Work group aims to ‘reframe’ payment for technology

‘Why is it important and what does it prevent?’
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Friday, February 3, 2017

WASHINGTON – The members of AAHomecare’s new Hi Tech Work Group will meet face-to-face at Medtrade Spring to set next steps in their goal of getting private payers to increase reimbursement for new oxygen and sleep therapy technology, or create new payment models for them.

Leading up to the event, members of the work group were gathering information about how payments for other product categories have been reshaped. One recent example: CMS classified “therapeutic” continuous glucose monitors as DME and assigned them a one-time fee schedule amount of $236 to $277, plus bundled monthly payments for supplies.

“It’s interesting that they recognized the therapeutic aspect of these devices,” said Maura Toole, director of field marketing for Philips Healthcare, who is leading the work group. “Being able to monitor sleep apnea and what’s going on with mask fit, AHI and periodic breathing—these are all therapeutic benefits that providers offer with new technology. We’ve all focused on utilization, and not as much about the therapeutic benefits. That’s a way to reframe the issue to payers.”

The work group encompasses a cross-functional representation of manufacturers and providers. Helping Toole to lead the group is Laura Williard, AAHomecare’s senior director of payer relations.

While the work group doesn’t have a road map yet to achieve their goal, their strategy is to set a precedent with one payer, then give providers tools that they can use to motivate other payers to follow suit, Toole says.

“With private payers, there’s no cookie-cutter, turn-key solution,” she said. “So we want some kind of mechanism that providers can use to take it further.”

Key to setting that precedent will be proving the value of new technology, Williard said.

“Why is it important and what does it prevent?” she said. “What outcomes can we ensure to get payment?”

Williard, whose main job responsibility at AAHomecare is to improve the HME industry’s relationships with payers, says she believes “there is an opening there.”

“In my initial conversations with payers, there is some openness to discussing this,” she said. “But you definitely have to prove the value of it.”