Exoskeleton Report Digital Magazine Issue 7 Feb 2, 2024

(VOL. 2 NO.1)

ISSUE 7

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MEDICAL EXO REIMBURSEMENT

Will this be a new page for medical exoskeletons and the entire industry in the U.S.!?

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INTERVIEW

ReWalk Robotics CEO Larry Jasinski on fighting on behalf of Medicare beneficiaries to support coverage and payment for its exoskeletons.

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EVENT RECAPS

Exoskeleton Presentations at the National Ergonomics Conference, Las Vegas ErgoX, Washington DC

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EVENTS CALENDAR

Exoskeleton Technology related events to watch out for.

ROBOTIC MEDICAL EXO

The single most notable development in the world of medical powered exoskeletons was the Centers for Medicare & Medicaid Services (CMS) revising its rules to include exoskeletons for reimbursement. The change comes under the Home Health Prospective Payment System Rule CMS-1780, “which solidifies the inclusion of exoskeletons in the Medicare brace benefit category.”

The next milestone will be determining how much devices like the ReWalk will be reimbursed for. CMS has proposed a payment level of $94,617 for devices fitting within this code, and their final payment determination is expected to be announced in February 2024 and take effect on April 1, 2024.

This is a monumental achievement for ReWalk Robotics and medical exoskeleton developers in the U S market, the implications of which will be felt for years to come. This has been a focused journey for many years, and accepting exoskeletons for reimbursement didn’t happen overnight.

The Exoskeleton Report was fortunate to get an exclusive interview asking how exactly this monumental milestone was reached, who the main drivers behind the curtains were, and what we can expect in the near future!

Read the full interview with Larry Jasinski, CEO of ReWalk Robotics, on the next page:

Photo: designer491 Getty Images

Larry Jasinski, CEO of ReWalk Robotics

ExR: Did ReWalk work on this by themselves or in collaboration with other advanced physical rehabilitation providers and associations?

ReWalk has worked tirelessly for over five years on behalf of Medicare beneficiaries to support coverage and payment for its exoskeletons. Throughout this process, ReWalk has engaged closely with the Centers for Medicare and Medicaid Services (CMS), and has appreciated the support of third party organizations, such as the Medical Device Manufacturers Association (MDMA), the Independence Through Enhancement of Medicare and Medicaid (ITEM) Coalition, and advocacy

November, 2023

groups, such as the Christopher & Dana Reeve Foundation and the United Spinal Association, as well as the many physicians, physical therapists, and ReWalk device users who have all lent their voices to advocate for broader coverage of exoskeleton technology for individuals living with spinal cord injury

ExR: What would the new pathway to receiving reimbursement approval look like?

CMS recently finalized that personal exoskeletons must be included in the Medicare brace benefit category starting on January 1, 2024, which will result in CMS applying a lump sum payment method to personal exoskeletons. CMS also recently initiated the process of establishing a national payment rate for the code describing the ReWalk Personal Exoskeleton.

A preliminary payment determination will be discussed at the November 29th HCPCS Meeting, and a final payment

Larry Jasinski, courtesy ReWalk Robotics

...rate is expected in 2024. With a clear brace benefit category assignment and national reimbursement rate, the process of submitting claims for reimbursement through Medicare is expected to be streamlined Interested Medicare beneficiaries with spinal cord injury can go to their doctor for an exam to evaluate medical eligibility for a prescription for the ReWalk Personal Exoskeleton. ReWalk Robotics is expanding its support infrastructure and is committed to appropriately assisting candidates every step of the way, including providing the necessary support to prepare and submit claims for Medicare beneficiaries that receive the ReWalk Personal Exoskeleton This process has already been implemented for the many Medicare beneficiaries within our current pipeline.

Would there be additional reimbursement for cost of ownership (training and device maintenance, etc.)?

