To maximize patient access to care, policies should be modernized to enable the broader digital health landscape

While the current Covid-19 pandemic has sped up the adoption of digital health technologies and […]

While the current Covid-19 pandemic has sped up the adoption of digital health technologies and the virtualization of several aspects of outpatient care—both keys to improving care access, optimizing health outcomes, and lowering costs—once the public health emergency ends, we need to reform legacy policies that continue to obstruct the use of digital health solutions.

Appropriate reimbursement and digital equity are a priority
The onset of the Covid-19 pandemic in the U.S. and the subsequent declaration of a public health emergency, among other swift federal actions, led the Centers for Medicare and Medicaid Services (CMS) to enact temporary waivers and flexibilities to expand telehealth coverage and reimbursement for beneficiaries beyond those living in rural areas.

To accomplish appropriate reimbursement and digital equity beyond the pandemic, we should build policies that clearly address the reimbursement of remote monitoring, digital therapeutics, and clinically accurate devices, sensors, and wearables. Until these policies are put in place, we can’t maximize patient access to virtual care pathways.

The pandemic has also magnified the disproportionate impact of disease on disenfranchised populations. Particularly for racial and ethnic minorities living in urban and suburban centers of the United States, access to technology, health literacy, and representation are optional if not completely inaccessible. Technology and digital health solutions can help reduce these healthcare disparities, and well-crafted policies can ensure these tools are available to the communities that need them the most.

Organizations like the Consumer Technology Association (CTA) and AdvaMed are driving meaningful changes across the digital health landscape through advocacy campaigns on health equity and access, identifying ways to modernize Medicare’s payment and coverage policies to remove barriers to digital health technology adoption for patients and providers.

Policymakers must streamline laws and make flexibilities permanent
Covid-19 has significantly shifted digital health public policy, and changes that were once likely years away have been implemented in mere months. Through the end of last year, CMS instituted hundreds of waivers, adding an array of typically in-person services to the Medicare telehealth list. Other agencies within the Department of Health and Human Services (HHS) were also empowered to temporarily ease restrictions on the types of technologies used by providers for virtual care and flexibility for providers to reduce or waive cost-sharing (copays) for telehealth and remote patient monitoring. These waivers and flexibilities have been vital to the rapid transformation from traditional healthcare to the age of digital medicine but will expire at the conclusion of the public health emergency.

This underscores the importance of more than 200 telehealth and remote patient monitoring bills pending at the state level and dozens of bills being proposed by Congress—from both sides of the aisle—to make some of these flexibilities permanent. It’s critical that policymakers work together to pass laws that will allow for continued access to digital health solutions beyond the public health emergency, particularly for at-risk and disadvantaged communities. This will ultimately improve patient care versus having a confusing assortment of laws that often work to the detriment of efficiency and what’s in the best interest of the patient.

We must have clarity in coverage to enable physicians and other healthcare providers to utilize and be reimbursed for clinically validated digital services. For example, a current Medicare beneficiary prescribed CPAP therapy as a result of an obstructive sleep apnea diagnosis must prove they use the device a specific number of days and hours, then have an in-person face-to-face re-evaluation with their physician before it’s even certain that Medicare will cover the therapy. Digitally connected CPAP devices provide a secure, cloud-based patient management system for ongoing remote patient monitoring, making it easier, safer, efficient, and more reliable for clinicians to access patient data, collect clinical insights, and reduce costs related to patient follow-up.

CMS should adopt new remote therapeutic monitoring treatment codes
Despite a growing worldwide interest in telemedicine and remote monitoring, physician ambiguity around reimbursement is creating barriers to adoption and preventing the delivery of effective, remote care for multiple conditions. Physicians and qualified healthcare providers should get assurances that these codes are cost-effective and provide a path to payment.

As one example, over the last several years, CMS has adopted, covered, and begun to pay multiple Current Procedural Terminology (CPT) codes for remote patient monitoring, including four CPT codes for the provision of “remote physiologic monitoring services.” However, until recently, it was unclear as to whether therapeutic monitoring was covered by those service codes.

Recently, the CPT Editorial Panel announced the creation of five new remote therapeutic monitoring treatment management service codes, effective January 1, 2022. Later this year, CMS will need to consider the adoption, coverage, and adequate reimbursement of these new codes. Without these services, providers may continue to confuse whether they (and their patients) may access certain digital health solutions to enable services that could significantly benefit care, lower costs, and increase access for underserved populations.

Further opportunities exist to clarify that CMS methodologies assess and determine the value of new innovations like artificial intelligence, clinical decision support software, and a myriad of solutions comprised of medical devices, medical software, and the cloud-based infrastructure on which these platforms are largely built. There are no benefit categories that consider modern digital medical technologies for coverage and payment. Meanwhile, the demand for virtualized healthcare pathways and digital health tools only continues to increase.

As the nation looks to embrace this latest healthcare technology revolution, governments need to work towards implementing a regulatory approach that considers all aspects of the digital health landscape.  Making the right temporary measures permanent after the public health emergency ends should be a national priority. The past year has helped prove how broader adoption of clinically validated digital health tools can help healthcare providers better manage patients, inside and outside traditional hospitals and office settings, and allows patients to have better visibility and more opportunities to manage aspects of their own health. Only with proper coverage and access to these modern technologies can we truly democratize healthcare and make the promise of digital health available to all.

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