Medtech trade group AdvaMed today called on the federal government to expand Medicare coverage to digital health technologies.
The Medicare statute does not directly address coverage of digital health technologies, nor does it specifically limit or prohibit their coverage. But it doesn’t make Medicare coverage easy, either.
AdvaMed released a white paper that recommends that the Centers for Medicare and Medicaid Services (CMS) recognize the value of innovative software and applications under existing Medicare payment systems, expand the use of remote patient monitoring and other digital communications between patients and providers, and better link Medicare coverage to FDA approvals and clearances of innovative and breakthrough technologies.
The group praised CMS’ flexibility in covering telehealth services and remote patient technologies during the COVID-19 pandemic, but said the agency should revamp outdated policies to cover more digital health tech.
The pandemic has been a catalyst for digital health technology, including telehealth, remote patient monitoring, connected health, privacy, security, scalabilty and interoperability, said ResMed CEO Mick Farrell at an AdvaMed news conference.
“The benefits of digital health are something that our company, ResMed, has been focused on for the last decade or longer, going back to paging technology, 2G, 3G, 4G and now 5G comms and the cloud-based systems that we have,” Farrell added. “But at the highest level, the benefit of digital health technology is that we are able to liberate data from closed systems to the cloud and give freedom to patients to get the care when they want their caer, to get the care how they want their healthcare and to get it where and in what mechanism they want it, whether it’s digital, whether it’s through the phone and whether it’s through direct, in-person communication with a doctor.”
Farrell noted that digital health technology has boosted sleep apnea patient therapy adherence at ResMed to 87% and lowered healthcare costs in the process. The company has also been able to drive chronic obstructive pulmonary disease and asthma patient adherence rates up 58% while lowering total healthcare system costs for those patients by 25% at the emergency room and through acute visits, he added.
AdvaMed plans to present the white paper to CMS, and said that if the agency fails to act, it will approach Congress for a legislative remedy. Richard Price, senior VP of payment and healthcare delivery policy, declined to speculate on how long the group would wait to make such a move.
“This is not going to happen overnight,” Price said. “We can’t predict right now when we would have to think about statutory amendments to create new benefit categories. The important takeaway is our belief that CMS does have authority now through its regulatory policymaking process to make these changes and we look forward to working with the agency to get those changes to become reality.”
Specific recommendations include that CMS:
- Cover digital health technologies such as software and devices that have achieved FDA’s breakthrough designation under the durable medical equipment (DME) benefit category, in addition to as well as prosthetics, orthotics and their corresponding supplies.
- Update cost assessments and review coding processes for technologies that may be indirectly covered within physician, hospital inpatient and outpatient, end-stage renal disease facilities and post-acute care settings.
- Better align incentives for the use of cost-saving technologies in alternative payment models and test new payment and delivery models that integrate digital health technologies into model design.
- In Medicare Advantage, focus on encouraging the use of health plans’ flexibility to expand access to digital health technologies.
AdvaMed’s paper further recommends that CMS:
- Review all Medicare regulations, policy guidance and program manual instructions to determine which changes should be made to accommodate digital health technologies.
- Apply and expand the lessons learned from the increased coverage and use of digital health technologies under the COVID-19 public health emergency waivers.
- Evaluate longer-term health system needs and make permanent the flexibilities that have increased coverage and payment for telehealth and remote patient monitoring during the public health emergency.
- Consider using waivers and flexibilities to expand coverage of digital health technologies not currently covered by the Medicare program to assess their potential impact on improving access, quality, and decreasing health system costs — especially in the context of health system changes accelerated by the pandemic.