CMS has not specifically addressed Medicare reimbursement for maintenance and servicing of the ReWalk Personal Exoskeleton. The ReWalk Personal Exoskeleton currently includes a 5-year warranty, which covers routine device maintenance and repairs during that time. Training is conducted between the individual device user and their local physical therapist and is billed to the individual’s insurance in accordance with their policy

How many people may qualify for a ReWalk in the U.S?

Based on our historical experience, we estimate that approximately 10% of individuals living with spinal cord injury will meet all the requirements (e.g., medical eligibility, motivation, etc.) for use of a ReWalk Personal Exoskeleton. The National Spinal Cord Injury Statistical Center (NSCISC) estimates that there are approximately 296,000 individuals in the U.S. who are currently living with spinal cord injury, so that would suggest that there are approximately 29,600 individuals who could potentially benefit from a ReWalk Personal Exoskeleton.

Left: Gene L in a ReWalk powered exoskeleton, courtesy of ReWalk Robotics

EXOSKELETON COVERAGE FROM THE 2023 NATIONAL ERGONOMICS CONFERENCE

BY MATTHEW MARINO, PT, MSPT, CPE, CPSS, CSCS, TSAC-F CEO AND HEAD OF PERFORMANCE | PRIME PERFORMANCE

The National Ergonomics Conference held in Las Vegas from November 8-10, 2023, showcased a diverse range of presentations including several related to occupational exoskeletons. Here's a snapshot of the noteworthy exoskeleton related sessions:

1. Title: Technology Pilot and Implementation Roadmap: Making Innovation Accessible

Description:

This session, led by industry and research experts, delved into the challenges and opportunities presented by emergent technologies such as Wearables, IIoT, Cobots, Computer Vision and Exoskeletons in addressing musculoskeletal disorders (MSDs). The panel, moderated by Matthew Marino and featuring David Brodie, Menekse Salar Barim, Rammohan Maikala, and Sarah Ballini-Ross, provided a roadmap for organizations to effectively navigate technology piloting and implementation The audience gained insights into managing projects, real-world implementations, and making informed decisions to support MSD risk reduction.

2. Title: Drivers of Successful Adoption of Industrial Exoskeletons

Description:

Matthew Marino, CEO and Head of Performance at Prime Performance, shared insights into the drivers of successful user adoption of industrial exoskeletons. Drawing from scientific studies and real-world implementation stories, Marino provided attendees with a comprehensive understanding of how to facilitate employees' intentions to use exoskeletons at work.

3. Title: Technology in Workers’ Compensation: Making the Workplace Safer

Description:

Woody Dwyer, Director of Loss Control at AmTrust Insurance, highlighted the role of safety technology including exoskeletons in managing musculoskeletal disorders Dwyer discussed how advancements in these technologies can assist companies in measuring and reducing workplace risk factors, ultimately decreasing the frequency and cost of workers' compensation claims.

Sarah Ballini-Ross and Matthew Marino at National Ergo Expo 2023 Las Vegas, courtesy of Prime Performance (website) (Matt’s LinkedIn), (Sarah’s LinkedIn)

4. Title: Field Testing a Low Back Exoskeleton in Manufacturing and Construction

Description: Kevin Simonton, Senior Human Performance Specialist at Pinnacol Assurance, presented findings from three pilot projects with HeroWear's Apex exoskeleton. The session focused on evaluating the exoskeleton's ability to provide assistance, reduce fatigue and back stress, fit into daily job tasks, and its potential for long-term use in manufacturing and construction settings

5. Title: Acceptance and Effectiveness of Workplace Wearables, Exoskeletons, and Robotics

Description: Jesse Jacobs, Product Director of Science and Research for Risk Control Services at Liberty Mutual Insurance, provided a comprehensive overview of current scientific knowledge paired with experiential insight on employee acceptance and effectiveness of sensing wearables, exoskeletons, and robotics

These 2023 National Ergonomics Conference presentations included several reoccurring themes and key takeaways about occupational exoskeletons worth noting

A.User acceptance and adoption of exoskeletons is still quite low because there are numerous factors (physiological, psychosocial, implementation related, work related, and policy related) that are not being taken into consideration when planning, preparing, evaluating, and integrating these devices into workplaces.

