Digital health tech usage has ramped up in 2020, an offshoot of the safety measures and lockdowns because of COVID-19. Physicians looking for pandemic-friendly options for better healthcare have turned to remote monitoring of patients, telehealth sessions, and health tools, putting on a fast track the patient care trends that have begun in the last few years. However, these new delivery methods are not yet sufficiently covered under current laws, which could affect the finances of so many Americans who rely on digital health technologies today.
Sounding the alarm on Medicare coverage
The Advanced Medical Association or AdvaMed, in collaboration with policy consultancy firm CapView Strategies, developed a report urging the Centers for Medicare and Medicaid Services to review and enact key changes to accommodate digital health. Titled “Modernizing Medicare Coverage For Digital Health Technologies,” the report asserts that the country has much to gain from these changes—from reducing healthcare costs to exploring the economic value of creating formal structures for the digital health sector.
The AdvaMed report’s recommendations
The report has an extensive list of recommendations, but there are several notable high-level proposals. For instance, the report stresses the need to expand Medicare Advantage, covering all digital health technologies like software, tools, services, and devices in the durable medical equipment or DME benefit category.
According to AdvaMed, CMS should have a DME pathway for devices like laptops and smartphones since these can run software used for medical purposes. Apart from this, the group says the CMS’ New Technology Add-on Payment (NTAP) methodology unduly limits the use of digital health devices, especially by inpatient hospitals. AdvaMed wants to lower the cost threshold for payments received under NTAP requirements.
AdvaMed and CapView also propose updating coding processes and cost assessments. According to their paper, CMS must ensure alignment with the FDA regarding technologies that could be covered within various settings, including inpatient or outpatient hospitals, post-acute care facilities, and others. The report also proposes a realignment of incentives on the use of technologies and that CMS must test delivery models and payment systems that integrate digital health technologies.
Changing coverage options: time is of the essence
AdvaMed makes 28 proposals in all; it is worth noting that the organization started the report at the end of 2019 before COVID-19 turned from remote medical news to a pressing global concern. The pandemic has thrown into high relief the need for revising CMS policies to include digital health.
Those involved in the research highlight the importance of providing data to patients and enabling them to get the care they want through the mechanism they prefer, whether digital or otherwise. Though the changes AdvaMed proposes wouldn’t happen as quickly as possible, a failure to heed these findings will prove costly for the CMS in the future.
Conclusion
2020 has seen most of the world rely heavily on digital health tech, and this development will not wane anytime soon. More companies will likely bring forward products for FDA approval—as such, Medicare must ensure their compliance and fit for the medical world.
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