Remote Therapeutic Monitoring: Beyond the Billing Code

Let’s be direct: RTM was not created to be simply a billing opportunity in the fee-for-service toolkit. According to Dr. Marc Gruner, who helped create the RTM codes, they were designed as a key component of the infrastructure to help physical therapists transition toward value-based care models.

Understanding the Noise (Concerns) in RTM Conversations

Concern #1: RTM Becomes Revenue Enhancement Rather Than Care Enhancement

Some observe practices implementing RTM broadly across patient populations primarily to capture additional billing codes. They see minimal clinical integration, questionable patient selection criteria, and marketing that emphasizes revenue potential rather than patient outcomes. This concern is valid because in fee-for-service systems, there's always an incentive to maximize billable services regardless of clinical necessity.

The evidence supporting this concern? Look at how RTM is sometimes being marketed to practices. Much of the messaging focuses on "new revenue streams" and "additional reimbursement opportunities" rather than clinical outcomes or care model transformation. When the primary selling point is financial rather than clinical, skepticism is often warranted.

Concern #2: Administrative Burden Without Proportional Clinical Benefit

Implementing RTM requires device distribution, patient education, data monitoring, documentation, and care coordination. For small practices without sophisticated technology platforms, this can become overwhelming. Skeptics question whether the juice is worth the squeeze.

This concern intensifies when practices lack the automation Marc emphasized in Episode 19 as essential. Manual RTM processes create exactly the kind of administrative burden that drives therapists out of clinical practice and into burnout. Automating what you can is key.

Concern #3: Patient Selection Is Often Inappropriate

Not every patient needs or benefits from RTM. Yet financial incentives in fee-for-service models push toward broad application rather than targeted use. Skeptics observe that many patients being enrolled in RTM programs would do just fine with traditional care—raising questions about whether RTM is genuinely serving patient needs or practice revenue goals.

The clinical reality is that RTM makes sense for many, but not all, populations, such as patients with chronic conditions requiring ongoing management, high-risk post-surgical cases, patients at risk of their condition decompensating or of seeking higher-intensity care, patients with poor adherence histories, and those with complex presentations requiring closer monitoring. Applying it indiscriminately suggests opportunistic rather than strategic implementation.

Concern #4: RTM Could Accelerate Depersonalization of Care

Some even have a deeper philosophical concern that technology-mediated care, even when done well, represents a step toward replacing the human elements that make physical therapy effective. Skeptics worry that RTM could lead to algorithm-driven treatment protocols, reduced face-to-face interaction, and ultimately the devaluation of clinical expertise.

Why Revenue-Focused Implementation Fails Patients

Let’s talk about those who view RTM primarily as a money-making opportunity. This perspective isn't malicious—it's a rational response to financial pressures facing physical therapy practices. Reimbursement rates have declined relative to inflation, practice expenses have increased, and therapists are looking for sustainable income models. Not to mention many of us would argue that PTs’ billing codes are valued too low when you consider their role (and their potential role with VBC incentives) in helping avoid high-cost and unnecessary care.

Nonetheless, thinking of RTM primarily as revenue enhancement creates several problems:

The FFS Trap

When RTM is implemented simply to capture additional codes within fee-for-service models, it perpetuates exactly the system that's failing us. You're adding more billing to a fundamentally broken payment structure. This might provide short-term revenue stability, but it doesn't position your practice for the value-based future that's already arriving.

Consider what happens: You implement RTM broadly, you capture additional reimbursement, your revenue increases. Then what? Here’s the risk, keeping in mind payers and plan sponsors have to pay out no more than the maximum amount budgeted per year: payers can see when utilization and spending on RTM is higher than was budgeted for, and they can adjust future reimbursement rates downward or impose utilization management restrictions as one way to address this gap. Then you're back where you started—except now you have the administrative infrastructure of RTM to maintain.

This is the race to the bottom Marc described in Episode 19 with early bundled payment models. Adding more services for the sake of adding them doesn't create sustainable value.

Misaligned Incentives

When RTM is viewed primarily as revenue enhancement, clinical decision-making can become compromised without us knowing it. You're incentivized to enroll patients who will be compliant with monitoring (to meet billing requirements) rather than patients who genuinely need closer monitoring. You're incentivized to continue monitoring for billing purposes rather than clinical necessity.

