The Centers for Medicare & Medicaid Services (CMS) must support and encourage the use of critical digital health tools for Medicare beneficiaries, said U.S. Rep. Vern Buchanan (R-FL), chairman of the U.S. House Ways and Means Subcommittee on Health.
“As a champion of medical innovation, I am concerned about CMS’ current approach toward digital health tools,” Rep. Buchanan said Nov. 7. “Their current assessment toward new digital health tools discourages and stifles innovative, life-saving technologies.
“CMS should rather encourage and bring eligible digital health innovations into Medicare beneficiaries’ care continuum, and I look forward to working with CMS to do just that,” he said.
The congressman’s comments follow an Oct. 30 letter he and two of his Republican colleagues sent to CMS Administrator Chiquita Brooks-LaSure in which they urged CMS to bring eligible digital health innovations into Medicare beneficiaries’ care continuum by clarifying whether digital medical devices, such as software as a medical device (SaMD), are included in existing benefit categories.
Specifically, SaMD technologies can be used to enable greater clinical communication and analyze critical medical data so doctors can provide information to patients in a quick, efficient and timely manner, according to the letter.
Rep. Buchanan and his colleagues pointed to this year’s Physician Fee Schedule, in which CMS requested input on how to improve the practice expense (PE) methodology.
“We are encouraged that CMS recognizes that its existing PE methodology creates significant barriers to the uptake of digital health innovations through the classification of most SaMD as indirect practice expense,” they wrote. “While the existing PE methodology is meant to account for a physician practice’s costs, both direct and indirect, the ongoing choice of CMS to categorize SaMD as an indirect practice expense discourages the uptake and use of SaMD, remains one of the largest barriers to meaningful Medicare payment reforms, and is long overdue for a change.”
CMS’ indirect methodology leverages cost bases and uses physician work relative value units (RVUs), they noted, but does not account for other factors like device maintenance.
“We urge CMS to evolve its PE methodology to reflect the value that software provides by incorporating the value of software into CPT codes to address PE and/or work intensity for RVUs,” added the members.
They called on CMS to act in its Calendar Year 2025 Physician Fee Schedule rulemaking to effect overdue changes to its PE methodology to accurately categorize and support the use of SaMD in Medicare; and to then launch a standalone consultation to inform broader reforms to its PE methodology, according to their letter.