Categorize functional, digital contributions

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Friday, February 22, 2019

CMS is standardizing patient functional assessment in nursing homes, home health agencies, long-term care hospitals and inpatient rehabilitation facilities via Section GG, focusing on the degree to which patients can independently perform activities of daily living. CMS is also changing reimbursement, moving from units of service to a focus on patients’ conditions and resulting care needs.

Let’s now think about CMS’s call for a new way to categorize DME. Is this an opportunity for HME to assert the importance of equipment as a fundamental component of aging in place?

We say yes. Let’s propose categories that recognize the degree to which devices (1) promote the functional capacity of users, i.e., “Device Performance Capacity” and/or (2) contribute to the Electronic Health Record of their users, i.e. “Digital Health Contribution.” This will make the value proposition of equipment—so obvious to those who need these devices—explicit to providers and payers.

Consider the following “Device Performance Capacity” tiers:

Low Performance Devices

These are the commoditized devices that are mass produced. They sell at low prices; little is expected in the way of device performance. Users of these devices require minimal assistance from the design of the device for mobility or to perform activities of daily living. Without the device, the need for caregiver assistance may still be required but is negligible since users perform much or all of the effort themselves.  

High Performance Devices

These are devices that have components and technology that make mass production difficult. They sell at high prices. Much is expected in the way of device performance: Users require the design of the device to substantially offset the effort needed for mobility or to perform activities of daily living. Without the device, the need for caregiver assistance would be substantial; with the device, caregiver assistance can range from none, to steadying, to just verbal supervision.

Complex Performance Devices

These devices also have components/technology that make mass production difficult and sell at high prices. Much is expected in the way of device performance. Users require the design of the device to completely offset the effort needed for mobility or to perform activities of daily living. Without the device, the users are immobile and unable to perform activities of daily living. Even with the device, caregiver assistance is indispensable.

In addition to the three “Performance Tiers,” devices would be eligible for an additional “Digital Health Contribution” defined as the degree to which the device supports the collection, trending and transmission of user data. Such contribution would be (1) low if only providing feedback to the user of the device; (2) medium if sending reports on a particular condition; or (3) high if sending alerts about changes in health status.

For example, walkers would be low performance devices. Walkers with a sensor—communicating the location of the device to a family caregiver—would merit a low digital health contribution.

On the other hand, manual wheelchairs designed to ease self-propulsion would be high performance devices. Such wheelchairs with a sensor—alerting a case manager to unexpected changes in frequency/speed patterns—would merit a high digital health contribution.

These price differentials should be large enough to recognize the increased costs associated with training/servicing at each “Performance Tier,” as well as the software and interoperability required of the device.  

As importantly, price differentials will reflect the benefits that flow from the improved functional independence created by DME, especially the support for aging in place provided to older adults aging into, or with, disabilities. Providers and payers will see reductions in the total cost of care as they see fewer institutionalizations and ER visits, as well as improved recruitment/retention of hard-to-find direct care staff. Innovative DME will need new conversations about systems “return on investment” and new contractual terms to get these higher priced, and higher functioning, devices into the homes of the people who need them.

Peg Graham, a long-time advocate for HME innovation, is seeking to commercialize a patented dynamic bedside commode, ThePPAL. Send comments to @The_PPAL.