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tv   CMS Acting Administrator Andy Slavitt to Testify on Medicare Doc Fix...  CSPAN  May 11, 2016 2:00pm-4:01pm EDT

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this is the initial gut reaction or more systemic? >> you also did a hypothetical matchup between donald trump and bernie sanders. sanders fared better than clinton did. >> slightly better. not enough to overtake donald trump. the biggest thing is the party affiliation is what matter. when we looked at service members who are republicans, they broke for donald trump no matter what the matchup was. in clinton's case, among democrats, she got 72% of all the democrats again, regardless of when she matched up with donald trump. we are still seeing them reflect the ranks too.
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that means that there is concern about foreign policy and issues and they are just not affecting how military members see the candidates. most military members conservative? >> it's one of those numbers that is always tough to get to. there some democrats in the recent surveys that we have done. it's a 2-1 margin. two democrats and quite a few independents. it's not surprising to us to see that folk who is like the republican nominee even with the criticism surrounding him. >> how will you follow-up on the poll? >> we are looking at a handful of issues throughout the summer. since a lot of readers were
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focused on the third party issue, we will look at that. we are talking about former marine corps general and there has been rumors about his entry into the race. we will be looking at third party options. the front-runners and searching for a way to vote. some of the folks we talked to in the survey said they want to vote and participate and this is one of the rights and responsibilities. they are just not liking these two choices they are presented. >> the military members are active and retired and a group of voters that you can count on
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to show up on election day? >> they usually are. there is a lot of difficulties with the overseas voters. the military members serving overseas with getting the ballots in on time. they will get sent back in time and trying to get them involved. it is a population that may be a little more so than the civilian population. they look at it seriously. whether or not that's enough to sway the election remains to be seen. you are seeing in the national 30 polls, that may be a toss up. it could be critical. >> all right, leo with the military times, thank you. >> any time. >> next on c-span 3, a hearing on a new rule specifying how doctors get paid for treating
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medicare patients. officials including the acting director testified for the house ways and means subcommittee on health. this is the share of the subcommittee and the legislation was signed into law in april of last year. live coverage here on c-span 3.
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>> we had almost yearly struggles with the dock fix. 17 later, it takes us to last march when we came in a bipartisan fashion with stakeholder input and technical support to pass the access and ship reauthorization act of 2015. with nearly 400 votes in the house, this legislation put an end to the growth rates of doctors focusing on patient care not worrying on unpredictable payments. they called us here to take a look at the regulations released by cms on april 27th and look closely at how they matchup with congressional intent and what the members are hearing from
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stakeholders as they digest 950 plus pages of regulations. that's the scope of the hearing. to discuss the implementation of the fee and there is a lot in the rule to discuss. on a bipartisan basis, we will dive in in a deep way and i would like to take a moment to encourage members on both sides as you hear from the stakeholders regarding concerns or thoughts about the proposed rule. please bring them to the attention of the staff to do robust oversight and keep cms up to date on the information as they formulate the final regulation. the passage confirmed commitment on both sides to keep medicare strong for america's seniors. this is important to me as well as many of you. both of my parents in ohio
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depend on this important medicare program. replacing the way physicians are paid and consolidating the measurement systems we have taken a great state towards the goal of fully integrated value-based care through the incentivization of high quality care. now the role is to provide oversight and in conjunction to provide education on how this new law will work for the various clinicians and provider groups. how will this affect specialty groups versus primary care physicians and how will the timing work? under potentially tight timelines. they hope to get more implementation. i want to make sure that we as congress recognize the facts
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with the law we passed. it was created as a budget-neutral program. high quality will take effort and as i said before such efforts must be recognized within the environmental and timing factors based in reality. additionally, the thresholds for providers to qualify as the payment models are high and are set in statute. working on a bipartisan basis is every corner of our country. they will allow us to follow into the next generation of value-based health care. now we can go to work. the member dr. dermott with purposes of an opening statement. >> thank you. >> when medicare was put in place some 50 years ago, a
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critical decision was made by the medical association in order to have them join in the effort. they demanded that they be paid their usual and customary fees. we on this committee have been since that time trying to get back the keys to the treasury. this is another effort here. this is the rule as a result of our efforts as he said at 15 years and it didn't work. it took us 15 years to figure out that they tried to do something different. i hope this is the beginning of a constructive bipartisan conversation about how to advance the shared goal of controlling costs and improving the delivery of health care. that was a tremendous accomplishment by putting an end to a cycle of dysfunction.
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we had the same thing happen every year. we will have a 20% cut in doctor's pay. we go out for another year and next year it's a 24% cut in doctor's pay and put a patch on it and did that again and again. for years we lurched from crisis to crisis to avoid what were draconian cuts in the payment. we ended up by spending more on the delays than it would have cost to do away with them in the beginning. last year we put an end to this bypassing macro. it's much more than just a simple repeal and also the most significant medicare program they have seen in years. we have set medicare on a sustainable course to allow us to pay for volume value in
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health care rather than volume. the law modernizes the physicians payment. instead of a patch work of incentive and models that consolidate programs into a single framework, it allows flexibility for providers that allows them to practice medicine emptily while holding them accountable for providing high value care. they are complicated issues and we are in the early stages of this proposed rule. it will take a while. we have seen the administration worked to implement the law through a process that is responsive to the needs of the public. proposed rule is consistent with the goals. it provides flexibility to participate in the merit-based or methods that reward high value care. this will make sure provider dos
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not end up with a one-size fits all approach or it makes sense for them and their patients. it is the product of an open process that began months ago through active outreach and consideration of comments and public workshops with stakeholders. they have heard getting people covered by health care is one thing. controlling the costs is another thing. this is about controlling the costs and i don't believe we have our arms around it yet, but we are in the process and that's why we welcome you here to make this presentation.
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thank you. >> without objection, that will be made part of the record. we are luck tow have them. they are at the centers for medicare and medicate services along with him have the daunting task of implementing this very important law. on a personal note, thank you for having me yesterday. it was nice to get to know you and members of your team. with that, please proceed with your testimony and we appreciate you being here today. >> thank you. ranking member mcdermott and members of the subcommittee and thank you for the opportunity to implement the medicare access and authorization act of 2015. we greatly appreciate your leadership in passing this important law that gives us a unique opportunity to move away from the suddenly uncertainty created by the sustainable growth rate to a new system that
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promotes quality and care for patients and sets the medicare program on a more sustainable path. the number one priority is patient care. thanks to single, they stream line the patch work of programs that measure value and quality into a framework called the quality framework program. they have the opportunity to be paid more for providing better care for the patients. by participating in more
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advanced models in homes. our goal is to make both of these flexibility, transparent and simple so physicians can focus on patient care and not reporting or score keeping. with the belief that the physicians know best thou provide high quality care with the beneficiaries. with the delivery, we reached out and listened to over 6,000 stakeholders including medical societies and physician groups and patient groups to understand how the changes were proposing may positively impact care and how to avoid unintended consequences. the feedback we received shaped our proposal in important ways and the dialogue is continuing. based on wa we learned, the implementation is being guided by three principals. first the patients are and must remain the key focus.
