Hello, from David.

This is the second edition of the CEO’s Corner in the Moterum Newsletter. My goal is to each month touch base on the myriad of changes happening within reimbursement, regulation, and delivery of healthcare. One area where change is happening at lightning speed is in Digital Health. This month, I want to talk about the changing landscape of reimbursement for digital health technology and treatments.

One area that has started to have broad coverage is telemedicine. Telemedicine is typically defined as the remote treatment or diagnosis of a patient, through the use of telecommunications, such as telephone, video, or internet. Almost all state Medicaid offerings include telemedicine coverage, but they differ widely in what types of services and diseases are covered. 36 states, plus Washington DC, have laws mandating parity between in-person and telemedicine services, for private insurers (https://mhealthintelligence.com/news/ata-releases-2019-update-of-state-by-state-telehealth-report-cards). Furthermore, telemedicine has begun to be expanded by technology in that 22 states and DC will allow remote patient monitoring and 29 states and DC allow store-and-forward (asynchronous) services. (https://mhealthintelligence.com/news/ata-releases-2019-update-of-state-by-state-telehealth-report-cards).
A new player on the reimbursement block of digital health are amendments made to the chronic care monitoring codes that took effect in 2019. Three new codes were added to the physician fee schedule:

  1. CPT code 99453: “Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment.”
  2. CPT code 99454: “Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.” 
  3. CPT code 99457: “Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.”

(https://mhealthintelligence.com/news/cms-to-reimburse-providers-for-remote-patient-monitoring-services).

While these new codes do not directly help patients with paying for technology at home, they make it significantly easier, and with appropriate reimbursement, for patients and their physicians to set up remote monitoring so that the patient does not need to come into the doctor’s office.
Another area where reimbursement for digital home health has been expanding is in the area of Personal Emergency Response Systems (PERS). These systems allow for monitoring of patients and elderly for emergency situations in the home setting, alerting a monitoring group, in the event of a fall, medical emergency, or other issue the user has. Many state Medicaid programs provide reimbursement for PERS. There are four main areas where Medicaid funding is found: 1) Medicaid Waivers, 2) Consumer Directed Services, 3) Medicaid State Plan PCA Programs, and 4) Money Follows the Person programs. (https://www.payingforseniorcare.com/medicaid-waivers/personal-emergency-response) More on these programs can be found at the website, Paying for Senior Care, which has excellent information on a variety of topics, including a list of state programs that cover PERS (https://www.payingforseniorcare.com/medicaid-waivers/personal-emergency-response).

While reimbursement is becoming a reality in the digital medicine space, there is still a long way to go to fully reimburse these technologies. It is expected that new payment structures and new technologies in the digital health space will be one of the areas of healthcare that will continue to change in the future. While digital health is the future, the reimbursement paradigms need to catch up.

In closing, on behalf of the Moterum Team, I wish everyone a Wonderful Holiday Season, and a very healthy 2020!

David

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