LEGAL UPDATES SUPPORT THE MEDARRIVE MEDICINE
The 2024 Physician Fee Schedule expands access to MedArrive services and providers.
Healthcare must constantly evolve to meet patients’ needs. Meanwhile, the legal and regulatory landscape is often playing catch up, as demonstrated in the long-awaited 2024 Physician Fee Schedule updates that expand access to essential community health services.
MedArrive has employed a multi-disciplinary, holistic patient care model focused on underserved communities since its inception in 2020. Now, managed care organizations, insurance companies, and other payors increasingly recognize the benefits of a whole-person approach in patient care, especially in needy populations with high healthcare needs. These payors acknowledge the value derived from holistic services by providers in the community, like the paramedics and emergency medical technicians who function as MedArrive’s field providers and are the backbone of MedArrive's clinical services programs. However, a significant hurdle to expanding access here has been the fee-for-service reimbursements available to providers in this field - especially from government payors like Medicare, the federal healthcare program for seniors and individuals under 65 with certain medical conditions.
This month, the Centers for Medicare & Medicaid Services (CMS) issued a final rule that announced policy changes for Medicare, including significant payment updates to the 2024 Physician Fee Schedule. Of note, CMS added codes to the Physician Fee Schedule to pay for Community Health Integration (CHI) and Social Determinants of Health (SDOH) Risk Assessments and an additional code for evaluation and management in longitudinal care. This expands access in two meaningful ways.
First, the final rule expands reimbursable services. Under the 2024 Physician Fee Schedule, the Medicare program will pay for services addressing social needs – the ancillary services crucial to driving better healthcare outcomes for MedArrive’s patients and delivering a return on investment to MedArrive’s patients’ insurance programs. In its renowned longitudinal emergency department avoidance program, MedArrive pairs medical evaluation and management by telehealth physicians and advanced practice professionals with in-person EMS professionals who also have remote support to address behavioral health and SDOH needs with the goal of reducing preventable emergency room and inpatient admissions. Now, CMS has also formally recognized that these services can deliver the value that MedArrive continues to provide:
“better understand the patient’s life story, care coordination, contextualizing health education, building patient self-advocacy skills, health system navigation, facilitating behavioral change, providing social and emotional support, and facilitating access to community-based social services to address unmet social determinations of health (SDOH) needs.”(1)
Also crucial to the mission-driven nature of MedArrive, these services “help contribute to reduced health care disparities in underserved populations.”(2) Reimbursement for these initiatives by federal healthcare programs is essential in increasing access to these services and improving health equity. Importantly, with reimbursement will come acceleration in the build-out of the underlying technology needed to support these programs, from sophisticated data-driven decision support to advanced logistics management.
Second, the final rule expands the types of reimbursable providers beyond traditional doctors and nurses. In addition to broadening the scope of reimbursable healthcare services, CMS increased the range of providers that can provide these services to government healthcare members. In its updates related to CHI, CMS is providing additional pathways to payment for services by professionals like MedArrive’s Field Providers, who can offer a range of healthcare services within their scope of practice. CMS has acknowledged what MedArrive has always known - these healthcare professionals have the expertise to drive incredible clinical outcomes for patients founded on the ability to establish trust with a patient in their home. Medicare coverage for these professionals’ services is vital in improving access to community health services. Finally, CMS formally recognized the importance of “community health workers, who link underserved communities with critical health care and social services in the community, and expand equitable access to care, improving outcomes for the [covered] population.”(3)
Moreover, CMS noted the added value of longitudinal care programs in driving positive healthcare outcomes, which is the focus of MedArrive’s clinical services programs. In its press release, CMS observed that "[b]uilding an effective longitudinal relationship, in and of itself, is a key aspect of providing reasonable and necessary medical care and will make the patient more likely to comply with treatment recommendations after the visit and during future visits."(4) For many patients, one-and-done is not the practical or affordable way to treat their conditions, and the federal government’s support of longitudinal healthcare programs should be here to stay.
MedArrive’s Chief Clinical Officer, Dr. Rocky Samuel, is excited to see the federal government catching up to MedArrive’s customers, who have long recognized the contribution of community health workers and services that address social needs in delivering outstanding medical care.
“For far too long, Providers have not been given credit for their heroic efforts to go above and beyond for patients who have fallen through the cracks in a broken healthcare system. These changes are a step in the right direction to enable delivery of high value patient care that focuses on the multi-faceted root causes of poor patient outcomes and treats the patient holistically.”
Lillie Werner Singh, MedArrive’s General Counsel, emphasizes the importance of these reimbursement updates in demonstrating the value of community-based care.
“Finally, CMS has recognized that community-integrated healthcare drives positive health outcomes for patients and significant savings for payors. By fronting the costs of whole-person healthcare that supports patients with chronic medical conditions and poor health literacy, the government saves money in the long term. Emergency room and inpatient divergence programs, like the ones we support at MedArrive, result in savings of thousands of dollars per patient by reducing unnecessary medical costs and establishing continuity of care with the right medical and behavioral health providers. These programs deliver incredible ROI [return on investment] to health. And, most importantly, they improve patient lives.”
Nonetheless, there are still meaningful changes to government reimbursement models necessary to further health equity. Ms. Singh suggests: “Reimbursement for AI-services is the next frontier.”
MedArrive is a tech-enabled healthcare company that supports longitudinal healthcare services, including in-home care for health plan members. MedArrive Inc., the MedArrive parent company, and its subsidiary MedArrive MSO LLC provide AI-powered technology offerings and management services to healthcare providers, like MedArrive, P.A. and Harris County MIH PLLC (collectively, MedArrive). MedArrive aims to bridge the gap between digital and physical care with proprietary technology capabilities and an innovative clinical service model. Our platform and software solutions enable healthcare payers and providers to extend their services into the home, thereby improving access and outcomes while reducing costs.
(1) Centers for Medicare & Medicaid Services, “Calendar Year (CY) 2024 Medicare Physician Fee Schedule Final Rule,” Nov. 2, 2023 (Available at https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-medicare-physician-fee-schedule-final-rule) (“CMS 2024 PFS Press Release”).
(2) Id.
(3) Centers for Medicare & Medicaid Services, “CMS Finalizes Physician Payment Rule that Advances Health Equity,” Nov. 2, 2023 (Available at https://www.cms.gov/newsroom/press-releases/cms-finalizes-physician-payment-rule-advances-health-equity).
(4) CMS 2024 PFS Press Release.