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financial incentives should work in the background. second, we are focused on adopting approaches that can be driven at the practice level. not one size fits all from washington. it will be important to define the measures of a care most fitting with their patients. third, we must aim for simplicity and physician practices are busy and seeking every opportunity possible to minimize distractions from patient care by reducing, automating and stream lining existing programs. among the many places we seek feedback, this is among the most important as the burdens on small and rural practices in success have increased over the last several years. one of the important opportunities will be for physicians to define and propose
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models for arrays of approaches and reflects the diversity of care and particularly as it relates to the various specialties that provide care. congress had the foresight to create a formal voice for physicians through the focused payment. with the important work and we are eager to work with them. with all the work that went into this, it is critical we receive direct feedback from physicians and other stakeholders. other significant efforts. our proposed rule is the first in a process. we look forward to receiving and reviewing comments to refine and approve our approach. in the month of may alone, we have 35 scheduled events and listening sessions to hear from a wide range of stakeholders and outreach will remain an
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important part of our work. the dialogue with this subcommittee and the larger committee and we share the goals of creating a more sustainable system with the smarter spending and keeping people healthier. we are striving to do just that and it will take work and broad participation to getting it right. i look forward to hearing your thoughts and answering your questions. thank you. >> thank you. as you know i represent urban and suburban and rural and most of the concerns i heard with respect to the future small and
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rural they are participating in the payment models and what i have not seen are any tears or virabilities in the amount of risk. with the small group clinician and large group clinicians. have you heard concern about this? >> i think the topic of particularly small practices in making sure they can succeed is of utmost importance. so long as they report, they can do just as well in larger sized practices.
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there additional steps and ideas and assistance with the models and opportunities to report in groups and using a reporting process that automatically feeds data and reduces the number of measures and lowers the burden f for overall practices. they could ease the burden that
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there is sensitivity there? our proposal allows this. secondly, we are required to measure the cost of care and we are going to be able to do that automatically by getting a claims feed that will require positions to send us no information whatsoever. there a number of areas where they will need to attest and whether they are doing a certain activity which will reduce the burden and looking more broadly at the experience for physicians. they can report in groups in
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many categories and finally i would say on this side and you and your team at cms, that we could do to ensure that as we lay the foundation going forward and there is buy in and complete buy in from the physician community. the system is not built with the inherent fairness issues going
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back to the rural provider or the group that has a bunch of angst. is there more that we can work together on? >> i think it's got to be a vital effort. last week i met with small practices from southern arkansas and oregon and new jersey and we have a meeting with rural health association at their annual meeting. we went out to kansas city to meet with the family practice. they are particularly concerned in washington if people are making centralized decisions that will impact their quality of care and what they tell us over and over again. when you talk to them and get more feet back, give us the freedom to take care of these
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patients. we know how to do it and let us define quality and select measures that are right and give us flexibility and don't make us focus on reporting and let us focus on patient care. it's really critical i think as we work and you hear input to get this to us and we hold ourselves to that standard that physicians are holding us to. >> thank you, sir. with that i recognize dr. mcdermott for five minutes. >> one of the issues about small practices and that leads me to the question of consolidation and driving doctors together in larger and larger groups. the question comes in my mind, i practice as an individual and in the military and in a group extra, one of the things that
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strikes me that will be lifl to deal with is the question of what is the best care. if you have a large organization and they have an mri and they want to use it and they can say don't use an mri and there will be patients out there who do not benefit from what they can find. a young woman was riding a bicycle and at 35 they found a tumor in her spine. if they had done that, they would have found it five years earlier. the organization was encouraging people not to use how are we going to make our judgment about
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whether we have quality of care if the majoror factor will be money. what is built in to look at the quality of care? >> so i think at the heart of the question, the most important thing is making sure patients get high quality care and we do believe if patients are getting high quality care, that will lead to better cost control. if someone gets the right surgery, they won't need a second. it is defined as making sure the care is coordinated. if they need a follow-up visit or has a prescription or something, they understand what that is and the system works and supports them. our job is to enforce that, number one. number two, i think our job is
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not to define quality ourselves as much as to take the best standards of care that they defined as quality and make sure we keep up with that and we keep the measures as the things that physicians decide as a group that they should be measured on. those are the things that -- and the third that the practice things differentiate. we believe they are the people that know best for what's right with their patients. nothing we are doing should be interfering with that. you have to be reinforcing those things. they give us the opportunity to say if you are delivering quality care, you ought to be rewarded for that.
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>> you are suggesting evidence-based medicine. i have been to the doctor recently and they send out a sheet to me and it said did you get good care? was he polite or nicely dress and blah blah blah. down at the bottom, were you satisfied with the care. if some people don't get a prescription or an extra or don't get a blood test or something, the doctor hasn't done anything. how do you measure then the patient who said i wasn't satisfied because i went away and my sinuses are a mess and i didn't get antibiotics. how do you deal with that? >> i was sitting down with physicians that were practicing medicine in arkansas. they are in one of the models, a
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medical home model where they have a per member per month number they hire to get the care. what they told me was now i actually can get paid to practice medicine the way i am supposed to. that's a way they reinforce and the better off we will be as opposed to if you don't make a cut in someone's skin or give them a prescription or something they leave with, that is not success. >> i have a medical home at the university of washington. >> we agree on something.
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thanks so much. i have 12 different questions i can ask on 12 different topics and my mom has one she shared with me she wanted to ask you. try to keep the topic to this most important law we passed. with that, you are recognized for five minutes. >> thank you. welcome. you said that cms is working to regain the hearts and minds of physicians through implementation of macro. that's great because many physicians in small practices have struggled to stay afloat in recent years. while there a lot of good things in the proposed rule, i have one issue i would like to raise with you. i am concerned by the estimates in table 64 where cms projects the greatest impacts to practice with nine or fewer doctors.
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the least to large systems with 100 or more docks. if cms is trying to win back the heards and minds, this proposal falls short since it will opinion to push them out of solo or small practices. can you me what cms is doing to ensure that solo practitioners and small groups can succeed under the mips and participate in alternative payment models by 2019. >> thank you. i actually welcome the opportunity to address this stable and for anyone who has not seen the table, the table is designed to estimate what the impact of these regulations could be on practices of various size. the first thing i want to make sure is that the question of
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making sure that small groups and solo practitioners can be successful is of utmost importance. i would indicate despite what the table shows, our data shows that physicians who are in small and solo practices can do just as well and do do just as well as physicians in practices that are larger than that. the reason that table looks the way it does is for one very simple and important reason. it counts if are the fact that in 2014 when the tableicata uses, most physicians and small and solo practices, many did not report on their quality. this is important for a couple of reasons. in 2015 and subsequent years, the reporting went up. at best this table would be conservative and as i explained to the chairman, r79ing ing re
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going to get far easier. it points to a couple of things we could pay attention to. making sure it's as easy as possible for physicians to report. one of the reasons we don't have the heards and minds of physicians is there is too much paperwork. >> i would agree. >> they need practice medicine and not do paperwork. there is a tremendous amount of effort so far and this is a proposal. this next period of time is a time when we are hoping people can give us further ideas and further ways that we can reduce the administrative reporting burden and to be clear, there is absolutely every opportunity and in fact an equal opportunity to be successful. >> thank you. maybe we better indoctrinate the nurses too. i thank you, mr. chairman. i yield back my time.
