Digital health service reimbursement: Breaking down the pros and cons

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How, and whether, to reimburse for use of digital health tools is complicated, says attorney Dale Van Demark, who breaks down the pros and cons of moving past traditional models when it comes to new technologies in a post to The National Law Review.

As the push for value-based purchasing grows, as well as efforts like population health management, “digital health tools can be valuable simply for the efficiencies improved quality they can bring to the delivery of healthcare services,” says Van Demark, a partner at law firm McDermott Will & Emery.

However, he also ruminates on the value that direct reimbursement holds, as well as some areas where it may not be needed.

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One example is telemedicine. For this kind of service, he says, reimbursement would make sense because it can mirror the way an in-person visit can be reimbursed.

But a lack of reimbursement standards has proven to be a hurdle for telemedicine, hindering adoption of the services by providers, FierceHealthIT previously reported.

On the other side, when it comes to provider-to-provider communication services or patient engagement efforts, the value of those “may be undercut by direct reimbursement” because it would be difficult to calculate, Van Denmark says.

He adds that the shift to alternative payment models (APMs) is not complete. Thus, APMs, Van Denmark says, “cannot be relied on to be all that exists at some platonic end-point of reimbursement reformation. Rather, fee-for-service is here to stay--at least for the foreseeable future.".

While electronic health record adoption spiked, in large part, because of definite financial incentives, he says, this doesn’t hold true for the current set of digital health tools.

He concludes that there is no “one-size-fits-all” solution, and that while direct reimbursement for digital health tools is not necessary in terms of the APMs, “there may be good reasons to push for direct reimbursement, at least for some digital health tools, so that they have a firm setting in the complicated world of healthcare reimbursement.”

To learn more:
- here's Van Denmark's post

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