Digital health, or health care enhanced or enabled through the use of technology, has changed the landscape of health care in America. Innovation in this field is at an all-time high, and 2024 will undoubtedly see further expansion and acceptance of digital health across the continuum of care.
Much of the momentum related to digital health adoption comes from the COVID-19 pandemic and the public health emergency (PHE) declared in response. With PHE-era flexibility deadlines looming, 2024 presents an opportunity for federal and state legislators to strengthen many of the telehealth programs and reimbursement methodologies that providers and patients have relied on over the past several years. It will be.
Below are the top five areas to focus on in digital health in 2024.
1. Expanding Medicare Telemedicine Coverage
Historically, the Medicare program's ability to cover telehealth services has been limited by Social Security's ability to limit telehealth coverage to certain rural areas and only when the patient is in a designated “origin location.” Act (Section 1834(m)) was significantly limited (hospitals, skilled nursing facilities, clinics, etc.). PHE's flexibility waives these restrictions and allows virtually all seniors in the United States to access telehealth services. Although these flexibilities have been extended through December 31, 2024, the Section 1834(m) limitations are scheduled to be renewed in 2025, resulting in 's telehealth insurance limits will be reinstated next year.
Of course, Congress is currently considering a long-term expansion of Medicare telehealth coverage and will likely enact legislation before sunset on December 31, 2024. For example, the CONNECT for Health Act of 2023, which has broad bipartisan support, expands the definition of site of origin to include the home and expands the definition of health care providers eligible to provide telehealth services. We plan to waive type restrictions and continue using telemedicine. Hospice recertification. This bill and others are actively being considered on Capitol Hill.
Although it is expected that some legislation will be passed before the flexibility expires, there are no guarantees regarding parliamentary action and the timing of the legislation's entry into force remains in question. Although there is widespread support for expansion, the legislative means to secure expansion are not yet clear, and several issues, including general funding, will be prioritized.
and whether to allow coverage for voice-only (telephone) services, whether to allow Medicare telehealth coverage in both rural and urban areas, and whether to allow coverage in both new and urban areas. The contours of the compensation bill need to be further elaborated. Established patients can utilize telehealth services if coverage is limited to a specific specialty or CPT code. Congressional decisions on these issues will be important in understanding the extent to which telehealth will change the Medicare landscape in the future.
2. The role of managed value-based care in expanding the use of telemedicine
Telemedicine and digital health tools appear poised to expand reimbursement opportunities within the Medicare program and other insurance programs, with successful integration into managed care plans and value-based care platforms. Adoption of these technologies is already accelerating.
Specifically, even if reimbursement is not available for the delivery of certain telehealth services or digital health tools, these technologies can help get patients to the right diagnosis faster and ensure more consistent patient outcomes. provides an opportunity to improve quality, efficiency, and access to care. -Provider contact information.
Ultimately, when effectively deployed, these tools can reduce costs and increase user satisfaction for risk-taking organizations. And since the financial performance of these companies derives in part from these factors, digital health tools that support these efforts may be worth the initial investment. Additionally, since a separate fee-for-service revenue stream is not required to realize such value, managed care organizations are far better positioned than traditional providers to ensure the financial viability of these tools. has high flexibility.
In 2024 (and beyond), the success of managed care plans and value-based care models that aim to increase patient engagement in preventive care and improve health outcomes for the patient populations these models serve will depend on remote We believe that successful integration of health services will be important. .
3. Remote patient monitoring
Whether called remote patient monitoring, telephysiological monitoring, or teletherapy monitoring, home health data collection technology is here to stay. For example, last year, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) signaled increased interest in the delivery of digital health services and announced both a work plan agenda item on the use of RPM services. Included in the Medicare program (and telehealth billing toolkit).
These OIG activities focused on a variety of measures, but all addressed OIG's concerns about fraud, waste, and abuse in the digital health field and ensuring that these services are available and adequately delivered to Medicare beneficiaries. This highlights the growing interest in ensuring that
However, reimbursement and compliance with the billing elements of RPM remain challenges, which are numerous and often difficult to achieve, further limiting the willingness of providers to engage directly with RPM. For example, Part B providers are expected to incur direct costs associated with RPM devices and must provide adequate clinical supervision (both in terms of physician supervision and clinical staff). Additionally, many conditions for which RPM is clinically warranted may not require 16 days of monitoring.
Therefore, we expect Congress to focus on revising and expanding RPM access, including reducing the 16-day data collection period to just two days (as currently proposed in the Remote Monitoring Access Expansion Act) . Although the Centers for Medicare and Medicaid Services (CMS) and the American Medical Association have laid the groundwork for the provision of home monitoring, the current framework is not readily adaptable for use by general practitioners.
In addition, as CMS has previously indicated, it will revise its fee-for-service methodology to allow vendors to be involved in care delivery, and the process to authorize licensing and other fees to make RPM more accessible. We plan to establish it. Whether it's Congress or CMS, it's clear that more needs to be done in 2024 to promote the use of RPM.
4. Application of artificial intelligence to telemedicine
Improvements in artificial intelligence (AI), both in medical devices and clinical decision support software, are expected to improve clinical productivity and decision-making in 2024. However, how AI is reimbursed remains unclear (except in limited circumstances under certain ambulatory payment classifications (APCs)). (CMS will pay for it), and both the federal government and state medical boards are considering the role of AI in the medical world.
For example, the Federation of State Medical Boards is ramping up a working group dedicated to developing a model policy statement on physician use of AI technology. This raises many important questions. What kind of work does a licensed medical practitioner do? How does the use of tools, especially those with unique aspects of decision-making, change the role and responsibilities of physicians in patient care? ?
The American Medical Association has developed an AI classification guide aimed at classifying the role of AI in medical practice. This taxonomy, along with guidance from CMS, could serve as the basis for driving state and federal reimbursement policies. In the coming year, CMS is likely to provide additional insight into the reimbursement of AI-enhanced technologies, not just for hospital services but also for practitioner services.
5. Acute treatment at home
Finally, home acute care is the final digital health trend we're watching for in 2024. In addition to the benefits of telemedicine and RPM services themselves, the continued development of digital health technologies also enables the delivery of care traditionally provided in facilities. For patients in the comfort of their own homes.
In this model, patients with diagnoses that would normally be treated in the hospital are instead transferred to their homes. Care is then delivered through a combination of RPM services, telemedicine-led practitioner services, in-person nursing/emergency medical support, and home delivery of medications and medical equipment.
Many hospitals participate in CMS' Home Acute Care Initiative, but this waiver, which provides hospital diagnosis-related group payments for home care, is scheduled to expire on December 31, 2024. As a result, many questions arise. There is still ongoing reimbursement for this type of service. We expect CMS to provide greater clarity on payment considerations for these types of services this year. Additionally, as this model becomes more mainstream, related issues regarding liability and appropriate licensing are likely to percolate and be addressed by state licensing authorities.
Overall, 2024 will be a pivotal year for the growth of digital health as a complementary area of medical practice. Decisions made by Congress, CMS, and state officials this year regarding telemedicine, RPM, and other technologies will have a significant impact on how Americans access health care.
If you have any questions regarding digital health technology reimbursement, licensing, or compliance, please contact the author or a Morgan Lewis attorney.