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>> thank you, mr. johnson. recognized for five minutes. >> thank you for your testimony. i think congress in passing macro gave a huge undertaking. i think it's obvious that we will need to keep the lines open and your outreach will continue as it has been. not just physicians, but patient feedback too. they are pushing hard to move to a delivery system. they come to a region of the country and established models of care. that's quite sometime. ultimately the alternative payment methods. they get to quality and out come based reimbursements. that's the direction they gave you. a lot of my providers were early stage first generation models. my question is what more can be done to provide an on ramp for advanced payments for the early
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stage. will they have to leapfrog and go on to gen two or three or four? >> you are raising an important question. where physicians have an opportunity as we mentioned, our fashions will have the opportunity to get rewarded for quality care. where physicians have an opportunity to and have had the opportunity to join with other physicians in the more coordinated care models, the medical home would be one example. we think those are a good idea. they are a good idea if they are right for the fogs and if the physician made sense for the patients and creates an opportunity in the right to earn more. that gives physicians an additional opportunity to earn 5% bonus on top of what they may
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be earning in these advanced models. the question is what's the requirement to get access to the 5% bonus and the legislation puts forward a number of requirements and the requirement really in a nut shell if i were going simplify, there has to be a higher degree of shared accountability from the physician and that shared couldabilicoul accountability and a minimal sharing of the cost with the medicare program itself. in order to qualify for the 5% bonus, i think the words that are in the legislation or there has to be more than a nominal risk. our job in putting the regulationing to is to put the definition around the nominal risk. we tried to do that in as consistent way as possible. it's one of the areas where we
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are inviting feedback and all of the models, whatever we are in will have to qualify based upon that definition. even if a physician is in a model that doesn't qualify, there is great opportunities and opportunities for them to grow into other models. >> the great cost driver is true at the federal level of the budget at the state and local and a rising health care cost. with the direction this rule is taking, can we sit here with reasonable confidence that that can lead to soft savings without the care our patients are receiving or will this turn into the situation where everyone is above average and qualifying for the bonus payments and there is no soft savings at the end of the day. >> we are all striving for a higher quality system.
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we all want our money spent more wisely. we don't want to do it in a way people feel like they are skimpying on their care. we have 10,000 new seniors every day in america and our jobs are to figure out thou take care of them better for less money. that means taking care of them in lower cost settings and comfortable settings rather than in institutions like reports. they are filths to the program. within the regulation, the pool balance is out and we will have to allocate money and have upward and downward to meet the test you talked about. that is nothing new. there upward and downward and this will be a simpler more aligned program that is easier to measure and take track up. >> recognized for five minutes. >> thank you. mr. chairman, i have an
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observation point and a nudge. the observation is this. there is a level of anxiety that is out there in the public life today because people look at congress and say nothing is happening. it doesn't involve hyperbole, but there is serious effort and we are on the verge of good things. just a little shout out and that is three cheers for something getting done. that is encouraging. my point is that debate matters. i would argue that one reason they were able to come together and they drove the discussion,
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it was because it had been well wrestled through in the united states over the past several years that we needed to do something on medicare. both sides had different views of the world, but it was normalized in that sense that these things had to change. debate matters because first you win the debate and then you win the vote. here's the nudge. this is a nudge for you. one of the things that i think you and i have talked about off line and you alluded to some of this too a minute ago, there is this tension out there and there is a tension that manifests and we had testing issues that came
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before us. there is always a new test and standard. they are a high school administrator. give me the straight scoop on the tests. he said peter, look. will you pick a test and not change it every four years? he said we are happy to be accountable, but that deeply resonated with me. the tension is i think health care providers want a standard and they want something that is predictable. they don't want something that can never be revisited. that was an
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overcharacterization. we had to kick the can down the road. my nudge is this. as you are going through and you are figuring this out and i appreciate the disposition and the comments thaw are taking in, if you can be mindful of the smaller practices, that is to try for us to listen and to
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learn. as you are navigating through the tensions of having something that can be predictable, but also maintaining the and that's the best of both worlds. with that, you don't need to yield back. >> we had these and this idea of making sure that people don't feel like the game is changing on the mid-course. there is enough that allows us to tell folks going in, here's how it works. in advance. there is nothing more frustrating than being told and you make up an important point making sure you are predictable
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with staying current with the state-of-the-art with the state of medicine. we think it's an effective process, but it's important that they have the flexibility to navigate at different times in their practice. thank you for being here. i'm sorry i had to step out and i hope i'm not going to be repetitive. not only with the committee, but the people and providers and patients that we represent at home. we want to make sure that it works. i would like to hear what the
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administration is doing to help providers get ready ahead of the 2017 start date and what would you recommend, is there anything we should be doing to help facilitate the transition. >> i will start to direct that as if what i would say to a physician who is wondering what it all means. there is probably five things i would say that i would keep in mind as a physician from i think our perspective. keep focusing on patient care. don't worry about the score keeping. it will be our job to put this
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forward in a way and it will be more stream lined than the processes people have to go through today. that's the first thing. the second thing is that we have to continue to talk to people and educate people as the opportunity as the chairman's question implied. is it because they will have the opportunity to decide which measures and which ways they measure quality? at some point they will be thinking about them and that's one of the important early things. if there opportunities, these coordination models, they should consider those. it won't be until the spring of 2018 that the physicians and they would need to report on
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that. it's important they not get too concerned. the final thing we would say and encourage for everybody is to provide feedback. in this comment period, we want physicians to be able to review this. we are setting up a number of sessions and we talked to 3,000 physicians yesterday on a call we do twice a week webinars to get the question answered and give us feedback on how it will affect your practice. >> as far as us being able to help facilitate the transition, any comments for the committee? >> i think the more listening sessions and open forums that there can be with physicians and giving them an opportunity not just to hear what is in the rule, but to tell us, i spoke with one of the members who asked me to participate in one of the sessions with people in their district. i think we have a lot of staff
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that are available to do phone calls and other things to reach out. let us know what you are hearing and our job is to be responsive. >> in my case, would you rather do a phone call or would you rather come out and do it in person? i yield back. >> the future subcommittee hearing. thank you are mr. chairman for joining us today. this has been said we are moving in a better direction and we have a long way to go. if we are going to make it so that physicians can once again care for patients about the amount of influence or burden from outside they have a willingness to do so. one is moving from meaningful
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use, we will call it, you have a 365 day rule in the past it always has been a 90-day rule. they comply for a 90-day a 365-day period. it only makes sense. nobody is perfect every day. and if they're going to get dinged because they're not able to comply one day or two days or three days we've simply got to move to a 90-day and i hope that you're able to work in that direction. >> so, it's one of the key areas we're inviting comment on right now during the comment period. >> i invite comment as well from folks whom i have heard. on the alternative payment models you've got a lot of docs, guys and gals, who have already modified what they are doing. the bundled programs and the future cgr program and yet it appears that those programs that cms has pushed on docs and encouraged docs and incentivized
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docs to doesn't qualify for apms that doesn't make any sense at all. i hope you are looking at grandfathering those or moving them in or allowing them to qualify as apms. >> so, congressman, one of the things that i think we have to do now that the law is being implemented is to go back and look at all of our models and see where we can make changes to them so that the participants in them can qualify. and i know that dr. conway is very much directing the team to look for ways to do that where possible. it has to meet certain requirements that have to be met. an example would be what percentage of the patients i'm seeing are part of this bundled payment. and so that -- because that's in the statute in the law we have to look at how we can modify with these programs or work with you on what our flexibility is to be able to do that. >> i agree with that. if you expand the ability to use the entire practice other than
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medicare that often helps them get to that. docs are frustrated for things they are held accountable which they have no control over. one is on 9 meaningful use aci issue and the data blocking occurring by the vendors. docs don't have any control over what the vendors do at all. how we can have a system that potentially punishes docs because of what somebody else does that they don't have any control over that does the make any sense at all and they are pulling their hair out trying to comply with this. if you could look at that, that would be appreciated as well. >> will do. >> i want to talk about the nominal risk. the nominal risk as i understand is a minimum of 4% of total spending to be qualified under an apm? >> that's correct. >> as you know the physicians control, i don't know, pick your number, 14%, 15%, 16% of total spending.
