide. But overall the trend has been positive in the sense of we're seeing more adoption. And from what I've heard from other codes that were released by CMS and covered it usually takes about five years for commercial insurances to start to adopt these codes more.
So if you didn't start here if you didn't start when RTM started, you are not late to the party. In fact, I appreciate being called a thought leader, but I think my best experiences that I can give you are all the mistakes that I've made and I can make it so you don't make those same mistakes.
So I will say still that it can be frustrating for clinic owners because what, how these commercial insurances reimburse may hinge on where your clinic practices in the United States. So it, we can't make big blanket statements about some of the commercial payers. For example, blue Cross Blue Shield again.
Texas Blue Cross Blue Shield, Texas, they'll reimburse for our TM codes in Oregon regions, blue Cross Blue Shield. They don't do that. So what we have to typically do is start with the insurances that we're comfortable with, that we know, like Medicare. And then if we need to, we, there are two kind of ways to go about this that I, that are fairly successful.
One is to like just straight up, call the insurance company, the commercial insurance company in your area and ask 'em about coverage for these codes. And then the other one is you can identify individuals who maybe have an insurance that they're covered with in a commercial insurance plan that you want to test.
Ask permission, do the RTM services and then test it, bill, bill it out. And I think that the final thing I'll say just on the population of people who are doing RTM, interestingly enough, high deductible planned plans that people are under are an interesting, like nuance that I didn't expect, where you might have somebody who has, let's say like a $5,000 deductible and the therapist can say, Hey, we have two options here.
The first one is we gotta I gotta see at least once a week, maybe twice a week. And I know it's gonna be expensive, but we gotta hit this hard or I have this other option. You can, you're gonna work with my remote care navigator, she's awesome. We're gonna connect, they're gonna connect between the visits.
Maybe we can space this out to like we once every three weeks, but they'll hold you accountable. We can, it'll be, now we're talking maybe about a cash pay options hey, it's $150 a month, but that's so much cheaper than seeing me, but I don't wanna waste your time. So you really gotta connect with this remote care navigator and make sure that you're doing the exercises too, and they'll give me information back.
So I think that one's been really interesting to see too.
Marla: Yeah, and you brought up so many great points and lots of questions coming in. So I love that you are utilizing this with many different populations. You're, you are testing it out, finding the right ones and then billing for it if, it is not per se covered.
And we'll jump into that in a little bit, but would love Vikram if you can now with all these different models, any thoughts on what you've seen out there? And obviously there's different models that work for different practices, but can you give some sort of advice to the group?
Vikram: Yeah, I think, definitely connecting with somebody like myself or Bryan or somebody who has experience working with lots of different practices, with lots of different workflows and situations we could help make a recommendation.
Certainly, I. The I'm seeing a lot of questions coming in on the billing side and that's, that is definitely, those are warranted. 'cause there, there are lots of questions on the billing side. It's not streamlined like other codes are. And I think that, that, along with other questions in terms of how your practice operates, can dictate whether a self-service model, like what Carina does, where your own providers manage their own de codes themselves versus a more outsource type model like what Sharon does, where you have relatively little to no impact on your clinic clinician's workflows because it's somebody else who's doing everything.
Obviously there's an extra charge for that, but then, you still get to take advantages of the, take advantage of the benefits of RTM. I, I think. A couple quick questions that I like to run through with somebody. First of all, if you have one-on-one visits with your patients that's one thing that tends to work better with self-service because Corina mentioned, if there's a cancellation there, now you have a full block open that provider can do RTM versus if you're seeing multiple patients, that potential benefit isn't there.
As well as just the level of. Kinda work the level of perception of your providers and their ability to potentially add on something to their workflow. Because if you manage it yourself, that's just the reality there. There are some things that we've been doing for years that are already, that will continue, but then there are gonna be some new things to be able to actually adopt this bill for it, make sure, it's getting implemented successfully.
So those are a couple of very quick things, but like I said, it's really gonna be a longer discussion about, what your main goals are with RTM as well as what your current situation is to see what kind of a strategy makes sense. And Sharon just said, he started with one strategy, it wasn't working, he switched to another.
Definitely experiment a little bit before you throw in the towel. If one of them doesn't get the results you're looking for.
Marla: Great that's super helpful. And hopefully it really does give an avenue for providers and owners that wanna learn more and reach out and find what works best for their clinic.
