Fortnightly Healthtech Update #26

A two year research project to develop a wearable specifically for patients in emergency air transportation.

The pandemic is stalling the rollout of Accountable Care Organizations (ACOs) in many places, but accelerating it in others. Visionary hospitals, such as Intermountain and Mayo Clinic are pushing ahead with hospital at home models. There are no payment details in that article, so I’m thinking the only financial incentive for the health systems is cost saving as part of an ACO. Also looking at treating people in their homes, DispatchHealth raises $136m for its model of delivering a medical team promptly to someone’s home. A service that I think would be attractive for ACOs.

By the by, perhaps one of the problems with Medicare ACOs is that participation can be relatively short-lived. It’s a five year minimum for the Medicare Shared Saving Program. Five years is fine for a bit of tinkering around the edges. But, is it really enough to get providers to commit to the deep, radical changes in care delivery that are needed? Like changing clinical practices and investing in telehealth to keep people with chronic conditions at home. Because according to the Medicare Payment Advisory Commission, we’re almost out of time to keep the ship off the rocks. The Medicare Part A trust fund will be empty in 2026. So a more rapid pivot to Accountable Care Organizations is highly recommended.

Circadia Health gets FDA clearance for contactless respiration rate monitoring using low-power radar. Can’t be a better time to release something that monitors a key vital sign while protecting caregivers and limiting opportunities for cross-contamination. The company suggests providers use the new remote monitoring billing codes introduced by CMS at the start of 2019. These codes can work well for reusable devices, but are going to be an economic challenge for disposable devices. In a healthcare facility, single use helps to limit cross-contamination and cut equipment cleaning work. In the home, that doesn’t matter so much, so disposable devices just add cost.

Masimo steps into new territory with Centroid, measuring respiratory rate, orientation and detecting falls. New territory because Masimo is most famous for measuring blood oxygenation and related parameters. On the face of it though, this device doesn’t seem to offer anything different to VitalConnect, the Philips biosensor, or the Biointellisence BioSticker.

A bit of a tangent, vital sign monitoring underwear for race car drivers.

Hospitals lost the latest (but not the last) round of court battles over price transparency. While they ready an appeal, the hospitals’ position is that it would be a bad idea to force them to implement it during a pandemic. Maybe, but they could have complied last year instead of fighting it all the way. I don’t think this will help much in itself, but it’s a start. Transparency for the big expenses isn’t just down to the hospital. For surgery, there’s the surgeon. Easy enough to find out if they are in-network ahead of time. But the other really expensive skill in the room, the anesthesiologist, the patient rarely knows who that is going to be until a couple of hours before surgery. In-network or out, you know nothing about arguably the second most important person in the OR (after you). Oh, and Aetna’s handy advice on avoiding surprise bills includes patients should know the billing codes for everything beforehand. So, really no chance for the average person to get a fair shake at a reasonable healthcare bill then.

Not the most comfortable looking design perhaps, but Kyocera helps develop wearable for remote rehab monitoring.

Apple is set to make arguable its biggest healthcare contribution to date, introducing watch functions that are broadly relevant for senior health. If this can truly be used for remote medical monitoring, the reimbursement codes noted above for Circadia Health are probably the likely path to revenue for providers. But healthcare costs overall are only going to drop if that remote monitoring means in-person visits can be avoided.

A couple of longer reads: First, The promise and the perils of virtual health care. The author asks, “is virtual care a future we want?” If it makes healthcare more affordable, absolutely it is! Second, McKinsey chimes in with the implications of COVID-19 for value-based care. The biggest point is very valid, that value-based care is fine for steady-state healthcare. Not fine for a pandemic – but then neither is the traditional fee-for-service payment model. More tellingly for me is confirmation of the glacial pace of payment reform. A quoted report states that only 6% of payments have downside risk for providers. And that percentage hasn’t changed in 5 years. By my reckoning, that means payment reform has either stalled, or it was just a fiction all along. Fiddling while Rome burns springs to mind.