Regulations Not Keeping Up with Technology

By Wayne Caswell

The rapid and accelerating pace of tech innovation has profound implications for healthcare delivery & payment, aging, and disability employment, but regulations that support that are spotty or nonexistent.

The good news

“Durable medical equipment” is a class of assistive technology that can be paid for by Medicare, Medicaid and many private insurance plans. Motorized wheel chairs most often fall into this category.

“Orthotics and prosthetics” is another category that earns similar medical coverage. Leg braces, prosthetic limbs, prosthetic eyes (ocular shells) tend to all get medical reimbursement coverage too, through Medicare, Medicaid or private insurance.

The bad news

Our nation’s medical regulations seem to have been written and finalized in 1962 because, if an assistive technology device was not invented by then, it appears it will never be covered. Common examples include: digital hearing aids for people who are hard of hearing, video magnification devices for people with low vision, screen reader software for people who are blind., augmentative communication devices for people with neurological disabilities, etc.

And then there are the antiquated rules that prevent effective use of telehealth and telemedicine. If ever there was a worthwhile healthcare policy issue affecting the elderly and people, addressing these issues is a big one.

One proposed solution

A new bill in front of Congress, if passed, would increase access to Telemedicine and Telehealth, with reimbursement through Medicare, Medicaid, CHIP, TRICARE, federal employee health plans and the Department of Veterans Affairs. But I expect it will become a major “States Rights” wedge issue, because it also provides a new federal standard for medical licensure.

As proposed, providers in all federal health plans would only need to be licensed in the state of their physical location and would be free to treat eligible patients anywhere in the nation. It would mean your primary care physician or specialist could reside in another state and practice medicine across state lines, and it could dramatically change the way health care is delivered and reduce costs.

I see telehealth as an important trend that might someday allow video calls to reach across international borders. The technology allows that now, just not the politics, because there are powerful special interests that want to protect the status quo. The Medical industrial complex doesn’t want to stop making $2.7 trillion per year (about 18% of GDP and rising), so it spends twice as much on lobbying as the Military industrial complex.

For more detail, see Proposed bill would expand telehealth services, bolster federal payouts.