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tv   Hearing Examines Health Care for People with Chronic Illnesses  CSPAN  May 16, 2017 5:35pm-6:30pm EDT

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thought he said and i know he feels that we had actually a great meeting with the foreign minister so we are going to have a lot of great success over the next coming years and we want to get as many to help fight terrorism as possible and that's one of the beautiful things that's happening with turkey. the relationship that we have together will be unbeatable. so thank you all very much. i appreciate it. we are going to meetings. [inaudible] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. visit] [captions copyright national cable satellite corp. 2017] >> the house in recess now, back at 6:0 p.m. eastern for votes and speeches. the house earlier today debating several bills relating to this week's national police week. later in the week, they'll take up a measure that would impose new sanctions on those who do business with or provide financing to the syrian government. we'll have live coverage of the house when they gavel green bay packer in here at c-span at
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:30 eastern. earlier today, health care experts testified on the benefits of tell medicine technology. and how it can help better manage the care of medicare patients. thises was held by the senate finance committee. sen. hatch: meeting will come to order. i would like to welcome everyone to this morning's meeting on bipartisan policies to care for patients with chronic conditions. it was almost exactly 2 years ago today we reformed a
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bipartisan working group cochaired by senators isakson and warner to work on legislation to address these issues. that working group spent many months listening to stakeholders in the health care community, both in person and through more than 850 formally submitted comments. in december 2015, the working group released a comprehensive policy options document. in october of last year we issued a legislative discussion draft. soon after that, cms finalized 4 of our policy proposals in its 2017 medicare schedule role, and 2 positions from our discussion draft were included in the 21st century cures act, which president obama signed into law this past december. in other words, several of the working group's policies have already been enacted, and we are working to get the rest
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signed into law and fully implemented. toward that end, we introduce the latest version of the chronic care act, a bill that encompasses the working group's proposals, in april. the legislation currently has 17 bipartisan cosponsors and has been endorsed by numerous organizations in the health care community. today is the latest step in our efforts. the next step will come later this week. we have noticed a markup for thursday morning. i want to thank my colleagues, ranking member sen. wyden, for his work on this matter. his passion for improving care for those with chronic conditions has been a driving orce behind this effort. of course, i want to thank senators isakson and warner, who worked tirelessly to lead our working group. through their efforts, the
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committee has not only learned about the burden imposed on medicare patients living with chronic conditions, but identified new policies to improve care coordination, increase value, and lower costs in the medicare program without adding to the deficit. today's hearing will provide us with an opportunity to examine these policies more expensively so we can better understand how they will help patients and enable providers to improve care and produce better outcomes. the bill includes a number of policies that would improve care for the chronically ill through increased use of elehealth by giving medicare advantage plans to certain accountable care organizations, enhanced flexibility to services to medicare patients with chronic conditions. enators schatz and wicker have been instruments in this particular effort, and i'm pleased to have them here with us to talk about how the chronic care act advances their
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policy goals. i would be remiss if i did not also recognize the finance committee members who have joined senators schatz and senator wicker's efforts to promote increased use of telehealth services. in that regard, we appreciate the leadership of senators thune, cardin, and warner on these matters. while many stakeholders offer key advice on telehealth policy, i want to thank the fine institutions in utah, specifically on the "telestroke" policy. specifically, the doctors of the university of utah as well as the doctor with intermountain health care. i appreciate your willingness to share their experience and expertise on technology to
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properly diagnose individuals presenting stroke symptoms. i look forward to hearing more on this particular aspect of telehealth here today. but first, our bill goes beyond telehealth making improvements to beneficiaries who receive care across the medicare spectrum including fee-for-service, accountable care organizations, and edicare advantage. we have a panel of recognized experts before us today to discuss all of these issues, and i want to welcome each of our distinguished witnesses. obviously, i'm well aware that there are some contentious debates going on in the health care space these days, and there is no shortage of political and partisan points that people would like to make in a venue like this. however, for today's hearing, i sincerely hope we can maintain the bipartisan spirit that has
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driven our efforts on chronic care act. toward that end, i respectfully ask members of the committee to focus their questions on the policy areas specifically addressed in the bill. with that, i'm going to turn it over to sen. wyden for any opening remarks he would like to make. sen. wyden: thank you very much, mr. chairman. i want to thank you, mr. chairman, your staff, senator warner, senator isakson. this is an extraordinary hearing, and i will touch on why. but it could not have happened if you would not have been willing to initiate a committee-wide process. again, i want to thank you for all the efforts to make this morning possible. colleagues, i looked forward to today for many years.