But that's not a one size fits all, and it's keep getting that right fit for your company. Now I know most groups here really wanna hear about the successes. Is the juice worth the squeeze? Please tell us, give us some data, give us some metrics. So we'll start with Bryan. What tangible impact have you seen on patient engagement, retention or outcomes that you can share that makes you keep doing RTM with your own clinic and other providers?
Bryan: Totally. Okay. So I think that the place where I would probably start again is conceptually made sense from the beginning, right? Since the inception we're like, okay, let's, this makes sense, but I have no data or anything to back it up, but let's try it. So we start doing the RTM and R TM fulfillment, and then anecdotally.
We are getting great feedback from patients who are like, yeah, I actually really like the accountability. It's nice when my week is hectic to have somebody check in on me and people aren't like avoiding the phone calls. They're looking forward to them. So again, another little piece of okay, like I think this is working, but we still don't really have enough data yet.
And really the biggest piece to it was that we need more time, right? We need people to finish their plans of care. So now that we have been doing this for so long now, we've been able to pull data and particularly the ones that I have been most interested in has been the visits per plan of care and length of stay, but particularly the visits per plan of care.
And it goes back to that first thing that I mentioned about, I. Patients self-selecting out of their visits, that fourth or fifth visit and leaving my opinion is that if there's a higher visit per plan of care, your physical therapists who are leading the plan of care are making the decision on when to discharge somebody, not the RTM service.
So I think that shows that people are crossing the finish line more often. And now I've been able to take our data and say, okay, we can compare Medicare individuals who are enrolled in RTM and those who are not enrolled in RTM and say, what was, what's our, what is it in terms of our total visits per dis per plan of care at discharge?
What's super cool. I don't like speaking in absolutes because as that usually is always a lie. Like it's the wrong answer on a test, and we know in healthcare absolutes don't really ever happen, but by far and away it, it really, every single one basically that I've been able to do this data on shows that people who are enrolled in RTM have more visits for plan of care discharge and additionally have a longer length of stay and for the indivi, for the groups even that I didn't get something that looked, as meaningful or maybe it wasn't quite there yet.
It was really just a matter of time. If I get, I would say that generally, if I can, when I pull these reports after about six months of doing this, then I see. RTM enrolled people are now surpassing anything that non RTM enrolled people do. If I pull it in three months, like I don't, I just don't think there's enough people who have discharged to really see it.
And then if it goes a year, like it just becomes more and more definite. So that's where I've been like, it felt good. Then it felt a lot, a little even a little better. And now I'm like, I am so leaning into this because it really feels like we're making a really strong impact for everyone, patients and clinics.
Marla: Yep. And Bryan, we did a research study back at Ivy, a retrospective cohort study, and it was on 10,000 patients and we actually saw that 15% fewer patients decided to end care five visits or less. And 40% more patients completed two plus in-person visits per week. So exactly what you just saw there.
And that obviously is good 'cause it means they came in more to the clinic, but it also means that they didn't fire you, they didn't leave your plan of care, which means they're going back to the doctor telling a great experience and probably telling more people to come see you. Great. Corina, what about you?
Can you tell us about the financial benefits for RTM? So we heard a little bit more of that visits per care but what about the financial benefits that you've seen?
Carina: Yeah, for sure. I can speak to that 'cause I know there's a lot of questions in the chat about, okay, so let's get down to it. Like how much money does this really bring in?
So just a quick reminder, I've got 4.5 FTEs. And 40% of my visits are Medicare, and we do see our Medicare as one-on-one for 60 minutes. So that said I can tell you last year we were paid $68,000 in RTM coats. So that's a pretty significant addition to my revenue right there. We average about an additional anywhere between 15 to $25 per visit per month of med of on our Medicare patients.
So I always look at what's my total revenue from just RTM that month, and how many RTM, or sorry, how many Medicare visits did I see that month? And I divide it and I let my team know because. In our clinic, we're mainly out of network, but Medicare, we are in network and it is our lowest payer. So by being able to add this service and being able to provide the app and more accountability we're seeing a lot better reimbursement per visit.
And I will also say that, 'cause I know there's a lot of questions. What about if, how are you getting the patient to actually check off the data? I will tell you that the majority of the codes that we bill are the eight zero and eight one codes, which are the monitoring minutes that we do as providers.
So we don't a hundred percent rely on the seven, five, and seven, seven codes. They're not as much of a build code as we would like, but those are the ones that the patient is responsible for their data. But we do still bill it, it's about 10% of the codes that we bill.