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it's really 25% 30% hit for the docs. how can we have a system that punishes the people that are -- where the rubber hits the road, trying to care for these patients and, again, for which they have little control over. shouldn't that be 4% of the physician total reimbursement? >> so, one of the -- one of the areas where we're looking for feedback in the comment period is both what is nominal risk, quantitatively. we've chosen a number that was consistent across the mips program but that's just in the proposal. >> doesn't that presume that the physician controls every dollar of spending? >> that's the second area that we seek feedback which is in -- under what universe total cost of care which, of course, the benefit of a total cost of care is a primary care physician has the opportunity to get rewarded for being able to keep the patient out of the hospital when they don't belong there and so forth. of course, as you point out the challenge with that as well. it is an area where we're
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looking for feedback and very much hearing your perspective. >> a lot of those things are out of their control. we'd like to believe they control them, but in an ideal world that might be nice, but a lot of the things are out of their control. i want to point out the table you identified table 64. by your own data stipulates that solo practitioners -- 80% of solo practitioners are going to see a negative adjustment. it's two-year-old data that will reward them in '19 based on what happened to them in '17 i would urge you to relook how you are adjusting that and in real time provide an update. >> we're going to look in the final rule having the most updated and accurate information in that table. again, while that table is -- would not be good news in reality, i don't believe it is reality. however, i will say that the silver lining is i think drawing attention to the impact of this regulation on small and solo practices is a good thing and so i think it's where we need to
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have dialogue and so defight the fact i don't think that table represents the reality i do think the reality of how difficult it is to practice medicine in a small or solo practice is very real so we're looking for ways to make sure we make it better. >> great. thank you very much. thank you, mr. chairman. >> thank you. i think you might be sensing a theme up here. mr.blumenthal, you are recognized for five minutes. >> thank you, mr. chairman. mr. administrator i appreciate the approach you've taken to help us turn the corner. i personally have found the charade we went through for some 17 years kind of embarrassing. dancing away from an event we -- nobody had any expectation should happen. we're dealing with a budget fiction. i think the agreement that was struck is reasonable. there is still much value to be squeezed out of the system.
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but i appreciate the fact and some of the references from my friend dr. price, we've got people in the middle of practice patterns. limitations on data. and just a whole host of other changes taking place. and i appreciate the commitment to do so in a thoughtful and deliberate fashion. you have also heard another theme emerge that people are keenly interested in making sure that we make this transition to rewarding value over volume. and that we've had problems in the past with some things theoretically -- i have strongly supported medicare advantage but at the same time the parts of the affordable care act to try and coax more value out of it. because theoretically it should enable us to deliver care more efficiently and we continue to have a pretty significant
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premium. the compromise that was struck and one that i thought was healthy was to provide bonuses based on performance and try and deal with some of the areas where there is some decidedly -- i don't know if one wants to call them outliers, but there's real performance problems being overcompensated coming from one of those regions that we like to think that if everybody practiced medicine like they do in my congressional district we wouldn't have the funding problems that we have. i -- you know, i'm looking at charts like this that kind of display how it's supposed to work over time. i wonder if you can just give us a sense of where you think the pinch points are. where will be some of the things that we need to be prepared to be able to work with you if there's further adjustments legislatively, if there are
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things that we need to do a better job of just being able to understand ourselves to explain to our community at home. where are the pinch points you think we need to zero in on? >> thank you, congressman. i think i point to a couple of areas that i think are really critical focus areas for us. one is the education and communication process. particularly with smaller practices and individual solo physicians. it is -- it's vital that we hear their feedback and understand what the impact of the decisions that we're making here today will be on their practices several years from now. so, that education process i think means a couple of things. one is that we talk in plain english instead of acronyms, which we are quite guilty of here i know. but we're trying very hard to do a better job at that. we've created simple fact sheets
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and training sessions and power points and as many opportunities as possible to do that. to the extent you can help us do that and tell us what you're hearing, that's going to be critical. the second thing that i think we will need to continue to hear from you all on and i think the conversation with congressman price is apropos to this is where there are places where you think we should -- there should be flexibility and how we should be exercising flexibility, whether it's with smaller practices or whether it's in how we define the models that qualify for the 5% bonus. in all of those areas your feedback on our interpretations are critical because we really do want to get to the best answer. and i'll tell you that we don't have a monopoly on that. we want to do that through the dialogue and the debate that
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congressman rosscom referred to. we'll have to look at this program at the end of its first year and understand what worked well and what didn't and what could work better and we can't be afraid to call out the things that didn't work as well and try to sit down and try to figure out how to make those things better whether it's with technical improvements or whether it's simply in how we're implementing things. >> mr. chairman, i do appreciate the opportunity to get into something which i hope we're able to periodically update, review. i appreciate part of this is process and part of it is performance and being able to strike that balance in a way that's protective of the people who depend on the service but also for the taxpayer i think is going to be a challenge for our friends at cms and for the committee, and i hope we can continue sort of zeroing in that fashion. >> thank you. all set. mr. smith of nebraska is recognized for five minutes. >> thank you, mr. chairman.
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thank you, mr. administrator, nor being here today. i represent a rural district in some parts more rural than others. 75 counties touching 6 states. we're spread out. the number one agricultural district in the nation. very productive. the nearly 60 hospitals in my district, about 54 are designated as critical access. that might be a single designation but that's about 54 different types of expertise and providers. and i'm actually inspired by the work that they do serving communities from smaller than 1,000 up to about 12,000 plus. nonethele nonetheless, they've got a very large task and i guess so do you. can you discuss the feedback you received from rural providers in response to the initial rfi and how you addressed that in producing the rule and then what rural providers in critical access hospitals can expect from this rule? >> yeah.
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thank you, congressman. and in your district and i think throughout the country, you know, we face the challenge of not having enough physicians in many cases enough specialties and, you know, there are many districts around the country where there are, you know, only one or two providers in certain specialties. so, we cannot allow the sideshow that goes along with the practice of medicine to make the practice of medicine less fulfilling and less rewarding. so, as it relates to the small physician practices, the medical home mod models that many are participating in we've had really terrific feedback from and i think what i hear from small physicians is give us the opportunity, find ways for us to have the opportunity to participate in some of these same opportunities and models that people do in urban settings
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and make them work for us. so, can you make changes to them that can work for us. that's i think one of the things. and then on critical access to hospitals, obviously for us, you know, so many of our medicare beneficiaries get taken care of and get treated and rely on in the critical access hospitals. and the economics of health care in rural america is different than it is in other places. and that is both is short-term issue that we have regulations as you know to deal with but it's also a longer-term question around how those hospitals are structured, what they provide and how we support them in the appropriate way. >> okay. in your response to the chairman you had mentioned reporting exemption for all? providers. at the same time i've heard questions from those who fall below the reporting threshold who would like to be able to report data. will they have that opportunity? >> so, it's interesting you say that. i had that feedback last night in talking to a specialty
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society who said, we want our specialty to be more engaged in the practice of medicine with seniors. and so we -- even our physicians who are only seeing all? amounts we want to do that. so, i will tell you that we've heard feedback in both directions and our job over the comment will be to take all that in and figure out how to do the best job accommodating the most types of practices possible. >> i appreciate that. i know that the providers that i talked to are constantly not just saying what the problem is but providing solutions and innovations and i would hope that we can empower providers to care for their patients without the government getting in the way or messing things up. thank you, mr. chairman. i yield back. >> thank you. former mayor of patterson, new jersey, is recognized for five minutes. >> thank you very much, mr. chairman.