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that is because the finance committee is now beginning to tackle the premier challenge of american health policy, specifically, by updating the guarantee of medicare to better serve seniors with chronic illness. when i was codirector of the oregon gray panthers, medicare had just 2 parts a and b. if you broke your ankle and had surgery in the hospital, you were covered by part a. if you got a really bad case of the flu and you went to the doctor, you were treated by the doctor in their office, and that was part b. that is not medicare today. today, medicare is cancer, it is diabetes, it is heart disease, it is strokes, and it is other chronic conditions. seniors who have 2 or more of these chronic conditions now account for more than 90% of all medicare spending. and today, older people get their care in a variety of different ways. there is still fee-for-service,
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and there is also medicare advantage, accountable care organizations, and a host of innovations being tested across the country. because medicare is a guarantee, a promise of defined benefits, it is past time to update this promise so as to deliver to patients with chronic conditions the best possible care in the most fficient manner. so as the chairman touched on, the legislation today begins this transformation. older people will get more care at home. less in institutions. there will be expanded use of life-saving technology. that is why it is so good to see senator schatz and senator wicker here to talk specifics. there will be a stronger focus on primary care and expanded
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use of nonphysician providers. now, in my view, still to come is ensuring that each senior with multiple chronic conditions has an advocate to guide them through what can be a teeth gnashing experience of trying to navigate american health care. 2 final points, one picking up on the debate about the affordable care act. i would just say, colleagues, this is the way to do it right. doors were opened here, not closed. there was bipartisan cooperation, not partisan econciliation. the public was asked to shave the bill, not take it for granted. and finally, i want to thank our partners. chairman hatch and i have senator warner and senator
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isakson coordinating this effort. the chairman made a mention of the fact that many colleagues both on and off the finance committee have really helped to produce what our witnesses are going to call this morning a model for how to take on tough challenges. it has been an honor for me to be part of this bipartisan effort on and off the committee. like you, mr. chairman, i'm pleased that our colleagues senator schatz and senator wicker are with us today. sen. hatch: we are pleased to welcome senator roger wicker and brian schatz to our hearing today. as i mentioned in my opening statement, these two senators have done a lot of work on telemedicine and telehealth issues. we appreciate your support and input today, and we look forward to hearing your thoughts on these important issues, and your perspectives on this important topic.
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sen. wicker will provide his statement first and then be followed by senator schatz. please proceed with your remarks and then we will take senator schatz next. sen. wicker: thank you, mr. chairman. thank you, ranking member wyden, and my distinguished colleagues. thank you for allowing me to share what we already know in my home state of mississippi, telehealth works. i'm glad to be here to discuss the promise of telehealth and celebrate the progress your committee is making with the act, which i have enthusiastically cosponsored. i would like to commend the leadership of the senate finance committee for their years of work to address the cost and quality of chronic care in america. today is a testimony to your efforts. i am pleased to be here today with my friend senator brian schatz. he and i are on the commerce subcommittee on communications, technology, innovation, and the
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internet. in the commerce committee, we have worked tirelessly to promote innovation by removing barriers to connectivity and expanding access to rural broadband. it was during a 2015 hearing of our subcommittee on the potential of telemedicine when senator schatz and i decided to join forces to reform how medicare reimburses elehealth. we were fortunate to form a team including senators warner, thune, and cochran, and the result was the connect for health act, a widely supported legislative proposal for elehealth. connect for health, s. 1016, is the product of hard work and determination. it is designed to improve the quality of care and cut costs. i thank the committee for improving telehealth provisions inspired by our connect bill in
