New Rules For Our Health’s Digital Future

New Rules For Our Health’s Digital Future

New Rules For Our Health’s Digital Future:  Technology promises to transform healthcare. It’s redefining how we interact with, and act on, our health data, and reshaping how care is delivered and coordinated. But uptake so far has been limited, particularly among the elderly, those with chronic conditions and others who could benefit most from a better, smarter healthcare system. To understand why, we need to look at federal reimbursement policies and their far-reaching, albeit often overlooked, influence on tech innovation. Payment rules shape access to technology Every year, CMS (the Centers for Medicare and Medicaid Services) develops regulations governing the payment of treatments and services provided to the one in three Americans covered by Medicare or Medicaid. They determine not only which technologies will be funded, but also how, when and at what level they will be reimbursed. Payment matters. So to lack reimbursement is, effectively, to not exist at all. For example, even though it’s becoming a common feature in the commercial market, telemedicine adoption in the Medicare population remains rare . CMS restricts when “e-visits” can be reimbursed — typically only if the patient is already physically present at a physician’s office or hospital, only in rural areas and only by live, two-way video. Similarly, Medicare pays for diabetes screening and treatment, but is silent on whether evidence-based behavioral and technology-enabled interventions intended to prevent disease are reimbursable. Unsurprisingly, to date, few seniors have participated in these preventative activities. “Of particular concern,” the agency has admitted in the past, “is the adequacy of Medicare’s payment systems in facilitating access to new technologies for Medicare beneficiaries.” Although difficult to quantify, the downstream effects may go further than access alone. These policies also shape how entrepreneurs and investors size up market opportunities and form views on product strategy. By erecting barriers to adoption of technology, CMS […]