CMS Flexibility Impacts Digital Health Innovation
Carrie Nixon, managing partner at Nixon Gwilt Law and moderator for the HLTH 2021 session, titled “The Evolution of Reimbursement,” started off the discussion by asking how payment policy facilitates innovation in digital health.
“Before the pandemic, we had guardrails placed by Congress, likely because of the potential cost. Telehealth was only for established patients and only for certain types of visits,” said Dr. Marion Couch, senior vice president and chief medical officer at Cambia Health Solutions and former CMS senior medical adviser. “By rolling back regulations, approximately 80 more services become available. It’s helped transform acceptance of digital health and telehealth.”
Greg Deavens, president and CEO of Independence Blue Cross, emphasized the importance of the waivers and of flexibility for CMS.
“Going forward, from a legislative standpoint, I hope there’s more flexibility provided to CMS and other bodies to make sure they have the ability to modify how business is done and how payers and providers interact in order for us to take advantage of the technological advances coming at us quickly,” he said. “Having the flexibility to adapt the system quickly is critically important.”
A Post-Pandemic Strategy for Telehealth
In many ways, the pandemic was the catalyst for innovation. Couch said that her hope is that with new services and providers available, the healthcare industry will exit the pandemic with a better understanding of where telehealth is valuable.
Deavens said reimbursement rates for telehealth visits should be closer to those for in-office visits to maintain telehealth use long term. Part of the reason telehealth reimbursement was so much lower than for in-person care is the use of office resources. However, other factors play into the value of telehealth, such as the ease with which patients and clinicians can set up and access appointments.