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the bill we are discussing today. in so doing, you are recognizing the promise of telehealth. i became interested in this topic because my home state of mississippi has led the nation in maximizing technology to improve patients' health. the university of mississippi medical center in jackson has been a leader in telehealth for over a decade. the team has managed to increase access to quality care and cut costs by using services like remote patient monitoring and tele-emergency, reaching some of our state's most rural, vulnerable, and costly patients. mississippi is a very rural state, and we have some of the toughest health problems, too. we have the fewest providers per capita, and the highest rates of heart disease and type two diabetes. these health disparities and barriers to access are what drove the university of
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mississippi medical center to experiment and innovative with telehealth. one of the many mississippi telehealth success stories is the diabetes telehealth network, a remote patient onitoring program that provides rural mississippi patients who have uncontrolled diabetes with routine access to a provider through a medical ablet. this partnership began following 200 chronically ill patients in the underserved mississippi delta. the technology allowed providers to monitor and care for the patients remotely on a daily basis, following their vital signs and intervening when things didn't look good. throughout the course of the first year, zero of the 100 patients were admitted to the hospital. think about that. no emergency room visits for
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any of these previously chronically ill patients. this is an excellent care that can improve patients' lives. in fact, telehealth can save money also. the mississippi department of medicaid found that if this remote monitoring program were extended to just 20% of mississippi's diabetic medicaid population, the state would ave $189 million per year. so, mississippi medicaid, like medicaid programs in virtually very state, is expanding access to and coverage for telehealth and remote patient monitoring. however, medicare is behind the curve, limiting access for millions of seniors. imagine the incredible impact this technology could have if medicare would allow its most vulnerable beneficiaries to use something like remote patient monitoring.
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i'm confident that the success we have seen in mississippi can be replicated for patients across the united states upon enactment of the chronic care act and, ultimately, enactment of connect for health. we are still looking for cosponsors, mr. chairman, and we will not stop until access to quality care through telehealth is realized for medicare patients. the chronic care act is a step in the right direction. we have more work to do in this space. and i look forward to continuing to work with each of you. thank you, sir. sen. hatch: thank you. i think i'm a cosponsor. if i'm not, put me down. senator schatz, we will take you know, and then we will turn to sen. warner, was played a significant role in this. sen. schatz: thank you, chairman hatch, ranking member wyden, distinguished colleagues and members of the senate finance committee, for holding this important hearing on bipartisan legislation. i'm happy to cosponsor the
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chronic care act, a bill that can help improve outcomes and disease management for people on medicare who have chronic illnesses. right now, progress in modern technology has not translated into progress across the health care system. that impedes the health system's ability to provide high-quality care, improve access to care, and to lower costs. and so it is time to bring medicare into the 21st century by taking full advantage of telehealth and remote patient monitoring. when we are talking about telehealth, we are talking about using technology to provide clinical services to patients remotely. telehealth more broadly can include nonclinical services like provider training. one type of telehealth relies on live video, audio or visual technology. t is like using a secure version of skype or facetime so
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that a patient can connect with his or her health care provider. when these substitute for traditional in-person visit, they can save er expenses, they save travel time. they use store technology, another type of telehealth which is exactly what it sounds ike. providers can take an image like the x-ray or other clinical picture, store it, and then send it to a specialist anywhere on the planet. there is also remote patient monitoring. if a high-risk patient with a hronic disease needs to have her blood pressure or blood sugar monitored, she can use the device at home to collect and send the data to a provider remotely and continuously. this improve the outcomes for the patients with chronic conditions and saves money, too. the veterans administration, the department of defense, and the private sector are all taking advantage of telehealth and remote patient monitoring and approving access to care,