B. Proof of the effectiveness and operational value of exoskeletons is still lacking with little to no strong evidence to support claims that these devices can prevent work related injuries or improve job performance Until a consensus is reach on these matters many companies are continuing to consider and approach occupational exoskeletons with skepticism and caution.

C There continues to be a lack of awareness that occupational exoskeletons exist outside the workplace safety, ergonomics and exoskeleton communities. Going forward it will be important that exoskeleton marketing doesn’t continue to overpromise and underdeliver, but rather than people get informed and educated on the proven benefits and risks associated with using exoskeletons.

D. Exoskeletons are still perceived as being too expensive for many businesses, especially small to medium sized companies where they have the potential to help improve the quality of workers’ lives

Exoskeletons have potential to improve the lives of workers performing physically demanding jobs as well as those experiencing injuries or pain seeking return to work. With this goal in mind, there is much more work to be done before exoskeletons are accepted and adopted on a global scale. Presentations like these and those shared at other conferences on exoskeletons that share valuable research, experience, and insights act as pivotal steps toward reshaping the landscape of occupational exoskeletons, emphasizing innovation and promoting collaborative solutions for the benefit of humankind

Sarah Ballini-Ross and Matthew Marino at National Ergo Expo 2023 Las Vegas, courtesy of Prime Performance (website) (Matt’s LinkedIn), (Sarah’s LinkedIn)

RECAP: 2023 HFES ERGOX SYMPOSIUM

WITH SPECIAL THANKS TO DR. CHRISTOPHER REID

Vendors also had a presence, with tables dedicated to Levitate, SuitX by Ottobock, and Evolutionary Tools.

The ErgoX Exoskeleton Track also had a closing keynote address by senior scientist, Dr. Jennifer Cowley from the Chief Digital and Artificial Intelligence Office (CDAO) which reports to the Office of the Secretary of Defense Her talk was titled “Accelerating the Adoption of Data, Analytics and AI for Decision Advantage.”

The 9th ErgoX was held in Washington DC on October 23rd, 2023. The ErgoX Symposium is an annual technology event hosted by the Human Factors and Ergonomics Society and aims to address the demand for safe and effective technology development. It’s comprised of 4 tracks: Cybersecurity, Exoskeletons, Extended Reality, & Robotics. This year’s event touched on the Future of Work theme and had invited keynote addresses by the Director of the National Institute of Occupational Safety & Health (NIOSH), Dr. John Howard at the opening of the event. His talk was titled “Emerging Technologies and the Future of Work”

Note that ErgoX will be taking a pause for next year in 2024 and returning in 2025.

Photography courtesy of Chris Reid

INTERNSHIP OPPORTUNITY WITH ASTM INTERNATIONAL

EXO TECHNOLOGY CENTER OF EXCELLENCE

The internship at ASTM’s ET CoE is structured to provide a comprehensive learning experience, focusing on the intersection of research, standards development, and practical application in exoskeleton technologies The role is ideal for students and emerging professionals passionate about shaping the future of robotics and wearable robotic systems.

Interns will be deeply involved in various facets of the ET CoE’s operations:

Support for the 2024 Exo Games: A key highlight is assisting in organizing the Exo Games, a competition for university students in STEM fields set to be held at ASTM headquarters in August 2024.

Research and Development: Interns will review the scientific literature and update the ET CoE bibliography.

Event and Meeting Coordination: The role involves planning and coordinating meetings and events, which is crucial for professional networking and project management

You'll be able to find out more and apply on ASTM’s Careers page: LINK

EVENTS CALENDAR

©Exoskeleton Report 2024

The Exoskeleton Report (ExR) e-magazine is written and produced by Borislav “Bobby” Marinov and the Exoskeleton Report

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