Wake up call for mobile health reimbursement

By Brian Dolan
03:40 am

Brian Dolan, Editor, MobiHealthNews“You are not going to get paid for cool ideas. You are not going to get paid for saving lives. You are not going to get paid for anything unless you can prove that you can save them money.”

If that sounds familiar, it may be because I started an editorial with those same words almost a year ago today. Or maybe you heard CardioNet founder (now Patient Safe Solutions CEO) James Sweeney speak at the Wireless Life Sciences Alliance event in San Diego last June.

His words were stirring then. Impossible to ignore now.

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This week CardioNet, one of the few wireless health companies with reimbursement secured, announced that United Healthcare, a large payer in the U.S., does not believe that CardioNet and other mobile cardiac outpatient telemetry (MCOT) services are "proven." The news followed on an update from the Centers of Medicare and Medicaid last week that confirmed their plans to keep in place the current reimbursement rate for MCOT services. That rate came about last September when CMS slashed the fee-per-service by about one-third.

Corventis is perhaps the latest wireless health startup to venture into the MCOT space. The company set up a testing facility in Pennsylvania, which is where CardioNet is also based, likely because Highmark CMS is known to reimburse for home telemetry equipment. To wit, CardioNet moved to Pennsylvania from San Diego years ago for this very reason.

But is there a cheaper way?

This week I had the chance to discuss this situation with another veteran in the wireless health industry, a physician who wished to remain anonymous.

The physician pointed me to another startup, iRhythm that has recently curried favor among some luminaries in the wireless health industry. That's odd because iRhythm is not -- in any way -- wireless-enabled. Quite the opposite, in fact. The startup uses "snail mail" to "transmit" their data. No wires but also no radios.

iRhythm's Zio Patch is designed to diagnose cardiac arrhythmias by providing (up to) seven to 14 days of continuous recording. The user then mails the Zio Patch back to the company's Independent Diagnostic Testing Facility for analysis. Real-time? No. Cheaper? That's the pitch: Cheaper and easier to use.

The costs associated with these new wireless health services have every payer squinting hard. And serious questions remain unanswered:

Is there a statistical difference between the care provided by iRhythm vs. CardioNet?
By connected vs. unconnected offerings?
Are MCOT service providers like CardioNet, Corventis and others in serious financial turmoil?
Should the focus switch to user experience: Design products that customers will want to buy themselves?
Is the industry acting too complacent, assuming reimbursement is just going to "happen"?

“In the world we are moving in to, more than ever, if you can’t justify the cost benefits, then you will fail,” Sweeney said.

Better consider us moved into that world. CardioNet's reimbursement kerfuffle over the last year is well-documented in this publication's archives. As a public company, their agony is, in turn, public. The industry as a whole must learn from it.