Marla: That's great. That's great.
I love that you gave real numbers and give the overall of what your clinic is so people can see that. I can give a little bit of insight from, as I said, a large enterprise organization when we did that research study, which was not all Medicare, it was a big mix and we actually saw 7% higher average revenue per patient per episode with R tm.
Very great to see your examples and that in a research study which was presented at A-J-A-S-N as well. And Sharon, any thoughts? Oh, is he there? I don't see him, so I may skip Vikram oh. Always back. Sharon, any thoughts from what it's bringing in your group from just whether it is what other metric you're looking at and what you've seen as success for you?
Charan: So I'll address the financial question 'cause I agree that's what's coming in. My battery's gonna die. Gimme just a second, please. I can address that because we've been with PT Wired from the very beginning, and so PT Wired has a pretty robust system with regards to monitoring and also remember for those of you who are asking, they're doing all of our billing for us.
So I not only get a report at the end of the month of what we charge, but I also get a report of what we've made. So Corina's doing everything in house. We're doing everything outta house. And so I have real numbers on a monthly basis, basically showing how many RTM codes, and we do all four because Stephanie is also monitoring.
Engagement. So it is important 'cause the two codes that are important for monitoring are different than the codes of engagement where they're actually doing it in compliance. With regards to how we track that, again, I get a monthly report from Stephanie and from Vikram basically outlining and by the way, sometimes like Stephanie May send a note and say, Hey, we noticed that your engagement is down.
And so that's another touch point because we don't always have access to the patients on a daily basis, and now we can go back. And the beauty of PT Wired is that it also has a messaging service. So now I can text the patient live and say, Hey, I noticed you haven't been getting in, and that this was one of the questions that somebody asked earlier, how can you guarantee that people are doing this?
We just call 'em out. Again we're in the industry a long time. We've been serving the community. So I can call a patient and say, Hey, I noticed you've fallen off. Why are you in pain? Is something going on? And oftentimes they'll be, oh, I was away on vacation. I just didn't do it. So I wanted to address the financial part of it.
Ours is out of house. I get monthly statements showing me what we build, what we've made that takes care of the financial side. A ton of questions are coming in about the PTA, and we can get into the logistics of that in a moment when we do q and a. But I wanted to be able to address your question, which was regarding the financial aspect.
The other intangible that I brought up very briefly that I think is a touch point that doesn't have a financial impact is that because these are Medicare patients, at least in our, because like Carina we're about 28% Medicare. Some of these clients are either widows or widowers. And so this is like an exercise for them.
They really enjoy this. It's engagement. I'm texting them and it keeps them engaged in a very social level. We try to create this almost like a gaming system. That's how we've gotten really good engagement. Prompt sends out a congratulations when you hit so many visits threshold, which I think is brilliant because that community also wants to be relevant.
The aging community wants to be relevant. They have grandkids that are all gaming, so we use this as a gaming system and they get these little congratulations at the end of the month and they love it. So for those of you that were asking questions about, how do you keep that going? We make it fun.
PT is fun, so we try to make it fun. I. Wow. I love that social aspect because some of these people, you're right, don't have that person calling them or caring about them, and this just gives them that, that ability to feel cared for and connected to, and we know that keeps people going. So I, I love that. And Vikram, I know you've seen a ton of data and results. I believe a TI just presented some really nice results as well. Would love to hear what you are seeing in the industry with all the different companies, small, all the way to large.
Vikram: Yeah. Obviously, Carina and Sharon and Bryan can tell about a lot of the more anecdotal feedback from patients.
But at a high level now that it's been a couple years, there's been more information across the board and some of the stats that just came out last month on RTM 22% in higher odds of meaningful reduction in pain for an RTM patient versus a non RTM patient. Everything else being equal 15% greater improvement in functional status for RTM versus non RTM and 20% sign higher completion rate to in-person PT for like treatment plan completion and adherence for RTM versus non RTM and to go to just.
Our study that we did that Bryan had referenced earlier in terms of looking at our RTM patients and non RTM patients and their plan of care length, what we saw was a, about a, if we go across the board for all the different clinics that we looked at, these data sets, it's an average of about five and a half.
Extra visits in the plan of care for an RTM patient versus a non RTM patient. So this is a huge difference. And it's not just the difference of, a patient not dropping out versus dropping out. It can be even as simple as that extra touch point being a reminder that they have a visit coming up tomorrow and then they don't forget it.
