Remote Therapeutic Monitoring in Physical Therapy: Bridging Care Gaps Through Continuous Patient Engagement

In light of the recent sale of Limber Health to Net Health, and continued slow adoption of remote clinical services, reimbursed through RTM codes, in the allied health ecosystem, this is our attempt to bring light to remote care and remote therapeutic services currently offered in the US. The healthcare landscape has undergone a fundamental transformation, with remote therapeutic monitoring emerging as a unique bridge between traditional episodic care and the continuous support that patients with musculoskeletal conditions truly need. As healthcare systems in the US confront escalating costs and increasing patient demands, RTM presents a natural complement that addresses one of physical therapy's most significant challenges: the vast care gaps that exist between clinical encounters.

The Critical Gap in Traditional Care Models

Traditional physical therapy operates on an episodic model, patients receive intensive treatment during scheduled visits, then return to independent management until their next appointment. This fragmented approach creates substantial care vacancies that are particularly problematic for musculoskeletal conditions, which constitute the majority of physical therapy cases and tend to be persistent, ongoing conditions requiring sustained management rather than acute intervention.

These care gaps represent more than mere inconvenience; they constitute a fundamental flaw in our approach to musculoskeletal health management. During these intervals, patients struggle with treatment adherence, pain fluctuations, and functional challenges without professional guidance, often leading to suboptimal outcomes and increased healthcare utilization.

RTM as the Essential Digital Care Continuum

Remote therapeutic monitoring fills this void by establishing a comprehensive digital care blanket that maintains therapeutic relationships and clinical oversight between traditional visits, when done well and under the accepted standards of care.. Unlike remote physiological monitoring, which focuses on vital signs and biometric data, RTM captures non-physiologic parameters essential to musculoskeletal care: pain levels, therapy adherence, functional outcomes, and quality of life indicators.

This continuous monitoring capability transforms physical therapy from a series of disconnected encounters into a more uniform continuum of care. This reduces the typical uncertainty and vacuum of information,  instead, patients remain connected to their healthcare team through real-time data sharing and responsive clinical support.

Current Adoption Landscape and Growth Trajectory

The evidence demonstrates RTM's expanding role in modern healthcare delivery. Medicare expenditures on remote monitoring services have experienced exponential growth, surging from $6.8 million in 2019 to $194.5 million in 2023, with RTM specifically accounting for $10.4 million in 2023. This growth trajectory reflects not merely technological adoption but a fundamental recognition of continuous care's clinical value.

Approximately 52,500 Medicare patients utilized RTM services in 2023, with nearly 60% of remote therapeutic monitoring targeting musculoskeletal disorders, the primary domain of physical therapy practice. While these figures represent less than 1% of Medicare patients currently enrolled in remote monitoring programs, they indicate substantial untapped potential for addressing the care continuity challenges inherent in traditional models.

The Imperative for Continuous Musculoskeletal Care

Musculoskeletal conditions present unique challenges that make continuous monitoring a significant value add in the entire episode of care. These conditions are characterized by:

Persistent Nature: Unlike acute medical conditions that resolve with treatment, musculoskeletal disorders often require long-term management and ongoing adaptation of treatment strategies.

Variable Symptom Patterns: Pain levels, functional capacity, and treatment response fluctuate significantly, requiring real-time monitoring and responsive clinical adjustments.

Adherence Challenges: Current statistics reveal that 83% of Americans do not follow treatment plans as prescribed, with physical therapy completion rates ranging from 45.5% to 100%, a gap that continuous monitoring can significantly address.

Complex Recovery Trajectories: Healing and functional restoration follow non-linear patterns that benefit from continuous observation and early intervention when setbacks occur.

Clinical Value Proposition Across Stakeholders

Patient-Centered Benefits

RTM transforms the patient experience by providing continuous engagement and support between clinical visits. Patients can report pain levels, exercise completion, and functional improvements in real-time, receiving immediate feedback and treatment plan adjustments. This continuous connection maintains motivation, addresses problems before they become setbacks, and provides the reassurance that professional oversight continues beyond clinic walls.

The convenience factor extends beyond simple accessibility, RTM enables patients with transportation challenges, mobility limitations, or complex schedules to maintain therapeutic relationships without compromising care quality. Early intervention capabilities prevent minor issues from escalating into complications requiring more intensive and expensive treatments.

Provider Clinical Enhancement and Value-Based Care Alignment

For physical therapy providers, RTM offers substantial operational and clinical advantages that align perfectly with value-based care models. The technology enables continuous progress tracking, early identification of adherence issues, and timely treatment plan modifications. This enhanced monitoring capability leads to improved outcomes, reduced readmissions, and higher patient satisfaction scores, a critical metric in value-based care models.

RTM codes and asynchronous data collection represent a fundamental shift toward outcome-focused care delivery. Unlike traditional fee-for-service models that incentivize volume over value, RTM billing structures reward providers for continuous patient engagement and measurable outcomes. The asynchronous nature of RTM data collection allows for efficient resource allocation while maintaining quality oversight, enabling providers to manage larger patient populations with enhanced clinical precision.

The technology facilitates data-driven clinical decision-making and provides objective metrics for treatment effectiveness evaluation, directly supporting the quality measures and outcome-based reimbursement structures that define value-based care. RTM's continuous monitoring capabilities enable early intervention and prevention strategies that reduce total cost of care.

