WASHINGTON – The Centers for Medicare & Medicaid Services has finalized changes to the Home Health Prospective Payment System that will allow home health care providers to include the costs of remote monitoring technology into the costs of Medicare cost report forms. Seema Verma, CMS administrator, said in a statement that enabling home health agencies to report the cost of remote patient monitoring as allowable costs on the Medicare cost report form will help foster the adoption of emerging technologies by home health agencies and result in more effective care planning. “The use of such technology can allow for greater patient independence and empowerment,” Verma said. “The new flexibility will further the adoption of technologies that allow patients to receive care at home and share more live-time data with their providers and caregivers, which will lead to more tailored care and better health outcomes.”
‘Unless there’s reimbursement our members won’t invest in it’
WASHINGTON – While the Medical Group Management Association welcomes proposed changes by the Centers for Medicare & Medicaid Services that improve coverage for some digital health services, the group thinks the changes may also prevent providers from offering other such services.
In the 2019 Physician Fee Schedule released in July, CMS proposed: reimbursement for virtual check-ins; a new code to describe the remote evaluation of patient-transmitted information conducted through store-and-forward video technology; and a new code for Internet consultation between professionals for the benefit of treating a patient.
But in a recent letter to CMS Administrator Seema Vera, MGMA said that the proposed changes could inadvertently prevent the adoption of telehealth by some providers because of the narrowly defined types of physician services that fall under the definition of telehealth within the meaning of Section 1834(m) of the Social Security Act, which imposes reimbursement limitations on telehealth coverage.
“What we want is an expansion of covered services,” said Rob Tennant, the health IT policy director of MGMA, a nonprofit association for professionals who lead medical practices. “Our members are both interested in telehealth and aggressively moving in that direction, but unless there’s reimbursement, they won’t invest in it.”
Tennant said that CMS must keep up with advances in technology and recognize that health care today needs to reach people where they are.
“There needs to be a broader policy change,” he said. “We assert that telehealth will decrease the cost of health care, and it’s only a matter of time before it is established as an integral part of a provider’s service.”
Tennant said that as people age they are more in tune with technology and will expect their health care provider to offer telehealth services.
“We’re on the cusp of real change in health care,” he said. “Practices will have to keep pace with this if they want to stay current and relevant.”
WASHINGTON, D.C. – The Centers for Medicare & Medicaid Services recently proposed changes to the Home Health Prospective Payment System that could pave the way for home health agencies to be reimbursed for remote patient monitoring under Medicare—and while it’s a positive move forward, industry experts caution that more needs to be done.
“It’s exciting to have CMS open the door to reimbursement for remote patient monitoring,” said Gigi Sorenson, chief clinical offider at telemedicine software/hardware provider GlobalMed. “Those institutions that blazed the path of remotely monitoring their chronically ill patients while absorbing the capital outlay should be praised. Now, with a clear path to reimbursement, it is likely more providers will launch RPM programs.”
CMS made the proposal as part of a larger group of changes to the HHPPS, which include allowing the cost of remote patient monitoring to be reported by home health agencies as allowable costs on the Medicare cost report form.
Under the proposed changes, home health agencies will not be reimbursed for remote patient monitoring services, but will be able to instead factor the cost of RPM into the costs-per-visit.
The proposed changes could boost a provider’s bottom line and will encourage a wider adoption of RPM in the industry, said Arlene Maxim, a home health expert and speaker.
“In the past, home health agencies have attempted to use telehealth with little success,” she said. “This will all change when the cost is mitigated and potential revenue can be generated.”
The proposals “would give doctors more time to spend with their patients, allow home health agencies to leverage innovation and drive better results for patients,” said Seema Verma, CMS Administrator, in a statement.
CMS expects the proposed changes to help foster the adoption of emerging technologies by home health agencies and result in more effective care planning, as data is shared among patients, their caregivers and their providers.
CMS is accepting comments on the proposed home health rule until Aug. 31.
‘This is a very small step’
WASHINGTON – The home health care industry is cautiously optimistic about Medicare’s proposals to reimburse home health agencies for remote patient monitoring and pay physicians for virtual visits.