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administrator slavitt, under your leadership, cms has stressed the importance of better data to improve quality, to improve outcomes and has made great strides in making that data available. included is a provision that allows innovators to use qe data to help us make smarter decisions. do you agree that the medical devices used in care -- and i'll focus in on that, particularly for the most common medicare procedure, joint replacements, play a role in health care quality and outcomes. medicare has no information on
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the medical devices implanted in medicare beneficiaries. i think we should let that settle in for a few seconds. extremely problematic i think. from an oversight perspective and most importantly from a safety perspective. you and i have had discussions. there is a history here. that we need to address. so, shouldn't this information be made available? administrator? >> thank you, congressman. so, the question you raised of -- is really one of should there be and how should we capture a device identifier in a unique way on every device. and i think that's the goal. it's a goal that we share. it's a goal that the fda shares. and it's critical for
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post-market surveillance to be able to understand the safety of how these devices work. so, there are several i think critical things that we can do and are doing and are trying to do to make this possible. so, despite our enthusiasm for this, and this is an issue that's long preceded me. as you know it's been an issue for quite some time. there are a number of parties who have a say in the matter of how this happens. i think as a first step we're moving forward with the incorporation of a unique device identifier into electronic health records. i think this is a strong step particularly considering the dramatic growth in electronic health records. but i know that there are also -- there's also an interest that on claim forms that there is a way to -- for providers to provide care to indicate the device identifier on the claim form.
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we think that also has merit particularly from a research perspective. i think there are a couple of issues to making that a reality. one is the committee that essentially designs the claim form which is made up of a wide group of participants and hospital and physician groups. second is making sure that if we at cms are given the charge to do this, that we can fund it and have the funds to do it operationally. and then the third there will be an education and training process because our history -- the history is that physicians don't automatically put the information they need to down on a form unless it's critical to them getting paid. so, i think we need to work through all these issues with you. we've pledged to do this with your office and we're working closely with the fda to find the best path forward. >> i think you've used the best word "critical." but if we don't do it this time we've got to wait another 15
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years before we change those forms, and our seniors will not be well served. this is important. i've been frustrated with cms's resistance to what i believe is a very important priority, particularly of safety. including the unique device identifiers on health insurance claims. in order for the udi to be added to the claims form as part of the next update, it would go into effect i think in 2021. that's the soonest. we need to act now. and i think -- i can't stress enough, mr. chairman, that we're talking about the safety of the people who use these devices. we all want to be on the same page. this is i think a good time for us to address this issue. number of cases, number of
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anecdotal stories, about not only seniors, by the way, but we're talking about seniors here because we're talking about medicare, that have had the problems. and we need to address that in order to improve safety. i mean, everybody on this committee talks about it. and i believe them in their hearts. here's a chance for us to do something about it. but i want to thank you, you've done a great job. and thank you for putting up with us. but we're not going away. thank you. >> thank you, congressman. >> thank you, mr. pascrell. ms. jenkins, recognized for five minutes. >> thank you, mr. chairman and thank you, mr. administrator, for joining us here today. medicare obviously plays an important role for many kansans. it's the largest payer for medical services and last year over 485,000 kansans had health coverage through medicare. we were pleased macra passed
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last year in a bipartisan manner with the passage of macra, we repealed sgr and instead put in place what we hope is a better reimbursement system for physicians. the relationship between a physician and a beneficiary cannot be underscored in importance, and i believe this is especially true when talking about seniors. with the moves that macra makes towards higher-value care centered on the quality of care administered by clinicians, it's ever important to ensure that we encourage greater and greater communication around decision making between the doctors and their patients. so, as macra's implementation continues over the next several years, do you see room to begin includie ing patient acvation measures and placing greater responsibility on the relationship and furthering the quality of care? >> yes. thank you, congressman, for
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that. i think that's a really important question and i think there is an opportunity over the next several years to begin to incorporate those engagement measures in. there are a few things that are in the current proposal that i would point to that take steps in that direction. one is there is a practice improvement focus opportunity on the creation of a joint care plan between a patient and a physician. you know, secondly in the advancing care information area, there is -- are opportunities that focus on measures around how patients and physicians are communicating using technology and making sure that information's being made available to patients electronically and through other means. but i think this is -- as you point out a ripe opportunity in a brand-new area of focus for more patient engagement. we've been meeting with a number of patient groups as we've been
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putting this work together, and that's an important area of feedback for us. >> all right, thank you, mr. chairman. i yield back. >> thank you, mr. davis is recognized for five minutes. >> thank you very much, mr. chairman. let me welcome you, mr. slavitt. i know you spent considerable growing-up time in evanston, illinois, which isn't very far from my district. and i also know that your mother lives in my district, and i'm pleased to tell you that i have not had any real complaints from her. and so that makes me feel good. >> that makes one of us. >> but let me compliment you on your work. medicine is a very complex environment. and there's tremendous complexity. and i also want to thank your staff.
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i have 24 hospitals in my district. 4 large medical schools, a number of research institutions and a very activated citizenry, so we get lots of inquiries, lots of calls for assistance. a lot of calls for clarification. and so we spend considerable time not pestering, but certainly inquiring of your staff. and i want to thank them for the kinds of sensitivities they have displayed. i also have a very activated medical community, physicians associations and organizations. and just last week i had a meeting with the chicago medical society. but i've heard concerns that under the proposed rule that
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we're talking about, only a limited number of physicians will meet the alternative payment model, or apm, criteria to earn the payment bonus. by your own estimation you have indicated that there may be only 30,000 to 90,000 physicians who meet these terms, which is a tiny fraction of the total medicare eligible doctors in the country. i'm certain that we'll hear some more from these physician groups. they'd like to know what could make it -- how likely is it that anything will make it easier for there to be more pathways to qualify for the apm bonus payments, and how can cms improve the opportunities for physicians to meet the advanced
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apm criteria and achieve the incentives to drive better wear that congress intended, and would you consider additional pathways that qualify as advanced apms to provide assistance for physicians who wish to enter the current model? >> thank you, congressman. and my mother made me promise to tell you that she was a teacher at howe and working with principal petech who knows you well and she made sure i said this publicly, so i've delivered that for my mother. >> thank you. >> and your question is an important question because it speaks to -- you know, physicians -- all physicians who participate in the medicare program are going to have a significant opportunity to get rewarded and get paid for
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providing quality medicine which is exactly what we hear from physicians that they want. some physicians will have the opportunity to go further, and i think the law allows those physicians to get a 5% bonus if they participate in these advanced payment models. so, our goal is not just to make the core program good but to create as many opportunities for physicians as possible to move into these programs. we can do that a number of ways. one of the important ways to do that is to simply create more models and more opportunities. we also have to make it easy for people to move back and forth if they choose to between programs. and i think that's one of the things that we're striving to achieve. and then as we talked about earlier with dr. price, how do we -- we also have to look at are there ways we can take existing models and make them compliant with this new law.
