Semler: CMS Risk Adjustment Changes in 2024 Medicare Advantage, Part D Final Rates

 Semler Scientific, Inc. (Nasdaq: SMLR), a company that provides technology solutions to improve the clinical effectiveness and efficiency of healthcare providers, commented on the recent Centers for Medicare and Medicaid Services (CMS) 2024 Medicare Advantage and Part D Final Rate Announcement.

"Semler Scientific remains confident that screening for peripheral artery disease (PAD) using our QuantaFlo® product is in the best interest of at-risk Medicare beneficiaries, despite CMS' decision to finalize removal of PAD without complications from its Medicare Advantage risk adjustment model," said Wayne T. Pan, Ph.D., M.D., chief executive officer of Semler Scientific. "Furthermore, a three-year phase-in of the changes to the risk adjustment model will support continued screening of at-risk asymptomatic patients for PAD during the transition period, which will contribute to the collection of even more clinical outcome data underscoring the importance of asymptomatic screening going forward." The removal of PAD without complications from the Medicare Advantage risk adjustment model was originally proposed by CMS in its 2024 Medicare Advantage and Part D Advance Notice, which CMS released in February 2023.

Using the American Heart Association/American College of Cardiology guidelines for PAD testing, Semler Scientific's QuantaFlo® has proven to be a fast, portable, cost-effective, and accurate tool that provides value to patients and payors. QuantaFlo aids in the diagnosis of previously undetected early-stage PAD and heart dysfunction (HD), enabling primary care physicians to treat risk factors that contribute to the progression of these serious vascular and cardiac diseases.

Semler Scientific believes it is essential that current testing protocols remain in place. With the potential to modify disease progression, Semler Scientific is optimistic that earlier diagnosis and treatment can lead to improved long-term clinical outcomes for patients. This was supported in the February 2022 publication of the Journal of Vascular Surgery, which found that a positive PAD screening test in Medicare Advantage patients was independently associated with an increase of ~60% to 70% for 1-year all-cause mortality and/or major adverse cardiac events (MACE) and a 40% to 50% increase for 3-year all-cause mortality and MACE. The authors concluded that these findings highlight an "enormous potential to realize cost-savings by reducing cardiovascular event rates and deploying population-based PAD risk mitigation strategies." Semler Scientific believes that the paradigm of earlier diagnosis and intervention will become the standard of care in managing patients with PAD and/or HD.

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