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Bringing Healthcare Into the 21st Century

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Last week, the House Ways and Means Health Subcommittee held a hearing entitled "Identifying Innovative Practices and Technology in Health Care." The hearing focused on ways to advance and modernize the Medicare system -- specifically taking a look at how use and implementation of new technologies can improve the delivery of services that many Americans count on.

Health Subcommittee Chairman Peter Roskam (R-IL) started the hearing by saying:

"The lesson we hope to learn here will be how Congress can help. Can we help both advance and expand upon these front-line advancements, while also leading to a new wave of innovators unleashed on the status-quo? In doing so we can equip our Medicare beneficiaries with the tools to benefit from pioneer ideas. We need to start implementing policies that open the door to these potentially life-saving medical devices, drugs, and delivery methods in the Medicare program. It is well past time that our Medicare system be brought into the 21st century. Continuing to fiddle at the edges of an aging health care delivery model can only do so much, we need to start having conversations about transformative modernization. I hope that today's hearing can continue this important conversation."

Rep. Erik Paulsen (R-MN) shared the frustration he is hearing back home from doctors who are spending too much time filling out paperwork, and not enough time with those that matter most: their patients:

"One of the chief complaints that I hear consistently from the doctors that I speak with on a pretty regular basis is the time that they don't get to spend with their patients. They do a ton of paperwork, the compliance costs, and it's just taking away from the doctor-patient relationship. How does some of the platform in practice work with Zipnosis? How does it change that? What does it do with that doctor-patient, compliance, paperwork component?"

Becki Hafner-Fogarty, M.D., Senior Vice President of Policy and Strategy at Zipnosis Inc., responded:

"Normally, if a patient and I are sitting in an exam room, I'm doing the data entry and all of the documentation. And I jokingly tell people that I went to medical school because I couldn't type… and focusing on a computer keyboard is not why I went into medicine. What Zipnosis does is we shift the data entry to the patient. The patient creates the information, our software translates that into a physician friendly… style note that all doctors are used to reading. And when the physician makes the diagnosis and the treatment plan, the software creates the documentation. So, our physicians literally spend two to three minutes on a telemedicine visit and it really streamlines and makes them more efficient. And they're not going back for two to three hours at the end of the day doing work after work which is something my colleagues who are still in practice do complain about."

Rep. Adrian Smith (R-NE) discussed how telehealth can have a significant and beneficial impact on the countless hours and costs associated with trips to the Emergency Room:

"One area of Medicare very much in need of innovation is long-term care. Medicare is the primary payer on the large health care costs of this population, such as the tremendous costs associated with trips to the Emergency Room, from skilled nursing facilities. And in fact, on average 19 percent of hospital transfers originate from skilled nursing facilities; approximately one in five patients admitted to a skilled nursing facility are re-admitted to the acute hospital ‪in 30 days. Studies have found promising results in the use of telehealth to cut down on these massive amounts of ER trips for our most frail Medicare patients and instead allowing patients to be treated in their homes. Telehealth can allow providers to be with nursing home patients at the time of their emergency. The difference this would make for patients especially in rural districts like mine would obviously be tremendous."

Right now, the healthcare industry is facing barriers when it comes to really being able to implement the use of telehealth. Sean Cavanaugh, Chief Administrative Officer at Aledade, spoke about this issue:

"The reason CMS and Congress have had such restrictions on telemedicine is the fear that it would not be used wisely, but overused. But, if you can get more providers to move to two-sided models, meaning have an incentive to not overspend but to use it appropriately, then CMS can unleash -- and they're started to loosen the rules on telemedicine, but only for providers who are on two-sided risk. So, the goal for all of us is to make those two-sided risk models workable for providers to take advantage of these technologies."

Mr. Cavanaugh also touched on an issue that frequently came up during the hearing, the diminishing role of legacy laws like the anti-kickback and stark statutes in a value-based health care environment:

"I just wanted to note, the anti-kickback rules that are referenced -- limitations on telemedicine -- are all artifacts of a… service system where the incentive is to do too much. How do we put guardrails around people doing too much? If you can get health systems and physicians in a value-based model where they're actually accountable for total costs of care, most of these concerns should fall by the wayside because they have no incentive to over use care. But that's the challenge: how do we get them to be truly accountable for total costs of care… we need to transition so that physicians and hospitals are willing to take some of the downside risk and be accountable."

Expressing the Subcommittee's determination to bring Medicare into the 21st century, Rep. Mike Kelly (R-PA) urged the witnesses to continue to share new, innovative ways to advance and improve access to healthcare:

"Help us to help you, from where we sit, to make it easier for you to do what you are doing right now… If we don't get it done today, keep coming back to us. This Chairman is dedicated to the idea that somehow we are going to make a significant difference in the way that we deliver health care and affordable and sustainable health care to the American people."

To close the hearing, Chairman Roskam said:

"One of the things that made such a strong impression on me when I came to visit you, Doctor Philip, in the practice in Wheaton, was just a different disposition and a different feel to how you were interacting. One of us said -- either you or I said, "this is like the TV show Cheers where you come in and people say Norm!'… you know your patients, you're happy to see them. Patients, you were telling me… well, you didn't say it this way but, you can't get rid of these people because they're finding so much love, and energy, and joy, and so forth… that's different, that's unique. I get in and out, as you can imagine, of a lot of medical facilities in this role and walking in it felt qualitatively different. There was just a different vibe that was going on at your clinic and it wasn't all technology, it wasn't all process, there was a different feel to it."


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