Healthcare System Economic Impact and Value-Based Care Integration

From a broader healthcare system perspective, RTM presents significant cost-saving opportunities that align seamlessly with value-based care objectives. Research demonstrates that direct access to physical therapy reduces both specific therapy costs and total healthcare expenditures. The economic value of physical therapy is well-documented, with benefit estimates including $4,160 for acute low back pain, $10,129 for stress urinary incontinence, and $39,533 for carpal tunnel syndrome.

RTM's asynchronous data collection and remote monitoring capabilities enhance these values by enabling population health management strategies essential to value-based contracts. The technology supports risk stratification, early intervention protocols, and outcome optimization, core components of successful capitated care arrangements. By shifting from episodic, reactive care to continuous, proactive monitoring, RTM enables healthcare systems to manage risk more effectively while improving patient outcomes.

The remote monitoring framework allows for efficient resource deployment and reduces unnecessary healthcare utilization through early problem identification and intervention. This prevention-focused approach directly supports the triple aim of healthcare: improved patient experience, better health outcomes, and reduced per capita costs, the foundation of value-based care models.

Implementation Challenges and Value-Based Reimbursement Evolution

Despite RTM's demonstrated value and alignment with value-based care principles, several challenges currently limit its full implementation potential. Traditional fee-for-service reimbursement policies remain fragmented, with the average per-patient cost increasing from $154 in 2019 to $431 in 2023. However, this cost increase reflects the transition toward more comprehensive, outcome-focused care models rather than simple volume-based services.

CMS has recognized RTM's value-based potential by designating RTM CPT codes as "sometimes therapy" codes that count toward annual therapy dollar thresholds without multiple procedure payment reduction penalties. This classification acknowledges that remote monitoring and asynchronous data collection represent legitimate therapeutic interventions that contribute to improved outcomes rather than duplicative services.

The Centers for Medicare and Medicaid Services has been gradually expanding coverage, with 42 states now offering some form of Medicaid reimbursement for remote monitoring services as of September 2024. This expansion reflects growing recognition that RTM's continuous monitoring capabilities align with value-based care objectives by enabling proactive management, reducing complications, and optimizing resource utilization.

However, the transition from volume-based to value-based reimbursement for RTM services remains incomplete. Current billing structures may not fully capture RTM's true value in preventing costly complications and improving long-term outcomes—metrics that are essential to value-based contracts but challenging to quantify in traditional fee-for-service frameworks.

The Path Forward: Strategic Recommendations

For Healthcare Policymakers

• Align RTM coverage and reimbursement with demonstrated clinical value

• Develop condition-specific billing guidelines that reflect optimal monitoring periods

• Establish standardized outcome measures to demonstrate RTM effectiveness

For Physical Therapy Providers

• Focus RTM implementation using ethical and standardized care models, with impactful partners who can optimize remote support through digital medium

• Invest in comprehensive staff training and workflow optimization

• Develop evidence-based protocols for RTM data interpretation and clinical response

For Healthcare Payers and Value-Based Care Leaders

• Develop RTM reimbursement models that reflect long-term value and total cost of care reduction

• Integrate RTM metrics into value-based contracts and quality measurement frameworks

• Support population health management initiatives through comprehensive remote monitoring coverage

• Align RTM billing with outcome-based performance measures rather than volume-based service counts

Conclusion: RTM as Value-Based Healthcare's Essential Infrastructure

Remote therapeutic monitoring represents more than technological advancement—it constitutes the essential infrastructure for value-based healthcare delivery that addresses fundamental gaps in traditional care models. For musculoskeletal conditions, which are predominantly persistent and ongoing, RTM provides the digital care foundation that transforms episodic encounters into comprehensive, outcome-focused therapeutic relationships.

The RTM codes and asynchronous data collection capabilities align perfectly with value-based care principles by enabling continuous patient engagement, proactive intervention, and measurable outcome improvement. This alignment represents a fundamental shift from volume-based service delivery to value-driven care management, where success is measured by patient outcomes rather than service frequency.

The current adoption data, while representing early-stage implementation, demonstrates clear growth trajectory and clinical value that directly supports value-based care objectives. Success in RTM deployment requires coordinated efforts across all stakeholders: policymakers must align reimbursement with outcome-based value, providers must optimize implementation strategies for population health management, and patients must engage actively with monitoring systems to achieve measurable improvements.

As healthcare systems transition toward risk-sharing arrangements and capitated care models, RTM's continuous monitoring and asynchronous data collection capabilities become not merely beneficial but essential for financial sustainability and clinical success. The technology enables population health management, risk stratification, and proactive intervention strategies that define successful value-based care delivery.

The future of physical therapy lies not in the artificial boundaries of episodic care but in the seamless integration of continuous monitoring, responsive clinical support, and outcome-focused patient engagement that RTM enables. This transformation from episodic to continuous, value-based care represents not merely an improvement in service delivery but a fundamental advancement in our approach to musculoskeletal health and human wellness. The imperative now is to accelerate this transition by creating the policy, financial, and clinical frameworks necessary to make RTM-enabled, value-based care the standard for musculoskeletal health management.

Reference: 

1. RTM vs RPM: Understanding the Key Differences | Medbridge. 

2. New Study: RPM Reimbursement Needs a Reset - Patient Safety & Quality Healthcare 

3. APTA Practice Advisory: Remote Therapeutic Monitoring Codes Under Medicare 

4. Evolving Remote Monitoring: An Evidence-Based Approach to Coverage and Payment - Peterson Center on Healthcare 

5. Trajectories of disability in low back pain