And then it's a difference between a no show and then somebody showing up the next day just from that extra touch point. There's a lot of things that go into it, but then obviously for the ones that it is, the difference between, dropping out in the first couple of visits like Bryan mentioned and finishing their course of care.
It's not even also just the difference in the revenue of that, those visits because, or less you mentioned now they're a fan that's gonna come back for, their next PT issue. Now they might leave you a Google review now when their brother gets gets some type of pt injury, now they're gonna refer them over.
So there's lots of different things that go into this.
Marla: Yeah. Yeah, that's, I'm so glad you're tracking that and you're getting outcome related data. 'cause that's really beneficial. I know that hopefully we start to move towards value-based care more, and this is one way we can continue to show that outcomes and our results of what we're doing for patients.
We know we're doing it, we just have to track it and show that. So tha thanks Vira. I appreciate that. And I do wanna say, a lot of people, we see tons of comments coming in and you may have tried it, maybe it didn't work. So it could be the tools and technology, right? There's success happening here.
We see hinge and sword and all these other companies connecting digitally and virtually and now going, I ping, right? So it's also about the tools and the technology. So make sure that you are looking and seeking out the tools that do make it more seamless and interoperable in your company and not add an extra significant workflow.
So with that I'd love to ask Bryan, can you give us just feedback on tools and implementation. So what do you, what are things that you like about your. Technology platform you're using for RTM and what are some things that you would say are must haves that you need in order to be successful and hit these codes?
Bryan: Oh, great question. Okay. I would say disclaimer first and foremost I use PT wired software for this and I don't take any credit in building any of it, but I did help with some feedback to begin with because Vikram knew how excited I was with RTM and back in the day, I feel like when RTM came out, there were a lot of softwares that were like, they just wanted to stand something up to stand something up.
And there wasn't a lot of thought into, okay, how do we make this so it's actually easier for people to either patients to engage with it or for somebody who's actually doing the RTM services to actually track it and monitor it. So they built like a, a spreadsheet. Carina basically already built it, but they built a spreadsheet and then they could charge for it.
And and like really, didn't say that you could generate so much revenue with RTM and you should just do it, but if you haven't experienced or tried some of the features with PT Wired, there's a lot of thought process that goes into it. So starting from just the person who's actually completing the RTM piece, I just think that the RTM timer is like fundamentally incredible because when you turn that timer on and you're in somebody's case who's enrolled in RTM, it is constantly track tracking your time and it actually logs when you're going to different places in PTY.
So maybe you're looking at their exercises and seeing if they actually completed them or mark them off. And then you, maybe you're going into the messaging system and messaging them to maybe they didn't do 'em and you're like, Hey, just checking in. It's constantly going like at jumping and logging, okay, now you're in the chat and you're in it for this long.
If you then jump right into another patient who is RTM enrolled, it identifies that it stops the timer for that former RTM patient and starts it with the new one that you're on. And then on top of that, it's okay, now let's say I'm just checking another patient that's not R TM rule, it's just somebody that's under my care.
It also knows to stop the timer and stop and it doesn't like record any of that for the non enrolled person. And the whole point of that was to intentionally make it easier for the person who is doing this to actually monitor it. And same thing on the backend with billing. There's some complexities with this because we're just, as PTs we're used to doing the very similar, every time-based codes, eight minute rule a MA, something like that.
And these are based on like a calendar month or if it's 9, 8, 9, 7, 7, it's a 30 day window, which is not the same thing. Which, which makes it really complicated. And so the PT wired system actually will track this and create the bill to be actually billable within the timeframes and rules that are set up by CMS for when they can be.
So I'm very biased, but I really think that this was built with that extra level of thoughtfulness and that's why I really love it. And then just in terms of, what else did you ask me? Like other things that you need to have?
Marla: Yeah. EMR or anything like that? Or what do you wanna see integrated?
Bryan: Yeah. I think that having an integrated EMR is gonna be huge. So I know that the connection between PT Wired and Prompt are even tighter now. And when we talk about some of those experiences with billing and being challenged with that, to have an integration with an EMR service that's looking to improve on that is huge.
Because once you unlock that piece, you unlock it for so many other clinics that want to do this, and they just can't get over that hurdle yet of the complexities. Because it is like, there are, we, when we do billing for clinics, there are complexities behind it that we hope that they never see, but we're doing for them that are hard.
