Big changes are coming to Medicare reimbursement for connected health

At HIMSS19, ACT | The App Association's Brian Scarpelli will lay out the details of what he calls a "sea change" in CMS' policy toward remote patient monitoring.
By Jonah Comstock
03:46 pm

For Brian Scarpelli, senior policy council at ACT | The App Association, it’s hard to overstate the changes coming to Medicare next month when it comes to telehealth and remote patient monitoring.

“Finally, after all these years, the Medicare system as of January 2019 is actually providing reasonable payment to physicians and other caregivers who are delivering care to Medicare beneficiaries, for taking that patient-generated health data and using it in care plans and for interventions,” Scarpelli told MobiHealthNews. “You find yourself wanting to use biblical adjectives, but it really is that big of a shift. It’s monumental. It’s a sea change.”

Scarpelli will lay out these changes and what they mean for physicians at HIMSS19. What he’s describing might seem, on paper, like incremental change: three new codes in the physician fee schedule, some new incentives in the Quality Payment Program and some additional coverage for remote monitoring for home health agencies.

But what makes it so dramatic is just how long even small changes have been in coming.

“The sad truth of the matter is that up until about two or three years ago, the Medicare system only paid for live voice or video calls and even then there were severe restrictions on when it would give payments to Medicare docs to deliver care via a telehealth consult,” he said, adding that the Social Security Act essentially excluded telemedicine coverage outside of rural areas and disallowed patients’ homes as an originating site. “Back in 1994 I’m sure it made a lot of sense when they defined telehealth in such a restrictive manner, but the law has not changed even one comma since then.”

The amount of money Medicare is spending on telehealth isn’t much more than a rounding error, he added.

“As recently as 2015, the Medicare system was paying under $30 million across the entire United States for an entire calendar year in terms of reimbursement for physicians. It’s a trillion dollar program.”

And these changes could be very far-reaching, as Scarpelli said Medicare tends to serve as a bellwether for private payers as well.

In his HIMSS19 presentation, Scarpelli will parse out the changes more specifically and help attendees understand how to use the new codes.

“I run into a number of organizations big and small who have business models that hinge on Medicare payments who are not spun up on this change,” he said. “They’re not fully aware of these changes to the rule and what it means to them. It’s not too late by any means, but the time really is now to go and to really seriously think about how these changes to the rules will open up new doors for companies that are in the health tech space.”

Scarpelli will be talk through CMS changes at HIMSS19 in a session titled “Medicare Reimbursement and Connected Health: Where are We?” It's scheduled for Wednesday, February 13, from 2:30 to 3:30 p.m. in room W315A. Register here for HIMSS19.

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