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improving quality of care, and saving money. the problem is that medicare is not. it is limited by an old law, section 1834m of the social security act, which puts restrictions on the use of telehealth. the law says that patients must be located in certain originating sites in order to use telehealth. they cannot be seen at home. they can only be located in certain rural areas. only certain types of physicians and practitioners can use telehealth under medicare. physical therapists or occupational therapist cannot. remote patient monitoring is hardly covered at all. that is why senator wicker and i, along with senators cochran, thune, warner, and 13 other members of the senate and almost three dozen members of the house -- and everybody is invited -- have cosponsored the connect for health act over the past two years. our bill would lift medicare restrictions on these of
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telehealth and improve coverage of her motivation monitoring. i know the chronic care working group has worked in a similar bipartisan fashion to build consensus and find ways to advance legislation. there are 4 provisions in the chronic care act and the connect for health act that would help patients lower costs. these include lifting 1834m restrictions that hold back patients who have had acute strokes or need home dialysis, people enrolled in medicare advantage, and accountable care organizations. while these provisions are an important first step, we still have further to go. we look forward to working with this committee to continue to advance the important provisions in the connect for health act, including improving coverage of remote patient monitoring, lifting 1834m restrictions, including global and bundled payments, and giving the secretary of health and human services more flexibility to waive these restrictions as certain costs
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and quality metrics are met. thank you to chairman hatch, ranking member wyden, senators warner and isakson, and all the members of the finance committee for the privilege of speaking before you today, especially thank you to my partner on this legislation, senator wicker. sen. hatch: well, thank you both very much. we are very appreciative that you appeared before the committee and gave your excellent remarks. we turn to sen. warner for whatever he would like to say. sen. warner: thank you, mr. chairman. i think it is particularly great to see that you both more purple ties today. that color coordination gives a little extra -- >> so did the chairman. sen. warner: so did the hairman. it shows when there is a will, there is a way. [laughter] this chronic care topic is obviously extraordinarily critical, and i want to thank the chairman and ranking member for asking sen.
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isakson and i to work on this roup with you. sen. isakson isn't here, but as with so many projects he has been a great partner. thank you and sen. wyden. i echo what senator schatz and senator wicker said in terms of telehealth being a critical part of chronic care. he truth is, as a population ages and americans survive acute illnesses to an extent previously unimaginable, we need to make meaningful reforms to our health programs so we can move medicare into the 21st century, to ensure high-quality care. although the rate of increase in the national health spending may be slowing, our aging population and the uncertainty around the affordable care act means our public health systems will continue to face serious inancial challenges.
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a now this area has been particular topic for sen. wyden for some time and he has repeatedly pointed out the fact that an individual has more than six illnesses in terms of chronic disease. that is only 14% of the medicare population, that accounts for half of the medicare spending, and as people continue to age, those numbers are only going to go up. tackling systemic reform, how we pay for quality, how we measure value, are key challenges in what we need to get right. this chronic care working group, which we have been part of and working with colleagues like senator wicker and senator schatz, i think we have got a good product, and i thank the chairman and ranking member. hopefully we will move on this even if we cannot agree on other areas in the health care field. our current system fails to adequately care for patients with chronic conditions. unfortunately, while our health-care system does a great
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job of paying for individual procedures -- surgery, chemotherapy, hip replacements, etc. -- it does not provide a good job of paying health care providers to coordinate care and to treat patients in a way that takes into account how these progressing conditions really do affect the lives of patients and their families. this working group received comments and subsequently meeting with our staff and individual stakeholder groups and put together a series of proposals that would modernize our health care system including these changes would expand the telehealth services to home dyalisis patients. and i have a daughter with diabetes. provide greater availability to ensure that individuals presenting with strokes -- stroke symptoms receive the best
