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| October 25, 2020

AdvaMed Pushes For Medicare Coverage of Digital Health Tech

Nqaba Matshazi

Nqaba has been working as an investigative journalist for the last 10 years. He has written for various media outlets across the world. Nqaba has been working as an investigative journalist for the last 10 years. He has written for various media outlets across the world.

The events of this year have created a sharp rise in digital health tech usage. This has ranged from telehealth to remote monitoring of patients to connected health tools. What we have effectively seen in the digital health sphere is the acceleration of trends and patient care modalities that were bound to happen eventually but whose fast-paced development was grounded in the pandemic.

In light of this, Medtech trade group AdvaMed has released a white paper calling for changes to Medicaid. The group is concerned that digital health tech is not sufficiently covered under the current statute and its white paper offers solutions to rectify this.

Breaking Down The Report On Digital Health Tech

AdvaMed’s “Modernizing Medicare Coverage For Digital Health Technologies” report was developed along with CapView Strategies, a policy consultancy firm. The aim of this report is to motivate the Centers for Medicare and Medicaid Services (CMS) to make key changes.

With software and applications being used daily across healthcare, Medicare must be in a position to support these newer technologies. Ultimately, this is a call for the CMS to get with the times, especially given the fact that healthcare costs are America’s biggest worry, which we covered here. And the report points out to CMS just how much economic value is held in the health–and digital health–sectors.

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AdvaMed Taking Steps For The Future, Based On an Ever-Changing Present

Speaking on the publication of the report, Scott Whitaker, President and CEO of AdvaMed said the following about the CMS and their handling of events;

“CMS has demonstrated incredible leadership facilitating access to telehealth technologies and other innovations during the pandemic, to the benefit of both patients and providers…The agency must continue to move forward and eliminate bureaucratic obstacles so that patients can be best served by digital health technologies that improve the quality and efficiency of care.”

It’s hoped that AdvaMed’s report will provide CMS with a path forward to help ensure reduction in obstacles and improved access to digital health technologies for Medicare patients.

Recommendations Made By The AdvaMed Report

The report is certainly extensive but there are some high-level recommendations which we can pick from the many suggestions made:

–    An update of cost assessments, coding processes, and alignment with the FDA for technologies that may be indirectly covered within inpatient/outpatient hospitals,  end-stage renal disease facilities, post-acute care facilities, and other settings.

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–    An improved alignment of incentives regarding the widespread use of technologies which cost-save, and for CMS to test new payment and delivery models that integrate digital health technologies into model design

–    Full coverage of health tech software, tools, and devices that have been designated under the durable medical equipment (DME) benefit category.

–    Expansion of Medicare Advantage to cover all digital health technologies.

The Need For Speed In Changing The Coverage Options For Medtech

In all, AdvaMed’s report makes 28 proposals to the CMS on digital health tech. Interestingly the report had been started at the end of last year long before the Covid-19 pandemic, which has only expedited the use of medtech nationwide.

During an AdvaMed press conference, Peter C.Farrell, CEO for ResMed which is a regular collaborator with AdvaMed, urged the following;

“The benefits of digital health are something that our company, ResMed, has been focused on for the last decade or longer, going back to paging technology, 2G, 3G, 4G and now 5G comms and the cloud-based systems that we have,”

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Farrell however was concerned that while many companies have focused on this, those at the highest governmental levels had not.

“But at the highest level, the benefit of digital health technology is that we are able to liberate data from closed systems to the cloud and give freedom to patients to get the care when they want their care, to get the care how they want their healthcare and to get it where and in what mechanism they want it, whether it’s digital, whether it’s through the phone and whether it’s through direct, in-person communication with a doctor.”

All those involved in the industry and the publication of the report understand that CMS and Medicare changes won’t happen as quickly as they should. There are a great deal of moving parts to configure. What we do know however is that a failure by the CMS to heed the advice will be costly in the future.

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More than advice, this report is a warning shot for the CMS, that now is the time to act to avoid bigger problems going forward.

The heavy dependence on the digital health tech of 2020 is not going to relent. If anything, we’ll see more companies bring forward products for FDA approval, such as these which we reported in this piece. Medicare must ensure that it is fit for its purpose in the modern world.


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