FREDERICK, Md. – A wearable by BioElectronics that manages chronic pain has been approved by the U.K.’s National Health Service and can now be prescribed by physicians there. The government-funded public health service has also agreed to reimbursement for the mHealth device, as well. “This is a major win for pain sufferers in the U.K., since they will now be able to obtain a prescription for ActiPatch, the cost of which will be covered by the government,” said Ian Rawe, director of clinical research at BioElectronics, in a statement. “We commend this move by the NHS, as this will open up the doors for reimbursement in the U.S. and other managed care markets.” The ActiPatch regulates peripheral nerve activity to provide pain relief. It was approved by the NHS based on clinical evidence and a health economics study, which found that the wearable significantly decreased pain and improved quality of life, while reducing overall health care costs by 42%. “This will likely have a tremendous impact on our sales and marketability of the product in the U.K. and elsewhere,” said Keith Nalepka, vice president of sales and marketing at BioElectronics, in a statement.
‘This change is a big step in the right direction’
BALTIMORE – The recent decision by the Centers for Medicare and Medicaid Services to expand reimbursement for telehealth is encouraging news for health care providers and a step in the right direction for its wider acceptance, experts say.
“It is definitely gaining steam,” said Gary Buss, associate vice president of Hoefer Wysocki Architects, which includes in its list of clients several clinics and health care facilities. “We are already seeing an increased interest in virtual consults, remote diagnostics, virtual sitters and a much more cost-effective solution for some home health monitoring. Additional funding will increase the adoption of these technologies.”
Beginning next year, CMS will increase support for health care providers who use remote monitoring tools and patient-generated health data to care for patients. The agency also created new codes to cover telehealth in lung cancer care, health risk assessments and chronic care management, among others.
Drew Schiller, CEO of health care data platform provider Validic, said remote patient monitoring programs faced challenges in the traditional fee-for-service world, with no mechanism for reimbursement for proactive care.
“This change is a big step in the right direction toward covering proactive RPM programs,” Schiller said.
Miranda Felde, vice president of patient safety at The Doctors Company, a physician-owned medical malpractice insurer, said CMS’s decision is good news not only for health care providers, but also their patients.
“The scalability of telehealth technology helps physicians and health care providers deliver value to patients,” she said. “Telehealth helps them provide direct and critical health care services by eliminating distance barriers, reducing delays in specialty referrals and improving patient convenience.”
‘As people monitor their fitness levels, they will be motivated to lead healthier lifestyles’
BOSTON – As the CEO of connected health technology company BeWell Connect, Olivier Hua is a big believer in the power of wearable devices and remote monitoring of patients for health prevention. Here’s what he had to say about how wearable devices and other technology are impacting home health.
HHTN: How does technology empower people to take charge of their own health?
Hua: As people monitor their fitness levels, weight and vitals, they will be motivated to lead healthier lifestyles, which will reduce their health care costs. Patients can monitor their own health, while still getting an expert opinion. Even more importantly, patients suffering with chronic health conditions like diabetes or high blood pressure can monitor their vitals on a daily basis, while sharing data with their doctors, reducing the amount of doctors’ visits they make. By empowering the patients, home health devices can ultimately give arguments to each individual to better negotiate with the insurers his/her healthcare costs.
HHTN: What are the obstacles to broader adoption of these devices?
Hua: Reimbursement is the key. Traditionally, reimbursement has been limited, so many people must pay out of pocket. Technologies are still fairly recent and are evolving very fast. Few of them were medical grade at the beginning, creating questions and/or doubts of their reliability. As more data and studies come out showing the benefits of at-home monitoring, including the cost savings for the patient and the payer in the long run by being proactive in monitoring, hopefully we will see a shift in the legislation. There’s a bill in process right now that would look to expand reimbursement for telemedicine and remote patient monitoring, so that’s a start.
HHTN: What needs to happen for wearable devices to be considered reimbursable?
Hua: The intention of these products is to help people improve their health and avoid a more costly or dangerous problem later, so the devices need to be medical-grade quality and FDA approved. Not all devices are created equal; it’s important the patient is collecting accurate data that he or she can use in conjunction with his doctor to monitor vitals and improve health.