Marla: Yeah, absolutely. And I think that's help, that really helps. And I wanna tell everyone, there are a ton out there, so please explore all of them as well and just look for these different pieces, like the integrated edition with your EMR or is it tracking your coding and your billing?
Is it helping with seamless billing? Or like Sharon said, do you not wanna have anything to do with it and it has a third party that's helping do that because maybe you can't do that in your clinic. And Vira might punt it to you as well, like what are those pieces that people should be looking for?
Not just HEP tracking, but other parts of it so that they can maximize with the whatever service they're using. Yeah. So the first step when you're looking at options is obviously making sure it's something that's compliant. I've seen a couple questions come in terms of, Hey, can I do RTM with this or that?
Vikram: And the answer is, you gotta talk to a compliance officer, get a, get an opinion on that. The. The most fundamental definition is that it needs to qualify as a medical device classified by the FDA, and that can include software as a medical device. So that's, you can reach out to the vendor that you're talking to, reach out to your compliance officer, and seek an opinion there.
But the answer is maybe depending on what you're looking at. So yeah I think that's one obviously the first step is figuring out which tool you're going to implement, figuring out what device you're going to use, to do this monitoring. And then from there starting to think about the strategy.
Am I gonna just try and provide this tool to patients and engage them for the patient usage based codes? Am I going to organize my provider's time? Like Carina mentioned, how she does with her team to also get the 9 8 9 8 0 9 8 9 8 1 time based codes. And. If I am, to what level am I trying to get that with all of my patients?
Am I just using cancellation times and getting as many of those as I can? So the, the different answers to those questions will dictate which tools and potentially which solution you actually go with. So that's really the first place I would start is figuring out like, what are my main goals for RTM?
Is it to bill all four codes to get the revenue? Am I more interested in the impact on my plan of care compliance? Am I more interested in just boosting my patient engagement based on the actual solution that I supply to begin with? Starting there is really gonna dictate the rest of the answers.
Marla: Great. Fantastic. I think that's really helpful. And I love hearing too that, there's a lot of additional parts that could be tracked, like walking and exercise and gait. And that's important too 'cause we really are trying to do the best service for our patients and that incorporates everything, right?
We wanna know their activity level outside of the clinic and that helps gain, give us the insight to be better providers and clinicians as well. I know we don't have too much time left and definitely wanna get to everyone's questions we're gonna start asking some of those, but you will see a popup to see if you have and wanna reach out and get or wanna hear from anyone after this presentation such as any of our clinic owners or PT Wired or prompt.
Please feel free to put that in there and we are absolutely happy to help and to reach out and even if it's not using one of our service, make sure that you are on the right track and getting those RTM ability there. So let's jump into some of these questions, and some of you didn't listen to me and put it in the chat, but that's okay.
I'll make my way through them. We have someone saying, using R tm, what is your provider to patient race ratios and have you been able to scale? I think, Bryan, that might be a good one for you.
Bryan: Yeah, sure. Again it's a little bit different because of, when we provide, if we have RTM people who are just doing RTM people or just doing RTM patients, so they're not necessarily treating at all.
But if they are doing full-time RTM, we see that a full-time RTM person can manage about 250 to 300, we'll call 'em patient lives per month. So quite a bit.
Marla: That's actually what I saw when we did a large enterprise. We had a PTA model who just did it for all the patients regionally and around that about rate.
Great. And then has anyone seen any impacts on arrival rate for RTM enrolled patients?
Bryan: I saw this answer or this question and I was like, oh, this is such a good piece of data. This is something that I would love to, with all my infinite time, I would love to actually peel back this and see if I could get some answers, but in here, and so I, yeah, I want to make, I wanna actually do this, but inherently same thing.
It's like probably yes. Do I know? No, but probably yes.
Marla: Yeah I don't know if I've tracked that Vikram, how about you?
Vikram: No, not yet. We've just looked at the plan of care length so far, but anecdotally, Corina or Sharon, have either of you noticed any difference there with some of the RTM versus non RTM patients?
I.
Carina: I couldn't say for sure. We have a pretty high arrival rate as it is. I think part of this is one component of it, but I couldn't say for sure.
Marla: Okay, great. Something we'll add to our
Charan: Yeah. And I will say the same thing as Carina. Our arrival rate is about 97%. So it's high to start with.
I, going back to that touch point that we talked about earlier to Corina's point, I think just that engagement, I, they just feel part of the team. They feel like they're part of the company and so them not coming is almost like they're disappointing us just because we've established that relationship.
And this is just one other aspect of that.
