Digital Medicine Pathway to Clinical Adoption: Comparative Clinical Evidence Essential Along Pathway Continuum Sylvia J. Trujillo Senior Washington Counsel November 1, 2018 #PCORI2018
Sylvia J. Trujillo • Has nothing to disclose. 2 • November 1, 2018
How is comparative effectiveness research in digital medicine necessary to facilitate clinical adoption? • What is AMA’s and physician interest in digital medicine tools (including telehealth, remote patient monitoring, and other modalities)? • What are the major barriers to physician adoption of digital medicine interventions like the ones discussed? • What additional information is needed to change practice? 3 • November 1, 2018
Why is digital medicine needed? No Ordinary Future Trends Current Challenge • Baby Boom size • Incidence of chronic disease and • Longevity prevention /chronic care • Lower birth rates management challenges • Strain on safety net program • Cost of health care • Growing shortages of clinicians and • Fragmentation of care and caregivers duplication of care and administration • Geographic mismatch between specialists and patients 4 • November 1, 2018
clinical 2016 AMA Digital Health Study efficacy demonstrated (as compared AMA commissioned survey to in-person of physicians care) Digital Health Study standard liability coverage and insurance payment coverage available Physicians Adopt Investigate physician Overarching finding: •motivations •physicians are optimistic that workflow data •current usage digital medicine tools will improve integration with privacy/security medical practice and patient care •expectations for integrating digital electronic health is assured health tools into their practice record (EHR) by experts systems 5 • November 1, 2018
AMA Digital Health Initiatives: Innovation to Clinical Integration Physician Questions: 1. Is it clinically valid? 2. Will I get paid? 3. Will I get sued? 4. Does it work in my practice? Discovery / Clinical Interoperability Validation Coding Coverage Infrastructure Liability / Med- AMA Initiatives: Regulatory Pricing Training / / QA Mal, PI, HIPAA Workforce PHYSICIAN INNOVATION NETWORK / PHYSICIAN DIGITAL MEDICINE PAYMENT XCERTIA INDUSTRY DIGITAL PLAYBOOK INNOVATION GUIDELINES ADVISORY GROUP EDUCATION CENTER NETWORK ADVOCACY & POLICY INITIATIVES 6 • November 1, 2018
Digital Medicine Payment Advisory Group 2018 2017 Enterprise solution Will I get paid? Will I get sued? Innovation Coding Coverage Inter-operability Regulation Pricing Liability Training Aggregate evidence base Gaps in coding Fair and accurate valuation Widespread coverage Program Integrity risks risks unique to digital medicine High Touch: 14 advisors with a staffer assigned to each advisor Mix of established players (such as Cleveland Clinical), national innovators, CPT Panel and RUC members 7 • November 1, 2018
DMPAG Objectives Establishment of a clear Creation and/or dissemination of data/evidence supporting the use of digital medicine technologies and pathway to clinical services in clinical practice. integration of digital medicine in order to ensure access to high Existing code sets (with an emphasis on CPT and HCPCS) and the level to which they appropriately capture these services and technologies. quality and safe clinical care for patients and their physicians that Factors that impact the fair and accurate valuation for services delivered via telehealth. promote improved health outcomes. The Advisory Group will address: Widespread coverage of digital medicine (including telemedicine and remote patient monitoring), including greater transparency of services covered by payers and advocacy for enforcement of parity coverage laws. Program integrity concerns of payers including, but not limited to, appropriate code use, and other perceived risks unique to digital medicine. 8 • November 1, 2018
DMPAG AMA • In-depth Interviews of DMPAG early adopters Environmental Remote patient Digital Health Implementation Survey of Clinical • Consultations with Literature clinical experts monitoring codes Playbook Internet interprofessional DMPAG Code • CPT Editorial Applications Physician Innovation Network consultation codes Panel Adopts submitted to CPT Codes Editorial Panel Education Center CMS Proposes • Final Rule will Coverage be issued in November FY 2019 Xcertia 9 • November 1, 2018
Evidence Base Needed to Expand Integration • Does digital medicine promote the quadruple aim? • Enhancing patient experience • Improving population health • Promoting value • Improving the work life of health care providers, including clinicians and staff • Does digital medicine modality provide care in less restrictive / less institutionalized sites of care in a clinically efficacious manner? (Care closer to patient) • Does digital medicine tool promote prevention (or delay onset of disease or mitigate impact)? • Does digital medicine modality promote care coordination or continuity of care? 10 • November 1, 2018
Learn More • www.ama-assn.org 11 • November 1, 2018
Thank You! Sylvia Trujillo Senior Washington Counsel November 1 st , 2018 12 • November 1, 2018
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