September 4, 2019

In the late 1960s, an absurd sitcom about a self-assured spy was part of the weekly entertainment fare for many American families.  It was called “Get Smart.”  You might recall that Maxwell Smart was the secret agent whose shoe doubled as a phone—complete with rotary dial on the sole.  Little did the creators of that comedic series know at the time how prescient the show’s name would become in the decades that followed.  In the 1990s the world was introduced to the term “smart phone.”  We’ve now got “smart meters” that are increasingly connected to our “smart homes.”  It would appear that the rush is on to “get smart” in nearly every area of our lives.

Yes, we’re entering a brave new world of intelligent instruments that yield instantaneous assessments and provide immediate feedback.  It’s as if the space-age gizmos of the Jetsons—another comedic predictor from the 60s—are arriving (by drone) every day at our door.  Do you think that medicine is immune from this trend?  The purpose of this article is to address what’s new in “smart medicine,” how this will play out in the years to come, and what you can do to prepare for, and take advantage of, this new reality.

A Wave in the Air

Modern medicine is increasingly moving in the direction of high-tech solutions, and facilities will need to ride this new wave if they intend to compete, and astutely treat, long-term.  Like the Golden Earring song from long ago, this new wave is wafting in the air, because so much of today’s smart medicine is dependent upon Wi-Fi, remote and cloud technology.  Think about the devices that people are using today that are connected to their bodies and that provide digital diagnostics on the spot.  How many steps did I walk?  It’s on my Fitbit.  How’s my heart rate?  Check the phone app.

Studies show that consumers are increasingly comfortable with, and dependent upon, personal devices, and that ultimately leads to better health.  The reasons are simple.  First, some people like owning the latest and greatest gadgets.  If these items are related to fitness, they are more likely to wear them, use them, or keep them in close proximity.  They are, therefore, motivated to keep track of their vital signs and exercise progress and to improve these metrics over time.  This ultimately leads to a healthier populace.  Diagnostic devices are not the only ones being sought by consumers.  According to a 2018 PwC Health Research Institute survey, 54 percent of Americans would be willing to use a government-approved app or online tool for treatment of a medical condition.

Follow the Money

According to a late 2018 Rock Health report, investors pumped a staggering $12.5 billion into digital health companies in 2017 and 2018, representing a 230 percent increase over such funding from the previous five years.  This massive monetary infusion clearly points to a major shift in the market.  This will only increase with the growing sophistication of AI, robotics and biopharmaceutical technology.  Accordingly, it would behoove healthcare facilities to familiarize themselves with, and begin to invest in, these promising new marvels of medicine—a few examples of which are provided in the section below.

Medico-Wonders from Techno-Wizards

The U.S. Food and Drug Administration (FDA) has already signed off on several new digital therapies, and more clearances are on the way.  Among those already approved are Boston-based Pear Therapeutics’ Reset mobile application for the treatment of substance abuse, and Stockholm-based Natural Cycles’ birth control app—which, incidentally, has nearly a million registered users according to company representatives.  Many other connected devices designed to treat conditions ranging from diabetes to central nervous system disorders are expected to enter the market this year.

The FDA is also developing a certification protocol for new digital-medical technologies.  According to the agency’s website:

The Software Precertification (Pre-Cert) Pilot Program, as outlined in the FDA’s Digital Health Innovation Action Plan, will help inform the development of a future regulatory model that will provide more streamlined and efficient regulatory oversight of software-based medical devices developed by manufacturers who have demonstrated a robust culture of quality and organizational excellence, and who are committed to monitoring real-world performance of their products once they reach the U.S. market.

So far, companies participating in this federal pilot program include Johnson & Johnson, Pear Therapeutics, Samsung, Roche, Apple, Verily, Fitbit, Phosphorus and Tidepool, among others.

Capitalizing on the Trend

Recognizing that providers are increasingly opting for new technologies to improve patient outcomes, the American Medical Association (AMA) created new procedural codes for 2019 that allow professional clinicians to capture payment for these digitally-based services.  For example, the 2019 CPT manual provides new coding options for providers who use technology to monitor and treat their patient from a remote location.  These include:

• 99453 Remote monitoring of physiologic parameter(s), (for example, weight, blood pressure, pulse oximetry, respiratory flow rate) initial; setup and patient education on equipment use.
• 99454 Device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.
• 99457 Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.

The 2019 Medicare Physician Fee Schedule (MPFS) Final Rule, published in November of last year, contained provisions that would provide Medicare payment for the above services.  In addition, there are now internet-based consultation codes, which allow clinicians to capture payment for their ever-increasing use of technology-based communications to coordinate patient care.  The following codes reflect such services:

• 99451 Interprofessional telephone/internet/electronic health record assessment and management service provided by a consultative physician, including a written report to the patient’s treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative time.
• 99452 Interprofessional telephone/internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes.

The inclusion of these codes is only the beginning.  Earlier this summer, we learned that the AMA plans on making available in 2021 a CPT code to reflect detection of diabetic retinopathy through an autonomous AI system that would obviate physician interpretation.  This may seem like a ho-hum development and barely relevant to the larger healthcare community, but that would be a mistaken assessment.  The AMA’s decision is quite historic because “it’s the first step in a process [that will] lead to payments for autonomous AI, in general,” according to the AI system’s developer.  This code will set the precedent, creating a pathway to payment for other AI technologies that follow.  This, in turn, will incentivize other companies in the digital therapeutics industry to ramp up the development of even more high-tech devices.

So, the future is here.  Smart medicine will continue to advance and proliferate.  Consequently, it would be wise for hospitals and health systems to acquaint themselves with these emerging technologies, even down to the device level.  They should be asking these questions:

1. Is this a device or system that can be used at our facility?  That is, will it mesh with our culture, current personnel, infrastructure, etc.?  If not, would its potential value in patient care and reimbursement offset the cost of any changes that might be necessary relative to these items?
2. What digital therapeutic devices or systems are on the market right now that would make sense for our facility?  Do we have individuals on staff charged with mining this information or interfacing with applicable manufacturers/vendors?  If so, are these individuals providing sufficient insights and ongoing recommendations?
3. How should our future staffing model be shaped in light of the AI technologies that are on the horizon?  That is, for the purpose of long-term budget planning, what will be the possible impact of such technologies on overall personnel numbers, compensation expenditures, and device expenditures?  Will these digital therapeutics lead to a leaner staff, and how might that impact the design of future facilities?

We are just now entering the first phase of what promises to be a revolution in medical diagnostics and treatments—a Jetson-like era of AI, physician-free automation and robotics.  It will be incumbent upon healthcare leaders to keep track of these new technologies and create strategies to appropriately incorporate the best of these into their institutions and practices.  We at MiraMed Global Services will work with you to provide insight on digital therapeutic reimbursement opportunities.  Please let us know if you have questions on this topic.  In the meantime, watch out for those flying cars.