Marla: Great. Great. That's really high by the way. Kudos too. I love that. And then what does documentation look like? Are you doing a soap No. On each while you're monitoring And Corina, I'll give you that question. I.
Carina: So this is a great way to PT Wired has really done all of this work for us.
When we get ready to bill, we click on the code in PT Wired, and it already has all the documentation right there as to when each of the, how the minutes we're all accumulated. And what we do is we just add it to, as a treatment, in the treatment tab as an RTM code, and we drop in, copy and paste it in or import it in to PT Wired, sorry to prompt and bill it out.
It's, even though it is a code that requires minutes, it is not a timed code when you're billing. So we slap one little minute on there just so that prompt, checks out easily. But we put all the data into that treatment notes section of that code, and we're done.
Marla: Great. Perfect. And then we have one saying we've struggled to get the live interaction as part of the 20 minute code.
Any successful implementation tips? And feel free anyone to answer this.
Carina: I can tell you so live interaction, the way it's defined does not mean that it absolutely has to be a phone call. It can be part of at the end of your visit as long as you're not billing that time in another CPT code. Or they come in a few minutes early and you check in and say, Hey, how's your home exercise program?
Did you have any trouble setting up the app? Do you need me to check anything that is actually live one-on-one direct communication with a patient? And there's nothing that defines it as having to be a phone call. So we get a lot of our lives in, in clinic, as long as they are not, those minutes are not counted towards a different CPT code.
'cause you can't double bill.
Marla: Fantastic.
Carina: And ours are our, ours
Charan: are all, I'm sorry to interrupt. Ours are all done by the remote PTA, so she's doing all the live for us.
Bryan: Yeah, perfect. And that just helps sometimes when the thing that's successful with that is basically like, it can't be on your physical therapist time.
It has to be on like your patient's time, so when they're available. And so if you're doing something where you're doing it over the phone, you just have to have somebody who's yeah, okay, I can meet with, I'll call you at two if that works for you.
Marla: That does help with having that centralized person to be monitoring all of them.
And I love this question, by the way. So Cecilia, thank you for asking it. She said that she wants to know, she's got some pain points with billing and she's using PT Wired and prompt, so she wants to know what's coming. When it is. Now that we've integrated the two, what's coming, that's gonna solve some of those pain points.
Vikram: All these billing questions like I said, they, I completely understand why they're coming in. Honestly, I think that's the most difficult part of RTM right now is figuring out the billing strategy. And so right now we already have an integration with PROMPT on the billing side. But it doesn't solve all the problems.
And what we're working on currently is making pretty significant improvements to that by tying the systems together more seamlessly. Some of the main issues that arose from billing RTM is just the fact that these codes are unusual relative to other CPD codes and the fact that you're billing them billing for services provided outside of a visit.
But then, some systems just don't allow for that. You have to attach it to a visit to be able to bill. So yeah, there, there's a, there's. Multiple solutions coming. Some of those include in prompt having payer rules that are linked to their RTM billing requirements to make sure that, for example, you're not billing 9 8 9 7 7 within 30 days of when you bill it last or billing 9 8 9 8 0 in the same calendar month that you may have billed it before or eight one that's not attached to an eight zero because that'll get denied as well.
So basically a lot of logic is being built in on the billing side to make sure that some of this thinking in terms of just understanding of the billing rules, you don't have to do because the system will be doing that for you. And then on just the integration between Prompt and PT Wire specifically.
We're working on some exciting new stuff related to when you're finishing a visit some automated checks into the PT wired system to see if there are codes eligible to be billed. So you can just be asked about that and have that added on versus needing to be operating in another dashboard, checking that regularly.
'cause we know, obviously the ideal way of this working is your in one system, which is your EMR. And that's the pri that's where you know, you really operate in completely and you don't have to be checking a lot of different systems to make sure you're not potentially missing a code that's eligible to be built.
So that's a short preview. Those this is in the works and there's more information on that coming. There's lots of new solutions on the billing side that we're working on. More info to come, but that's a little preview.
Marla: Great. Great. Thank you and thank you guys really so much for being on here today and for being early adopters to help make the product better.
And also to share with everybody some of the challenges. It really is ones like you who have pushed the field to be able to just provide better patient experience and care. And to all of you who attended today, thank you for listening and for really, again, being advocates to give better patient experience and connect with patients better.
So please feel free reach out and we will send the recording to everyone. See you next time. Bye
Charan: bye.