This creates exactly the kind of overutilization that drives healthcare costs up while failing to improve outcomes—the opposite of what our profession should represent.

Don’t Miss the Strategic Opportunity

The biggest problem with revenue-focused RTM implementation is that it completely misses the strategic purpose these codes were designed to serve. RTM isn't the end goal—value-based care is. RTM provides infrastructure, workflows, and data capabilities that practices need to succeed when they're accountable for outcomes across entire episodes of care.

If you implement RTM purely for fee-for-service billing, you're building the wrong infrastructure. You're optimizing for volume when the future requires optimizing for value.

RTM is Infrastructure for Value-Based Care

So if RTM isn't primarily a billing opportunity, what is it?

Marc's explanation was clear: "Remote therapeutic monitoring was created to provide the things that are necessary—technology and care navigation—to create a glide path towards value-based care models."

Understanding this requires understanding what value-based care actually demands from providers:

Accountability Across the Care Continuum

In value-based arrangements, you're not just responsible for the services you provide during scheduled visits. You're responsible for outcomes across the entire episode—including what happens between visits, after discharge, and in the patient's home environment.

RTM provides visibility into these previously invisible periods. It creates touchpoints that allow you to monitor adherence, catch complications early, and intervene proactively rather than reactively.

Prevention of Unnecessary Downstream Utilization

Value-based care succeeds when you prevent the expensive, low-value care that patients often seek when they're not adequately supported.

Emergency room visits for musculoskeletal problems (a site of care where it is sadly still rare to find a PT).

Unnecessary imaging.

Premature progression to surgical interventions.

Hospital readmissions after orthopedic procedures.

RTM creates the continuous connection with patients that enables this type of prevention. When you maintain periodic contact, you:

catch flare-ups early

provide guidance that prevents panic and inappropriate care-seeking

adjust treatment plans based on real-world data rather than patient recall during quarterly check-ins

This is exactly how Remote Patient Monitoring (RPM) functions in advanced primary care practices—it’s a tool to help prevent hospital readmissions and ED visits by maintaining continuous connection with high-risk patients.

RTM applies the same logic to musculoskeletal and conditions of movement impairment.

Data Infrastructure for Demonstrating Value

In value-based care, you need to prove your impact on outcomes and costs. RTM provides the data infrastructure for this demonstration. You're collecting patient-reported outcomes, functional measures, and activity data.

This data becomes essential when you're negotiating contracts, reporting to payers, or demonstrating the value of physical therapy services within larger healthcare systems. Without it, you're making claims about your effectiveness based on limited evidence. With it, you have robust data showing real-world outcomes and highlighting the economic value of physical therapist care.

Team-Based Care Workflows

Value-based care requires working more strategically with teams rather than delivering all care directly. Physical therapists need to function as "quarterbacks" of care coordination—evaluating, developing treatment strategies, making clinical decisions—while PTAs, care navigators, and support staff handle the work that’s not top of the PT scope of practice. No one working in healthcare can or should be working in anything less than the top of their scope of practice.

RTM creates workflows that support this model. PTAs can conduct device training and periodic check-ins. Care coordinators can monitor data and escalate concerns. Support staff can handle logistics and scheduling. The PT focuses on what only a PT can do: complex clinical reasoning and decision-making.

Why RTM Helps Therapists Get on the Value-Based Care Journey

Now we can address the question directly: Why does RTM matter for therapists interested in value-based care?

It Develops Essential Competencies

Succeeding in value-based arrangements requires skills that most therapists haven't developed in traditional fee-for-service practice:

• Interpreting patient-generated data and identifying trends

• Conducting asynchronous care and virtual assessment

• Coordinating care across extended time periods

• Making clinical decisions based on continuous monitoring rather than periodic snapshots

• Working effectively with teams where you're not the primary point of contact for every patient interaction

RTM forces development of these competencies. You can't implement RTM well without learning to work differently. And these are exactly the skills that value-based care demands.

It Creates Proof of Concept at Small Scale

Most therapists have no experience managing patient populations across extended episodes. RTM allows you to start small—maybe with 20-30 carefully selected patients—and learn how to maintain continuous connection, monitor outcomes, and prevent complications.