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course of treatment. so some of the telehealth components of your legislation, improve the design of medicare advantage to provide targeted high-value services for individuals who need it most. another provision of what we are proposing is provide better care planning services directing g.a.o. to submit a report to congress to inform the development of a payment code for comprehensive care planning. this is an issue i have been working on since my tenure. my mom had alings i'mer's for 10 years and didn't speak for 10 years and trying to get that right and we don't want to be nation in rillized the world. although not perfect, these initiatives move the medicare systems towards better coordination, better quality, better cost effectiveness and
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makes steps in moving us into the 21st century. i thank you for letting us work with you and i think we have a good product. senator hatch: we appreciate the work and appreciate both of you at the witness table. thanks for being here. we have the opportunity to hear from four other witnesses that will help inform our path. welcome these four witnesses and thank them for their willingness to testify today. we will hear from the direct toffer of health policy at the bipartisan policy center. prior to joining, ms. hayes was an associate research professor at george washington university school of public health. prior to joining, she served as vice president of health policy for jennings policy strategies ink and practiced law and worked
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for ealth policy adviser o large catholic health care systems. she served as health policy adviser to members of the senate and house of representatives in both political parties. served as a program consultant to the state of missouri. medicaid agency and as health and education policy adviser for the state of texas. ms. hayes received a bachelor of arts degree in international studies from the university of north carolina at chapel hill and jury is doctorate from washington college of law. following her remarks, we will here from professor of neurology at harvard medical school and executive vice chairman of neurology at the massachusetts general hospital where he is the
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chief of the stroke division and serves as director of the telestroke network as medical director for mgh telehealth and co-chair of the innovation partners health care. he has authored over 250 peer-reviewed articles and has chaired or co-chaired many of the current practice guidelines for stroke and telehealth enabled care delivery. he graduated from harvard medical school in 1991 and completed in neweroclinical care and vascular at the massachusetts general hospital. he is testifying on behalf of the american heart association and american stroke association. third, we will hear testimony from the president of the upmc for you, a managed care organization that serves
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prisnsnhehric ce acwhh il un ovio includ ithneenatn ogm dff y o suororhe inurxpiee ariti i onof inothosrica coont itwsid mbg mode. il piesaye prrie neidods, o-deods los idti wh e styf hi ct d uliti a oswi t penalf congig cts itlls a.oto dlo socewi a sfien peodf meo he iac onhe befia'sar a b trut t t e oth asemt ri. urrosio pa t abitof.c.oxpd le
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me sutns pvisatnt acssoerceo st magehe dea amb o polaonac wh sutns anitane ucssl alrniv in aitn is tl n ove scity csusefo prarcahycis ur lotis a lal f mta heth svis er vua ntt c banmptaar ofar i ulwodsk tomtt csirhexpsif tehethoncdeudnl anll cmucaoneten prids,araneran paen iaeaesfaio peal i l-iom mmits at m n he ce tvioonrein chlo. aow pies isna.
6:26 pm
d ermabe aosfo delonghe iraruur t adnier t bef, wld tnlbefith pie b hi oherode by ireinheotti f ar sin a t mice ogm owinthot stf re inntesouncra titso raiin nwo tht ming tirhoes a w. onehf t.c.nd t nir al ste iha yofoourosao pre aly dow cts i okorrdo wki wh yo tacevou srego a bteheth stefo al arins anyo nar tc tnktoll urf y. welurtoenoryd fit.
6:27 pm
setowyn:y an f ki ts birtan eor t binyryg sf u nai aicref at it le r seby w i 7 yes d tinto g tou isazof dto' vitan muip pscptns a tts tetes aeres. d smso nd'm reecngn ds wn wa coirto othgrt ntrshi c bchlein ifou a iyo 3s d ir hlt. heouelulf ofououeay in a piur f wt 'sik i yoara siowh h ltlehric cdion nc,ayea dea, abes and wt pps y arbacay o tre oyo
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ow nth wdsifouren odedaradnte an yowi bab tha hp d . yetaedbo a paenceer hltla theeaty iisorot sio,hereeayut the he o. pat e ctef at is li f seby o i75 yes o tge uinhe moin a wdeho t hk e ey gngo ae t gg a ts uf tou e d. vy iorntueio an'l aweth itw ys onis wn e tit ces in t ergcyooita stkeheo ny teshe ar oer pies, 6 a
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direenicri a ltle micio a ty dn he e ne odi't unrsndhereriior sothg thaedndidt ket he ltocr' si ae e airef prenon so t iues n kwlge d i n aese t imovthreah. thhaen i nigin ts crib cplysm. d omheerecvefha its keo seo ith mmit t ara lgtof ayn e spalft a ro i t utestess foay inouay y centth hoitndava n ali a c't sakel u-e'reaw hend sethnlendus src chniheth


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