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so, we are going to work on all three of those avenues, because it is a goal that for any physician that wants to move to one of these advanced care -- you know, advanced apm or care coordination models, that they have the opportunity to do so. >> thank you very much. thank you, mr. chairman. and i yield back. >> former mayor marchand of texas is recognized for five minutes. >> thank you, mr. chairman. does the cms have the resources to approve and implement the new alternative payment model proposals in a timely manner? >> thank you. so, i believe the question is can we implement new models in a timely manner. and one of the things that we have to do. and the answer is, yes, we do. we need to in concert with the committee that was set up by the congress, the petech, we need to
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receive proposals from physicians, because physicians can generate their own proposals for models and quality, and then work with them to as rapidly as possible test them and put them into action. it's one of the things that we have had the opportunity to work on over the last six or seven years through the innovation center. it's something that we have gotten better and better at. and we are eager to get going with this committee to get as many models in as possible so that we can get more and more models approved. and i had a chance to speak with that committee and speak in front of that committee to try to encourage more model development. >> there's a deadline period, so you're confident that you can get all that done by the deadline? >> well, this -- fortunately this is something that will be ongoing. so as soon as we get models in we can get them tested. but this committee i believe will be standing for a number of years. i'm not sure if we know -- i don't know the exact number of years, but it will be ongoing
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because physicians will be able to continue to develop new models. >> so, the transition in governments that's coming up won't have any effect on this process? >> no. the committee -- the staff at cms will work with the new secretary, whoever that is, and continue moving that forward very much with that, and i think there is -- as i've heard today and i think is -- we continue to hear, there is a strong bipartisan commitment and a strong commitment to this program and moving this forward, so i don't see any concerns at this point. >> and just some input. in my district i hear from two different groups, and this is concerning the new program where you basically are, let's say a knee replacement or hip replacement, you're basically going to fund a lump sum for that. i'm hearing from seniors who
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think that the doctors and hospitals are going to cut corners so that they'll make the most amount of profit and just hurry them through the system. and then i'm hearing from the doctors and the hospitals who are afraid that they don't -- they're not going to get enough money to take the kind of care of their patients that they need to take care of. so, i guess you've created a pretty positive -- these two tensions that are working out there, and the -- could you just make a comment about that. >> sure. i think what you're referring to is a new type of payment approach, new for medicare, but it's been ongoing in health care for a long time. it's called the bundled payment. and really the idea behind a bundled payment is so that people -- everyone who is involved in the patient care, whether it's before they would have a surgery, the surgeon, the anesthesiologist, but also the people that take care of the
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patient afterwards, have an alignment to get on the same page, to provide a high quality outcome and to do it as a team. and so it's a -- it's a -- it's relatively new to medicare. we've had good experience, good feedback so far, but as with anything new, we continue to look for feedback, for data, for experien experiences, and in particular if there are beneficiaries in your district or hospitals or physicians in your district that have experience with the program, we would love to get them from you or your staff. >> well, the group that i hear from the most is the in-home health care people who feel like they're kind at the tail end of the process and that they may be the ones that -- and they feel like they're the most cost effective of all, yet they feel like at the end of that process there may be some shortchanging going on.
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>> thank you. >> okay. thank you. >> thank you. mr. lewis is recognized for five minutes. >> thank you very much, mr. chairman, for holding this hearing today. mr. administrator, thank you for being with us. thank you for all of your great and good work. can you talk more about what people on medicare might experience as a result of this change in payment policy? how will smaller provider groups be impacted and the doctors who need help to get up to speed? >> thank you. so, i think the most important thing that we have an opportunity to focus on here is patient care and improving patient care. and i think the ways to do this are several-fold. first is this -- this new legislation allows us to pay
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physicians more for providing higher quality care. and the objective is to do this in a way which allows the physician to define what they believe to be the highest quality care from a menu of options and reward them for achieving those benchmarks and i think physicians have been asking for that in one form or another for quite some time. secondly, though, it's important to do that in a way that frees up physicians to actually practice medicine instead of just keeping score. and too many programs result in a lot of paperwork and a lot of score keeping and a lot of reporting. and we need to minimize that by simply phi i simplifying wherever possible. the role of small physician practices which you also mentioned is critical here, and as we mentioned earlier, we believe that small solo and solo practitioners have every opportunity to be just as successful as larger size practices. and our data suggests that that
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indeed happens so long as the smaller practices report. so, that means we need to minimize paperwork. we've also put in place some accommodations for smaller practices, including some technical assistance, some additional models and ways that they can get excluded from reporting if their volumes are too low. >> thank you. furthermore, mr. administrator, this is a very large regulation, over 900 pages. it's pretty big. it's a lot to digest. a lot to understand. if you had to tell your doctor the highlights of these changes, what will you tell her? what will your doctor need to know to maximize benefits avoid payment cuts? >> great. that's a great question. and it may be one of the most important things that i can communicate today. first of all, it's to keep
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focusing on patient care. there is nothing in here that should distract anybody from patient care. and, in fact, it will make it easier by streamlining a patchwork of programs that are already out there today into something simpler. so, that's first. second, is they'll have the opportunity to select goals that they believe are right for their practice, right for their patient population, and at some point in time they'll have the opportunity to do that. third i think would be that over time there will be opportunities for them participate in more advanced models like the kinds you asked me about earlier. fourth is they don't need to really worry about reporting anything until spring of 2018, and we will make it clear what needs to be done well before then. and then finally the last thing and this is more of my ask of them is to provide feedback whether it's to this rule, whether it's through the medical
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society they belong to, the state medical society directly to us. we really need line physicians who are practicing medicine every day to give us their feedback about what works about this rule and what might be the unintended consequences. >> thank you very much. and, again, i appreciate your effort, your great and good work. and thank you for being willing to serve. >> thank you. >> mr. chairman, i yield back. >> thank you, mr. lewis. mr. paulson is recognized for five minutes. >> great to see you here. welcome. rather than on an airplane going back and forth to minnesota. as has already been said, you know, last year both sides took very historic action to move forward finally get rid of the flawed medicaid payment formula based on the sgr and wonder if we're going to fix it every six months or every year. and like any law, passage is just the first step, right? it's the implementation that has to be carried out and followed through and making sure it's
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done correctly so that we're achieving the intended results. i want to thank you at the outset for working with physicians and patients and having the appropriate dialogue with the stakeholders to make sure we're implementing in the correct fashion. i want to continue on the comment theme and mention at the outset it is important to know that i continue to hear from folks back in minnesota as well that aren't in large, integrated practices, solo practices, small group practices, et cetera, that do have that concern. and as you mentioned you want to make sure they have every opportunity to participate. i think they want that reassurance and we kind of need to keep monitoring that going forward. and i thank you for that. let me ask you this question, i've also heard from a lot of physicians and doctors in minnesota about the meaningful use program for electronic health records and how it doesn't do a very good job of taking into account the way physicians treat patients and use their electronic health care records. is this rule the same old, same
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old. or do you make real changes in how you are going to be encouraging doctors to actually use their electronic health care records? >> thank you, congressman. i would agree our district practices some of the best medicine. the meaningful use program is something that we took an extremely hard look at. we took a step back because the meaningful use program actually is responsible for helping to make technology pervasive in medicine, and that's a very good thing. we look back five or six years ago most physician offices, most hospitals, didn't have adequate information technology. today by and large, 97% of hospitals, 70% of physician practices have technology. but as we look at how to go forward, we spend a lot of time talking to physicians and hearing exactly what you said, congressman, which is that the meaningful use program was focusing on making sure they were using their computers and not focusing on taking care of
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patients. we also heard that physicians want their technology to be more connected. they want to be able to get information back and forth from other physicians when they refer patients or from hospitals, and they're also frustrated that there isn't enough connectivity and the data doesn't flow as easily as it should and so we've been asked and focus on it and i believe have focused on in this rule changing the program so it becomes much more flexible, moves the focus to the patient away from the use of the technology, focuses on the interaction in communication, and allowing the free flow of data to move back and forth. those are the areas that we emphasized. we look forward to the comments in the comment period about whether or not we've done that well. >> does it seem like the proposed rule replacing meaningful use with this new category, advancing care information, we have all the different acronyms but accounting for over 25% of the physician's performance score in the first year. is that essentially
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interoperability for electronic health care information for venders, for hospitals, for all the different actors and players and physicians and providers, is that the intent? that the information will be that readily available and shared and not just actually on the computer but using the information? >> that's the intent. all of us have opportunity in that regard. if we can make the health care system more interoperable, i think we would do it. but this requires venders to share data to publish to what they call open apis to not talk about data blocking which the congress has expressly asked vendors not do. and physicians to a large extent are really a victim of what the technology allows. they all want to share data. i have not met a physician who when they refer a patient doesn't want to know what happened to that patient and get that back electronically. but it's the technology that really needs to do that job.
