At the beginning of this month, MobiHealthNews noted in an In-Depth report that a new class of wireless, wearable activity tracker is increasingly finding its way into the clinical space, especially to help people with movement disorders or lower body injuries. That trend just got a big boost from the US Department of Veteran Affairs, which thanks to a recent change in its contracting template will soon begin reimbursing its doctors for activity trackers in some circumstances.
"We’ve allowed for outcome monitoring devices for the first time ever," Dr. Joe Miller, National Program Director for Orthotic and Prosthetic Services at the VA, told MobiHealthNews. "And we’ve developed a methodology for paying for these devices. The industry is constantly referring to different devices and outcomes. But nobody has prescribed a way or developed a way for how you go about collecting those outcome measures."
The change the VA has made is to introduce a new mandatory template for providers to use when negotiating contracts with the vendors that sell prosthetic limbs and custom orthotics for injured veterans. Part of the impetus is to keep the costs down by giving VA medical centers across the country a consistent idea of what they should be paying for various systems. But, for the first time, the contract also allows providers to be reimbursed for monitoring devices that can, in turn, deliver data on the effectiveness of prosthetic devices and how much patients are using them.
"This new development really puts us in the world of wireless healthcare assessment management for the first time," Miller said. "We’re very excited about that and we’re hoping that the local facilities on contract with us and our own internal workforces will begin prescribing these devices for new prosthetic limbs. And we’ll be able to look at how this affects different outcomes of care and healthcare utilization."
The VA won't be reimbursing for Fitbits and Jawbone UP devices, however. The contract template specifies that the devices be able to measure a number of highly specific metrics such as stance and swing time, gait symmetry, dynamic function, cadence and cadence variability, step count, numbers of steps per time interval, peak performance, and functional level assessment. And they have to record continuously and accurately as well. One such device is modus health's StepWatch.
"Every time something like this happens, and there’s obviously so much discussion around digital health and on the clinical applications, the questions of who’s going to pay for the devices?" modus health CEO Douglas McCormack told MobiHealthNews. "So the more examples there are of private sector and public sector individuals coming on board with this type of program, I think it just helps and builds on the overall body of work and it helps build toward broader adoption of these types of solutions."
Miller estimates that as of now only about 5 percent of VA clinics are using wearable devices to monitor patients' use of prosthetics and orthotics. Within the next couple of years, as providers renew their vendor contracts, that number should go up considerably, which could lead to cost savings or improvements in care. He also stressed that the VA wants to use step data to improve care for patients, not to aggregate it, and that the data, and the devices, will belong to the patients.
"The device becomes [owned by] the veteran, and they own that information," he said. "If we want to see it, it’s the veteran who allows us access to that."
The change was motivated by an Inspector General audit of the VA's practices around procurement of prosthetics. The VA needed to show it was being responsible as new technological advances cause the price of prosthetics to rise in recent years.
"We want to continue supplying state of the art devices," Miller said. "But we have to have an understanding of what they do. We have to continue to report to Congress as well as to the American people that we’re utilizing the funds we receive in a very efficient and effective manner, and this is one way to do that. And that will keep us -- hopefully -- funded for these new technologies in the future."