HHTN: How is technology changing the way home health care is delivered?
Hua: Technology is changing the way physicians monitor patients, and it is enabling those with chronic illnesses to monitor their own health at home, while still keeping in touch with their doctors. All medical data recorded is transferred via Bluetooth to the user’s smart phone, which can then be sent directly to the physician, who can intervene if need be. This eliminates the actual trip to the office, but the doctor is, and will still be, involved in the process.
‘We have to be able to show a return on investment’
CHICAGO – Health plans, hospitals and employers depend on technology like wearable devices to better understand, evaluate and manage the health of their populations. Lori Herb, senior director of clinical outreach and engagement at health care analytic solutions and services company Geneia, talked with us about the role of wearable devices in remote patient monitoring programs.
HHTN: What role do wearable devices play in health care management?
HERB: Wearables allow for the use of biometric data to be incorporated into existing case and disease management programs to better manage the health of the members participating in these programs. These patients are the highest risk and having this data allows for improved outcomes by reducing cost, and improving quality and program satisfaction.
HHTN: What are some obstacles to broader reimbursement of these devices?
HERB: We have to be able to show a return on investment as we expand out to additional disease states. Using analytics to identify members who would benefit from home monitoring is key to improving outcomes and seeing a return on investment.
HHTN: Do you think we will see broader reimbursement in the future?
HERB: If there continues to be positive outcomes with the use of devices, there will be greater consideration for reimbursement. We need to continue to see improvements in the risk of the population, resulting in lower costs and improved outcomes.
HHTN: Why is this a technology that’s worth reimbursing?
HERB: Technology allows for better use of clinical resources by providing the ability to intervene in a patient’s care when needed, sometimes without even needing to make a visit to the home.
WASHINGTON – A recent report by the U.S. Government Accountability Office found that while health care providers recognize the benefits of telehealth and remote patient monitoring, they are not taking full advantage of the technology due to lack of reimbursement.
The report, conducted as part of the Medicare Access and CHIP Reauthorization Act of 2015, found that Medicare, Medicaid, Veterans Affairs and the U.S. Department of Defense used telehealth to treat fewer than 12% of beneficiaries from 2014-2016.
Harry Wang, senior director of research at Parks Associates, said the blame is not entirely that of the Centers for Medicare & Medicaid Services, which acts as the “gatekeeper” of Medicare’s reimbursement policy and has historically been slow to embrace telehealth technologies for fear of over-utilization and cost overrun.
“The telehealth industry has several of its own barriers to blame, including the lack of cross-state licensure framework; higher cost of telehealth equipment in the past; and physicians’ own concerns about new work flow and lack of direct reimbursement for telehealth,” Wang said.
The slow adoption of telehealth, or the hope of accelerated adoption, should not be pinned on one agency, he said.
“It should be a collaborative effort to make practicing telehealth as if it is equitable to a face-to-face visit in consumer experience, clinical outcome and payment,” said Wang. “Only then will doctors be willing to invest in telehealth solutions and drive the overall acceptance of telehealth as a normal practice.”
The good news is that CMS has efforts underway, like models and demonstrations that offer alternative approaches to health care payment and delivery, to reduce barriers to increased use of telehealth and remote patient monitoring. The GAO report said these efforts have the potential to expand the use of the technology for Medicare beneficiaries.
NEW ORLEANS – Telehealth regulation and reimbursement are hot topics at the state and federal levels, as the benefits and value of using technology to remotely deliver health care are proving hard to ignore.
In the last year, more than 200 telehealth-related laws were introduced at the state level and 64 at the federal level, according to Lisa Smith Mazur, a partner in the law firm of McDermott Will & Emery and a speaker at the recent Home Health Technology Summit.
“We’re seeing a lot of evolution in regulation and reimbursement—things are improving,” said Mazur, whose practice focuses on digital health.
Mazur said the regulatory concerns with telehealth that persist are around the lack of a direct clinical setting and the potential lack of jurisdictional reach.
“Accordingly, standards of care and licensure have been a primary focus of regulatory concerns and development,” she said.
But while concerns are still being worked out, the benefits of telehealth are being recognized.