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we think in the ehr certification that just came out and in a number of the other activities we think venders are going to move in that direction. they need to move in that direction. >> good. thank you, mr. chairman. appreciate it. yield back. >> thank you, mr. paulson. thank you, mr. slavitt. one comment related to that is we can discuss this more. as you develop a final rule and the performance period begins on january of 2017, venders are going to have a limited time to reconcile with this new rule. and then physicians are going to have to digest the new rule. so, you know, i hope that, again, particularly for the small -- the small group, rural markets, i hope that you'll work with us to make sure that that implementation is done smoothly.
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and related to that, i don't know if you think you have some authority in this area. so, the gap of time between performance period and then the payment year for physicians is two years. yet the clinician reporting period is a shorter period of time. do you think cms has the ability through rule making the authority to change that a little bit? >> yep. so, one of the things we do seek comment is -- on are the proposed measurement periods and payment periods. what i will say is a couple things. one is we have two feedback periods built in so that one in the middle of 2017 and one in the middle of 2018 to provide information back to physicians. so there is a more current feedback loop. second thing i'd say is because we have focused so much on reducing burden and reducing the number of measures and so forth,
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that is -- we have had some feedback that people want to make sure that that starts as early as possible. we've had other feedback, of course, which tells us make sure we have enough time. make sure we have enough time to do the things we need to do. make sure we don't get penalized unnecessarily because we didn't have enough time. and to your earlier question, mr. chairman, if people will begin on the older technology and move to the newer technology, they will not get penalized for that. so, we are making those accommodations. but, of course, the purpose of the comment period is for people to tell us what are the things we missed. what are the things that could have an impact on someone's practice or on their patients that we didn't think of and that's one of the reasons why if there's an important message today to get out it's to, please, engage in the rule and give us the feedback that we need to hear. >> well, i can't thank you enough for coming today. as you can tell, in a bipartisan way members have a lot of interest in this and not just the subcommittee level but the committee of the whole as well
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as the congress. and we really appreciate you taking the time and look forward to working with you and your team as you continue to develop this and ultimately put it into -- into process the way that we all intended it to be and appreciate the fact that you were so kind yesterday as well. look forward to working with you. hopefully we've treated you nice enough that you'll come back, as we have this bipartisan concern about the way this unfolds. so, as a reminder any member wishing to submit a question for the record will have 14 days to do so. if any members submit questions after the hearing i ask that the witnesses respond in writing in a timely manner. with that, again, thank you, again, and this committee is adjourned. >> thank you.
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on "american history tv" on c-span3 -- >> there has never been a full accounting of fbi domestic intelligence operations. therefore, this committee has undertaken such an investigation. >> on "real america" the 1975 church committee hearings convened to investigate the intelligence activities of the cia, fbi, irs, and the nsa. saturday night at 10:00 p.m. eastern the commission questions committee staffers frederick schwartz and kurt smothers detailing fbi abuses including attempted intimidation of martin luther king jr. >> king, there's only one thing
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left for you to do, you know what it is. you have just 34 days in which to do it. this exact number has been selected for a specific reason. it has definite practical significance. it was 34 days before the award. you are done. >> then associate fbi director james adams admits to some of the excesses while defending a number of other fbi practices. then at 8:00 on "lectures in history" -- >> the rest of this may in a bad life see a death or two. they see hundreds. and so they're the first to sort of see patterns or shifts in how people are going out of the world. so, they are the ones who sound the alarm. >> a university of georgia professor steven berry on the role of a coroner and how they should light on the emerging patterns of death in a society and spot potential problems with public health. and then john kerry who served in the vietnam war and later
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became a vocal opponent of the war shares his views on vietnam at the lyndon b. johnson presidential library in austin, texas. >> our veterans do not receive either the welcome home nor the benefits nor the treatment that they not only deserve but needed. and the fundamental contract between soldier and government simply was not honored. >> then at 8:00 "on the presidency" -- >> one other person sitting at home watching tv watched reagan deliver the speech. it was dwight eisenhower. he immediately called his former attorney general and said, what a fine speech ronald reagan had just delivered. he then called a former special assistant and said what an excellent ronald reagan had delivered. dwight eisenhower wrote back a multistep political plan for ronald reagan to follow. reagan would end up following eisenhower's advice to the
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letter. >> we examine dwight d. eisenhower's behind-the-scenes mentoring of ronald reagan and the pivotal role he played in reagan's political evolution in the 1960s. for the complete "american history tv" weekend schedule go to house speaker paul ryan says the republican party needs to be unified to beat the likely democratic candidate hillary clinton in the november election. he spoke at a briefing earlier today on the opioid bills the house is considering this week. speaker ryan and house republican leadership will meet with donald trump tomorrow morning. house minority leader nancy pelosi's briefing follows the speaker.
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good morning. good morning, everyone. i'm susan brooks. i represent indiana's fifth congressional district. before i came to congress in 2013, i'd spent about 22 years in the criminal justice system. first as a criminal defense attorney representing people often afflicted with drug addiction. then as a u.s. attorney prosecuting drug traffickers in indiana. but i will tell you after i came to congress i became much more engaged in the drug addiction and the substance abuse problems facing our country, because you may not realize, but 78 americans lose their lives every day to an overdose. 78 americans.
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that's almost 15 -- 15 people on a regular basis every hour lose their lives. i'm going to talk to you about one of those lives today. because she drives me. she's part of the reason why myself and so many members in the house are focused on this horrible epidemic facing the country. justin phillips, a mom in indianapolis, lost her son to an opioid overdose. he had been a high school senior at 18 years old, football player, great young guy. he got hooked on heroin. by age 20 he had lost his life. this is after he'd been in treatment, recovery. she stood by him. she worked with him. but he lost his life to a heroin overdose at age 20. so, she started an organization called overdose lifeline because she said she needed to do it until the dying stops. and the dying is happening every hour, every day, all across this country.
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so, she started an organization overdose lifeline that focuses on providing -- raising funds for naloxone treatment for first responders. our first responders day in and day out are saving lives in our neighborhoods and communities and in our family's homes. i'm really pleased that the house is taking up more than a dozen bills focused -- because so many members of congress feel strongly about this. i'm proud to be leading a bill hr-4641 which talks about trying to change the culture in this country of the prescribing practices. because 80% of those dying of heroin started with a pain prescription addiction. and so my bill is about a task force bringing together patients, treatment providers, prescribers and the federal agencies involved with the prescription problem facing the country. and to bring to congress the best practices, how do we change the culture of the prescribers in this country?
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we've got to get people off of the pain meds so then those people will not turn to heroin and that will eventually save lives. everyone's had a lot of great ideas. we're going to bring a lot of proposals to the house floor from members all across the country. these are very bipartisan bills. this is something that affects so many lives. we're doing it is for justin. we're doing it for her young son aaron sims and with that i'd like to turn it over to representative dold from illinois. >> i'm representative bob dold representing illinois' tenth district. in the suburbs of chicago, the area i represent, we're losing one person every three days in the county. we lose one every day in cook county. this is an epidemic. but today i want to talk about one in particular. his name is alex. and here with me today are alex's father, gary, his mother jodi, and his sister chelsea.
