http://www.mobihealthnews.com/content/digital-health-trends-and-predictions-2018-part-2

a few posts on the nice shifts in the BIG pic of healthcare.

4. Reimbursement could mean a big uptick in remote patient monitoring

Two major things can hamper the adoption of a good idea in healthcare: too much regulation and not enough reimbursement. It’s the latter that has held back the adoption of remote patient monitoring. However, as of 2018, a new reimbursable Improvement Activity is being added to the Centers for Medicare and Medicaid Services' Merit-based Incentive Payment System (MIPS), which encompasses using digital tools to monitor patients outside the hospital.

“This is a big game changer,” Gary Capistrant, chief policy officer at the American Telemedicine Association, told MobiHealthNews. “They don’t consider this telehealth, so it’s available to people in metropolitan areas and providers are moving forward. And it fits into the coverage they’ve added in recent years for chronic care management. That’s the big opportunity that’s there.”

Morgan Reed, president of ACT | The App Association, stressed that remote patient monitoring isn’t just reimbursable, it’s potentially going to be one of the best ways for providers to get full value from MIPS.

“Under this program, if a physician requests that a patient provide them with patient-generated health data and then they review that data, that counts as an improvement activity under MIPS,” he said. “And why that’s important is this is the highest quality score for an improvement activity. It means money in their pockets through the bonus from the MIPS program.”

Reed said CMS expects a quarter of a million claims to be made under the new code next year. And the existence of the code will likely have trickle down effects for private payers as well.

“In short, the whole field of remote patient monitoring and patient engagement has had a chicken or egg problem,” Reed said. “We could build the software, but if it wasn’t economically or, from a liability perspective, good for the physician, they wouldn’t buy it. Physicians would request it, but if there weren’t enough physicians out there requesting it, than we wouldn’t build it. So the important part of what’s happened is it’s a marriage of the two aspects you need. The support from the physicians to make it worthwhile for them to buy our software, and that makes it worthwhile for us to write the code so they can start utilizing these capabilities.”

Of course there is further still to go for reimbursement, Reed said.

“The other thing that I think will need to be done is ensuring that for certain remote monitoring devices you can get a portion of the cost of those devices reimbursed through your HSA or FSA,” he said. “Right now you can go get your bottle of aspirin covered as long as your doctor writes you a prescription for it. If the physician writes you a prescription to say ‘I need to monitor your a-fib,’ you should be able to use your HSA or FSA to cover the cost of a remote patient monitoring device that you might wear on your wrist.”

Dr. Eric Topol, founder and director of the Scripps Translational Science Institute and a longtime digital health thought leader, said he expects further technological innovation on sensors as well — something else that could be accelerated by the availability of reimbursement.

“I think we still haven’t seen the combinations of technologies, so for example I’m very keen on remote monitoring of all vital signs,” Topol said. “That would include blood pressure, heart rhythm and rate, oxygen saturation in the blood, temperature, respiratory rate, right? We should have that now and we don’t have it yet.


wkav, just as you said 



That would be the equivalent of a hospital room in the patient’s bedroom. So the problem we have is we have the parts, but not the sum of the parts. And no one has done the assembly to equate a patient’s bedroom to the hospital room with respect to vital sign monitoring. I’m waiting for that to happen. I think it will happen.”

The other trend that will drive a shift toward care in the home is the “silver tsunami” of the aging baby boomer population, combined with an institutional realization that home care can actually be cheaper for hospitals and more satisfying for patients.

“Demographic trends … have now converged in the past four or five years with the realization that treating people at home is actually more effective and cheaper if you can scale it,” John Gardner, managing partner at NGP Capital, told MobiHealthNews. “That taking people and guiding them into large institutional settings, the assumption that that was a cheaper way to provide healthcare to the mass market is actually not true. … That’s a huge opportunity that’s going to see a lot of progress.”

Dr. Joseph Smith, whose company Reflexion Health is built around caring for seniors at home via technology, agrees.

“No surprise, when you ask seniors where they want their care delivered, they want it in their home,” he said. “Why do people go to the hospital? It’s because they have to. They don’t want to be there and they certainly don’t want to be in skilled nursing facilities. And they certainly don’t want the hassle of going back and forth to a physical therapist’s office. Keeping people off the roads, particularly people who are recently post-surgery, all of that just makes a world of sense.”

The other Dr. Joe, Partners Healthcare VP of Connected Health Dr. Joseph Kvedar, cautioned that as this space opens up hospitals might need to fight to hold onto it as their own.

“It seems like illness management for sure is a new beachhead for any number of individuals,” he said. “As providers, we don’t do a particularly good job. We’re much more incentivized and geared toward managing things that are acute illness — whether it be accidents or injuries. We are set up to manage things when you get sick. Hopefully we do a good job of making you feel better. Chronic illness management is less episodic, much more ongoing. We’re not incentivized to do it financially, set up, or trained to do it. That leaves it as an open area. Companies like CVS and Walgreens are very interested in that space.”