“Professional associations are coming to the table and looking at telehealth as a solution and they’re encouraging providers to use it,” Mazur said. “Each of the different stakeholders is coming together.”
The current state of reimbursement for telehealth is not great, said Mazur, but things are looking up. Medicare, with its traditional high barrier to reimbursement, is slowly expanding, but Medcaid still looks at telehealth as experimental and has scattered and inconsistent requirements for reimbursement, she said. Commercial payers were initially resistant to telehealth, but they have been steadily more accepting, she said.
An area that is breaking open is the self-pay, Mazur said.
“For someone with a high-deductible health plan, it’s sometimes cheaper and more attractive to just pay out of pocket for some health care,” she said.
Mazur believes payment reform for telehealth is on the horizon with new payment models like the Children’s Health Insurance Program (CHIP), the Medicare Access and CHIP Reauthorization Act (MACRA) and the 21st Century Cures Act.
CHICAGO – Lisa Schmitz Mazur believes that reimbursement for and regulation of digital health will continue to evolve as patients and providers embrace its role in the delivery of health care.
An attorney who specializes in digital health topics, Mazur will present a session on the reimbursement and regulatory landscape at the 2017 Home Health Technology Summit March 26-28 in New Orleans. She took some time to talk with us recently about her experience navigating reimbursement and regulations, and the race to capture patient engagement.
HHTN: How have you seen provider clients approach the issue of reimbursement?
Mazur: The reimbursement environment is changing for the better. There is a growing recognition that digital health tools are imperative for a transition from payment based on volume to payment based on value that is evaluated in terms of measurable improvements in care delivery and population health. For example, digital health tools are being used in countless ways by physicians, hospitals and other health care providers to deliver higher quality, lower cost care, under alternative payment schemes or quality-based reimbursement models. Prominent among the many examples is the use of digital health tools by accountable care organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP). Under the MSSP, ACOs receive incentive rewards if they are able to improve the quality of care provided to Medicare beneficiaries, and decrease or control health care costs. ACOs use digital health tools to better coordinate and deliver higher quality and more cost-efficient care to maximize their financial rewards under MSSP.
HHTN: How do you see the reimbursement landscape improving?
Mazur: The opportunities for digital health tools to assist providers to improve the quality of care and decrease expenses are impressive. While direct reimbursement is largely limited to telemedicine services, the shift toward alternative and value-based payment models will certainly incentivize the further adoption of digital health tools by health care providers, as these tools are critical to complying with new payment schemes. We will likely see enhanced reimbursement of telemedicine services in the coming years. But just as (or even more) importantly, we will see enhanced use of digital health tools to enable strong performance under value-based payment models.
HHTN: In your experience helping provider clients develop digital health programs, how did you help them navigate the regulatory challenges?
Mazur: Health care providers face both immense opportunities and daunting challenges when developing and implementing these programs. One key challenge relates to compliance with the often-complex state and federal laws and regulations adopted by the numerous regulatory bodies responsible for overseeing different aspects of telemedicine. Because innovation is moving faster than the law in this area, in-house counsel and compliance officers must pay careful attention to legal and regulatory developments and be prepared to identify and develop strategies to address the many potential compliance and liability risk considerations arising from the use of telemedicine and other digital health tools. In addition to understanding and monitoring, and developing responsive compliance strategies for these legal and regulatory requirements, health care providers, patients and consumers must approach telemedicine and other digital health tools with a reasonable degree of caution. Providers must perform sufficient “due diligence” to determine whether the digital health tool is capable of effectively meeting their specific clinical and business needs, as well as the needs of their patients.
HHTN: Because this market is still evolving, how do you see it shaking out over the next five to 10 years?
Mazur: Digital health is in the early stage of its evolution, but growth even in the short term will be exponential. I anticipate that we will continue to see patient/consumer engagement through mobile devices, and health data will be increasingly created, used and shared in a digitally dispersed environment by all industry stakeholders. Health systems, hospitals and providers are at the center of digital health innovation as they are responsible for identifying the key areas of need, and licensing or developing digital health solutions that work. While the regulatory framework is currently lagging, I anticipate that the laws will “catch up” in some areas and will remain complex and unclear in others, and government agencies will remain highly interested in how these technologies are used by patients/consumers and providers.