Though it’s technically been around for decades, virtual care is a relatively new concept in healthcare. And thanks to emerging value-based models and new reimbursement allowances, it’s also being utilized more and more to help improve access and quality of patient care.

Given its importance, understanding virtual care is critical to maintaining current standards of care. Seizing the opportunities for reimbursement represented by the different types of virtual care could also help some providers expand their practice scope and care strategies (and potentially gain some great outcomes in the process).

With that in mind, let’s take a closer look at the four primary types of virtual care: hospital-at-home (HaH), remote therapeutic monitoring (RTM), remote patient monitoring (RPM), and chronic care management (CCM).

What Are the Different Types of Virtual Care?

Virtual care refers to healthcare that’s delivered virtually or remotely, meaning that the patient and the doctor or care provider are in separate locations, and using technology to communicate.

Although remote care and telehealth are often used to refer to this type of care delivery, virtual care best captures its transformative power. By bringing together the key functionalities and tools associated with remote care technology, virtual care platforms like CareSimple offer healthcare providers the power to manage patients virtually, in a setting outside of the standard hospital or clinic.

Despite what its name may imply, however, virtual care doesn’t always require advanced technology. For example, many of the interactions now reimbursed by the Centers for Medicare & Medicaid Services (CMS) include telephone communication.

To gain a better understanding of the more specific instances of these systems, and how they’re defined by CMS reimbursement guidelines, let’s take a closer look at the four main types of virtual care.

Hospital-at-Home (HaH)

What is it? Hospital-at-home (HaH) is a model that allows patients to receive hospital-level care in their home or place of residences. Johns Hopkins School of Medicine, which owns the Hospital at Home® trademark, invented the concept two decades ago for senior patients who did not accept to be hospitalized or were at increased risk of infections. With the launch of the Acute Hospital Care At Home program by CMS in 2020, combined with the COVID-19 outbreak and the increased need to free up bed capacity, HaH is being used more than ever before.

What’s it for? As opposed to delivering just one aspect of care, HaH is designed to serve as a full substitute for acute hospital care, delivered remotely and powered by 24/7 clinical service in the backend.

HaH is used to treat patients who are candidates to be hospitalized but stable enough to stay home. It is often deployed with patients suffering from serious injury or a chronic condition like chronic obstructive pulmonary disease (COPD), heart disease, kidney disease, diabetes, cancer, stroke, multiple sclerosis, Alzheimer’s disease, or septicemia.

53 health systems, 116 hospitals in 29 states are currently included in the Acute Care At Home program. In the fee-for-service model, transitional care management (TCM), which typically follows HaH, is the CMS payment model for the “30-day period” that begins when a physician discharges a patient.

What tech does it use? HaH uses a sophisticated combination of remote monitoring devices and telehealth communications. Because of the high level of care being delivered, the devices used must be hospital-grade, with the ability to capture patient vitals on a continuous or semi-continuous basis.

Remote Therapeutic Monitoring (RTM)

What is it? Just as its name suggests, remote therapeutic monitoring (RTM) refers to the use of specially designed technology that combines remote monitoring (RPM) with the management of therapeutic care. (In terms of CMS reimbursement, this therapy is so far restricted to musculoskeletal or respiratory care.)

What’s it for? Remote therapeutic monitoring lets therapists and other care providers view and manage patient data, such as physical status and medication adherence, and provide data-driven therapy in the form of educational content or coaching sessions. 

RTM is used to provide therapy-related care. This can include therapy after discharge for surgery due to injury, as well as for certain medical conditions. So far, CMS-reimbursed conditions are limited to the musculoskeletal (recovery from injury or surgery) and respiratory (chronic respiratory conditions like COPD) systems. However, experts expect the list of covered therapies to expand in the years to come.

What tech does it use? RTM involves the use of devices, or entire platforms and systems, to carry out specific monitoring and/or communications tasks. Some of these devices may be the same as used in RPM. The educational component of the therapy can be provided using an application, telehealth or just a regular phone call.

Remote Patient Monitoring (RPM)

What is it? Remote patient monitoring (RPM) involves the use of specially designed devices to track, monitor and/or manage patient data and communications on a remote (or virtual) basis.

What’s it for? With remote patient monitoring, doctors and advanced practitioners (like nurse practitioners and physician assistants) can help patients manage chronic conditions by closely monitoring vital data like heart rate and blood pressure. RPM care also includes regular check-ins, usually also carried out remotely (via phone or a video chat, for instance).

RPM is most often used to provide care in the home for people with chronic conditions, including COPD or other severe respiratory conditions, heart disease, kidney disease, cancer, stroke, diabetes, Alzheimer’s disease, influenza and pneumonia, septicemia, or a recovery from a serious injury.

What tech does it use? RPM uses a range of tech from remote medical devices to advanced RPM platforms that can be integrated into a facility’s EHR system to deliver more seamless care. 

Chronic Care Management (CCM)

What is it? Chronic care management (CCM) refers to the management of patients with chronic conditions like cancer or heart disease. This makes it similar to remote patient monitoring; however, the primary difference between RPM and CCM is the lack of the need for continuous monitoring of vital signs with the latter.

What’s it for? CCM’s role is to go beyond a standard office visit to include ongoing guidance, assistance and assessment. With the goal of providing support for patients to manage their chronic conditions, chronic care management consists primarily of nurses calling patients to coordinate care, check in, and offer coaching.

Like RPM, CCM is used for the treatment of people with chronic conditions, including COPD or other severe respiratory conditions, heart disease, kidney disease, diabetes, cancer, stroke, Alzheimer’s disease, influenza and pneumonia, septicemia, or recovery from a serious injury.

What tech does it use? Like RPM, CCM can use a range of technology; unlike RPM, it requires very little. Providers need only a telephone to call patients and software to update their care plans. Other functions used in CCM include a time tracker that can integrate with an organization’s EHR system.

Looking for Help Understanding the Different Types of Virtual Care or Reimbursement Rates?

If you’re seeking guidance on the best use of the different types of virtual care technology, we can help. Contact us here to connect to a CareSimple specialist.

If you’re looking for details on the specific CPT Codes for RPM, RTM, CCM and others, we encourage you to download our handy Reimbursement Tree for a convenient and up-to-date one-page summary.