This creates a proof of concept that builds confidence and demonstrates feasibility before you take on the larger risk of value-based contracts. You're learning the mechanics of extended care coordination in an environment where you're still getting paid fee-for-service, reducing the financial risk of the learning curve.

It Positions You for Opportunities

Healthcare systems and payers are increasingly looking for providers who can manage patients across care continuums, not just deliver episodic services. Having established RTM capabilities signals that your practice has the infrastructure, workflows, and mindset necessary for value-based arrangements.

This matters when opportunities emerge—whether that's joining an ACO, participating in episodes of programs, or partnering with health systems on integrated care models. Practices with demonstrated capabilities in and results from remote monitoring and extended care coordination will be preferentially selected over those operating purely traditional models.

It Aligns Financial and Clinical Incentives

Perhaps most importantly, when RTM is implemented strategically, it begins aligning your practice's financial sustainability with patient outcomes rather than visit volume. This alignment is the foundation of value-based care.

Consider the physical therapy EQIP episodes of care that Marc described that’s in use in Maryland, where therapists are accountable for total musculoskeletal costs over six months, not just their own visit volume. They succeed financially, earning a portion of the savings, when they prevent unnecessary imaging, injections, surgeries, and emergency department visits, for example. RTM becomes essential infrastructure for this success because it maintains the connection and visibility needed to keep patients in the therapist's care loop rather than seeking inappropriate downstream services.

If You're Preparing for Value-Based Care

Then approach RTM strategically. Here are some ways to do that:

• Start with patient populations where continuous monitoring genuinely impacts outcomes (chronic pain patients, high-risk post-surgical cases, patients with complex presentations or poor adherence)

• Invest in technology platforms that provide automation and integration with your EMR

• Develop team-based workflows where PTAs, care coordinators, and support staff share responsibility for monitoring and routine contact

• Track not just whether you're billing RTM codes, but whether you're preventing downstream utilization—unnecessary visits, imaging, procedures, or ED admissions

• Use RTM data to demonstrate outcomes and build the case for value-based contracts

• Think about RTM as one component of extended episode management, not as a standalone service

If You're Already in Value-Based Arrangements

Then RTM becomes essential rather than optional. You need the visibility, continuous connection, and data infrastructure that RTM provides to succeed when you're accountable for outcomes across entire episodes.

In these arrangements, RTM stops being about "generating additional revenue" and becomes about "preventing costs that reduce my shared savings." The incentives align properly because you only succeed financially when patients genuinely benefit.

Addressing the Technology Concerns

Marc was emphatic about one point: manual RTM processes are too burdensome. Without technology automation, implementing RTM well is nearly impossible for most practices.

This creates a real barrier, especially for small independent practices. But it's also an opportunity to be strategic about technology partnerships. Consider looking for RTM platforms that do things like:

• Integrate seamlessly with your EMR system

• Provide automated data collection and flagging of concerning trends

• Support team-based workflows (so multiple staff members can access and respond to patient data)

• Include patient onboarding and education support

• Generate documentation that satisfies billing requirements without creating additional administrative work

• Provide analytics showing clinical outcomes and utilization patterns

The technology investment matters because done well, RTM reduces administrative burden rather than increasing it.

Why This Matters for Our Profession

But we can't fulfill the roles we are meant to play in the next iteration of healthcare delivery using infrastructure built for solely visit-based care. We need continuous visibility into patient progress. We need ways to maintain connection after routine appointments cease. We need data demonstrating our impact on outcomes and costs. We need workflows that leverage teams effectively.

RTM provides these capabilities, but only if we implement it with clear strategic purpose rather than opportunistic billing focus.

The first new physical therapy code in 20 years (thank you to Dr. Gruner for his role in facilitating this!) represents recognition that our profession needs to evolve beyond traditional visit-based care. The question each practice must answer is: Will we use this opportunity to genuinely transform how we deliver care? Or will we simply add another billing code to the same old model?

As Marc said: "Care moves in a direction, and you want to be on the train moving in the right direction."

RTM is part of that direction. But only if we understand where it's actually headed—and why.