Providers Struggle to Add New Tech as Payment Models Can’t Keep Up

Go to any skilled nursing or senior living conference, and you’ll be greeted with a wide array of exciting new technologies with the potential for making residents’ and workers’ lives better.

On the flashier end, there’s full-size exoskeletons that can help seniors walk again, or virtual-reality games that help users re-learn how to swallow and perform other basic activities; on the more ordinary but still impressive side, there’s predictive software that can help practitioners prevent hospitalizations, and compliant videoconferencing programs that allow doctors to treat residents remotely.

Of course, faced with reimbursement pressures in a changing payment landscape, it’s easy for an operator to look at this nearly infinite array of tech options and say: That’s great, but how do I pay for it?


Part of the problem, according to senior tech researcher Liddy Manson, is that new gadgets and software evolve far faster than the government’s ability to figure out a way to reimburse for them.

“I think Medicare was legislated in a very specific way, and their payment models follow that legislation,” Manson, director of the AgingWell Hub at Georgetown University’s Global Social Enterprise Initiative, told Skilled Nursing News. “This is not a jab at Medicare in any way, but it’s pointing out a difference in the metabolism.”

Take, for example, telemedicine, which Medicare only covers in rural skilled nursing facilities. That only equates to about one third of the more than 15,000 skilled nursing facilities in the country, Tapestry Telehealth COO Mordy Eisenberg told SNN earlier this summer. And while Eisenberg expressed optimism that a recent move by the Centers for Medicare & Medicaid Services (CMS) to expand telehealth coverage for physicians could signal a future push toward fuller SNF reimbursements, that day remains far-off for now.


The potential is there: Extrapolating from a single-SNF study in which telehealth helped save $1.5 million in potential rehospitalization costs, a study backed by telemedicine firm TripleCare estimated that the federal government could save $1.5 billion per year by promoting the more widespread use of the technology.

To help bridge the gap between the speedier world of tech development and the more deliberative actions of the federal government, Manson pointed to the work of the Center for Medicare & Medicaid Innovation (CMMI), as well as the public-private Medicare Advantage plans that have incentivized more creative cost-saving solutions.

Manson herself came to Georgetown after a 25-year career in technology that included founding BeClose, a smart-home platform for seniors that was sold in 2015 to The Washington, D.C.-based AgingWell Hub serves as a joint venture between Georgetown’s McDonough School of Business and multinational technology and consumer-product company Philips, with the goal of bringing together multiple public and private players in the service of developing new senior-focused technologies.

Multiple upsides required

Key decision-makers at health systems and other providers can receive hundreds of pitches per day from vendors of technology services, and in order to cut through the noise, Manson suggests that developers should focus on how multiple players can benefit by incorporating the tech into an overall health landscape.

“Whoever is buying this product has to see a value proposition that they can extend into other lines of business as well,” she said.

Manson gave the example of diabetes treatment programs at MedStar Health, a major hospital chain in the Baltimore-Washington metropolitan area. Using smart glucometers, physicians and other providers within the MedStar network were able to intervene with patients who weren’t treating their diabetes effectively before they required costly hospitalizations; the network also partnered with ride-sharing service Uber to ferry patients without reliable transportation options to their appointments, providing a shared upside for Medicare, the patients, and the hospital.

“There needs to be an ROI,” Manson said. “A lot of organizations are running very thin margins, but technology that solves a 2% problem isn’t something they’re going to stick their neck out on. It’s going to have to solve a 20% problem.”

Taking advantage of existing tech

Manson’s vision of the senior tech future looks a lot like the medical care present for her teenage daughter, who uses her iPhone to help manage her diabetes and other chronic health conditions. With a few taps of the same device she uses in her everyday life, she can check her blood sugar and view her lab reports online.

“In the past three years, diabetes as a disease has been transformed by what you can do with an iPhone,” Manson said.

And as seniors become more comfortable with smartphones, tablets, and ride-share services, Manson predicts that developers will focus more on incorporating health care into these staples of modern life. Instead of adult children initiating an awkward conversation about how it’s time for their adult parents to stop driving, tomorrow’s seniors will gradually initiate that process on their own when they discover the convenience of Uber and Lyft — until they eventually decide to eliminate the hassle of driving altogether.

“I think that kind of thing will make a big, big difference,” she said. “And I don’t think it needs to be technology with a capital T. I think it’s going to be a continuum,” she said.

Editor’s note: An earlier version of this story misidentified the backer of the telehealth savings study. SNN regrets the error.

Written by Alex Spanko

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