In the 2019 Medicare Physician Fee Schedule and Quality Payment Program unveiled last week, CMS proposes allowing the cost of remote patient monitoring to be reported by home health agencies as an allowable cost on the Medicare cost report form. It also proposes paying physicians for virtual check-ins with patients and evaluations of patient-submitted images.
Industry experts want to make clear that, while the proposed changes are a step in the right direction, there is still a long way to go.
“This is a very small step toward recognizing the value of remote patient monitoring, as future reimbursement policy considerations will now have the benefit of data regarding cost,” said William Dombi, president of the National Association for Home Care and Hospice.
While the proposal would position remote patient monitoring as an allowable charge, home health agencies still won’t be reimbursed for them, said Joy Cameron, vice president of policy and innovation at ElevatingHOME and the Visiting Nurse Associations of America.
Still, “as an ‘allowable’ cost under Medicare, agencies will be able to denote those services and costs in their annual reports and it will be a cost of care, rather than additional administrative costs or seen as a surplus when margins are calculated,” she said.
Cameron believes RPM is an increasingly important tool home health agencies can use to collect data on patients.
“This data can be used to monitor issues and concerns, and to help provide data to care planning modifications and needs,” she said.
‘The traditional model of patients interacting with their health care providers has become outdated’
YARMOUTH, Maine – As the home health care industry continues to adapt to advancing technologies and the regulatory issues surrounding how to use them, attorney Lisa Schmitz Mazur has been helping industry leaders make sense of it all.
A partner at the McDermott, Will & Emery law firm, Mazur advises health care providers and technology companies on a variety of legal, regulatory and compliance matters with a particular focus on digital health, including telehealth, mobile health and consumer wellness.
Mazur will present an important overview of the home health technology regulation and reimbursement space at next week’s Home Health Technology Summit in New Orleans. Here’s a preview.
HHTN: How is technology impacting the delivery of health care today?
MAZUR: The traditional model of patients interacting with their health care providers within the four walls of a medical facility—with minimal or no interaction between scheduled patient visits (unless a medical emergency occurs)—has become outdated. Technology has enabled health care providers to interact with their patients on a more regular basis, and empowered patients and consumers to track and manage their health conditions, share information with health care providers and receive health care services and resources when needed. When used appropriately, these tools promise to improve the health and wellness of users and to reduce health care costs.
HHTN: How is this advancement of technology forcing changes in regulation and reimbursement?
MAZUR: Although there is great recognition among accrediting bodies, payers, regulators, providers and patients that digital health tools offer solutions to improve health and lower health care spending, health care providers and technology companies are still faced with navigating the complex, and, at times, overwhelming laws and regulations that govern digital health solutions, many of which were drafted for a different time, sometimes many decades ago. For example, the hundreds, perhaps thousands, of state and federal privacy laws can be daunting to identify, let alone navigate. In addition to state and federal regulatory schemes, digital health providers are also required to meet payer standards if they want the service to be covered and reimbursed by payers. That said, there is increased recognition of the value of these solutions by payers and regulatory bodies, which has created some efficiencies and lowered certain burdens in very recent years. The recent guidance offered by the U.S. Food and Drug Administration is a great example of this change.
HHTN: Are the FDA’s recent guidelines and efforts around digital health good news for the home health care industry?
MAZUR: Absolutely. The Digital Health Innovation Action Plan and other FDA guidance statements greatly clarified how digital health technology developers should approach development, classification and post-market product decisions and surveillance. These clarifications have encouraged innovation while still maintaining FDA oversight where it’s merited.
HHTN: What are some of the biggest challenges to wider reimbursement of home health care technology?
MAZUR: The biggest challenge continues to be effectively confronting the concern that these technologies will result in more services and, therefore, additional costs to payers. Until such time as there is clear and overwhelming evidence that these tools result in cost savings, payers will continue to express fiscal concerns and expand reimbursement at a slow pace.
HHTN: What is your vision of home health care in 10 years?
MAZUR: While the hype of artificial intelligence is more significant than what is currently happening today, there is no doubt that AI-powered health care has proven itself to have great potential. Clinical decision support tools are already being used as a way to focus the role of human health care providers in care delivery and have been found clinically appropriate in certain care settings. The potential of AI to address a myriad of different health care issues—ranging from increased access to care by helping providers to better leverage resources to lowering the cost of health care delivery—will continue over the next 10 years.
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.