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alex was an all-american kid. he grew up in buffalo grove. went to stevenson high school, which was a great school in the tenth congressional district. he played sports. got good grades. had lots of friends and went off to college. what happened there, though, is that something mysterious happened. alex would check himself into a hospital. he was sick. his parents didn't know what was going on. his teachers didn't know what was happening. but actually what was going on alex was with drawing -- he was in withdrawals from prescription drugs. he would get better. he would get out. he would repeat the cycle over and over again. and this happened until alex's sophomore year, just before his final exams alex actually overdosed on prescription drugs and heroin and died. just like the story you heard from susan a minute ago, he was 20 years old. i can't even imagine the pain as a father of losing a child to a heroin overdose.
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to any sort of an overdose. and frankly, that's one of the reasons why our bipartisan bill which is going to be voted on tonight named in alex's memory is that first step step forwar. it increases access to the life-saving antidote, which has already saved nearly 100 lives in lake county illinois alone in just alternates over one year. what happened is that the community got together, the lake county opioid initiative said what can we be do differently? they worked with first responders with stakehold, students, treatment facilities. what they were ability to find is the first-responders are on the cease faster than the paramedics, the police actually asked if they could have niloxone, because they diplomat want to watch someone die while they were just standing there. the world health organization says if we can actually put it out there, we have an
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opportunity to save an additional 20,000 lives each and every year. this is a decisive step to not onlysh from falling victim, but also to help those in our communities struggling to get their lives back on track. through lali's law and these other bills, it's mike sincere hope that alex assist l.a.s memory will be giving thousands of others at a recovery, and sparing the families from this incredible heartbreak. i want to turn it over to the speaker now to talk about some of these bills. >> i know some of you are here about a meeting that is happening tomorrow. i'd like to talk to you about a meeting i had yesterday. i met with the family of jason simkekowski, he was raced in stevens point, wisconsin, a place i've been to hundreds of
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time. after high school he entered the marines. he reached the rank of corporal. he was a son, he was a husband, and he was a father to a precious little girl. two years ago jason entered the v.a. medical center to be treated for anxiety. he never went home. under medical supervision or the appearance of it, he died of an overdose from opioid painkillers. we now know that jason's death could and should have been prevented. no one should seek help and receive mistreatment in return. no one. so jason's family pushed for reforms that will make the v.a. improve its practices in the way it monitors prescriptions. yesterday the promise act passed the house. jason's family was there in the gallery to watch it. it is one of 18 initiatives that we are acting on to address the opioid epidemic sweeping across this country. you just heard about two others.
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many states have taken action, but this threat also requires a national response, so whether it is protecting infants, whether it is stopping kingpins or pushers, or making better use of data, we are going to take all of these ideas, pass them through the house, go into a conference with the senate, and we intend to put a bill on the president's desk fast. this is not just about process. this is not just about legislation. this is about saving people's lives. it is about honoring those who are taken too soon. it is about honoring those who want a second chance, who need and deserve a second chance. and it's also about protecting the next generation, those of us raising that next generation care so deeply about this. that is what this week is about. >> as you heard from everyone here, addiction tears families
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apart. it doesn't matter what neighborhood you're in. it doesn't matter your age, doesn't matter the color of your skin. it's reaching every single district. i want to give some special thanks here to congressman bob dold, congresswoman susan brooks. they never gave up. they worked together in a bipartisan manner. when you talk about and listen about the bills on the floor this week, there will be 18 of them, dealing from every aspect of this challenge that we have in america. i want to thank the senate, the senate has worked hard on this as well. we expanded in the areas that the senate did not. we streamlined with the sensenbrenner bill and actually provided more money. it has reached every place, and it's an epidemic. what the speak just talked about, there is a certain area that's grown more than anywhere else, and that's our vet advance. they've been over-prescribed, coming back with ptsd. this will deal with it.
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so when we leave the floor this week, this is the place that all of america can be proud, that we're finding solutions in a bipartisan manner, and dealing with it in the right approach. s a. opioid abuse is a major crisis in america, and the house has taken very started action this week to address the problem. we're going to merge together with the senate's work so we can finally get a bill to the president's desk that targets this problem. as you heard from some of the authors of the legislation we're bringing forward susan brooks and bob dold have real specific legislation to go after areas of this problem. there are a number of overt bills, larry bushen, who brought forward a bill this week to make it easier for people to get treatment. we know that 44 people die every single day from opioid abuse in america. when you look at how it's a
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gateway to deeper problems, 80% of all heroin users started off abusing prescription painkillers. so we're targeting this problem, and it's really good that the house has taken this seriously and moving legislation in a bipartisan way. something else we're doing this week is starting to focus on police week, standing up for our law enforcement, on the front lines protecting our communities and it's a very different job for them. one bill we passed yesterday, truly savings lives is the reauthorization of the bulletproof vest program. more than a mill won police officers around the country have gotten bulletproof vests to save their lives through this program, so it was important that we passed legislation yesterday that will go to the president's desk reauthorizing the bulletproof vest program, which has directly saved the lives of officers all around this country. well, let me express my
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sincerest thanks to alex's family for being here this morning and joining us, and representing thousands across the country right now their directly impacted. i also want to recognize the leadership, the commitment of representative bob dold and representative susan brooks on this important issue. as we come together this morning, we're reminded of the pain and suffering this epidemic has brought to families, neighbors, communities in every zip code across this country. for years i've actually been working on legislation to ensure proper use of prescriptions, and through that work, i can tell you this issue is personal. sadly, you don't have to go too far to hear of stories. last week i visited a pharmacy? spokane, and it's right next door to a high school that is facing unprecedented opioid abuse and overdoses. they're doing everything they can to combat it. it's heartbreaking. as i spend time talking to the
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individuals gathered, i couldn't help but think of the words of addiction survivor nick yakob. he recently shared with everyone in this room -- survivors aren't bad people trying to be good. they're sick people trying to get well. s no one can fight this battle alone nor should they. the bills we will pass this week will increase our understanding about the crisis, promote innovative care, and work together to combat the stigma against those seeking help. at the end of the day, we're in this together. these are our communities, our hometowns, as our voices in the house of representatives, we are committed to, whoing together with the local leaders to find the best solutions to end this epidemic, restore america's promise and confidence in their futures. >> does anybody have any questions? manu.
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>> reporter: thank you, you've begged repeatedly for unity, a lot of reps say by your decision to withhold your endorsement of donald trump actually makes it harder for the party to unite. are you concerned by not endorsing trump, the party will have a difficult time -- >> no, i think we're trying to be as construct i have been as possible for a real unification. to pretend we're unified as a party after coming through a very bruising primary which just ended about a week ago, to pretend we go into fall half strength. this election is too important to go into an election at half strength. that mean we need a real unification of the party. after a tough primary, that's going to take some effort. we are committed to putting that effort in. i want to be a part of that unifying process so we're at full strength this fall so we can win this election. we cannot afford to lose this election to hillary clinton, to
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pack the supreme court, to keep the liberal obama agenda going. bev to be at full strength to we can win this election. we have to go through the actual effort and congress of unifying. >> reporter: you've been very vocal in your differences on policy with donald trump. so what is it that you need to hear from him at some point to fully endorse him? and is there a situation in which you can't? >> i think this is are conversations -- i don't really know him. i met him once in person in 2012. we had a very good conversation in march on the phone. we just need to get to know each other and as a leadership team we are enjoying the fact we have a chance to meet with him. i would rather have a conversation in person than through the media, no offense. >> reporter: the policies -- >> this is a big tent party. there is plenty of room for different policy disputes in this party. we come from different wings of the party. the goal here is


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