[House Hearing, 114 Congress]
[From the U.S. Government Publishing Office]
LEGISLATION TO IMPROVE AND SUSTAIN THE
MEDICARE PROGRAM
=======================================================================
HEARING
before the
SUBCOMMITTEE ON HEALTH
of the
COMMITTEE ON WAYS AND MEANS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED FOURTEENTH CONGRESS
SECOND SESSION
__________
JUNE 8, 2016
__________
Serial 114-HL09
__________
Printed for the use of the Committee on Ways and Means
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COMMITTEE ON WAYS AND MEANS
KEVIN BRADY, Texas, Chairman
KEVIN BRADY, Texas SANDER M. LEVIN, Michigan
SAM JOHNSON, Texas CHARLES B. RANGEL, New York
DEVIN NUNES, California JIM MCDERMOTT, Washington
PATRICK J. TIBERI, Ohio JOHN LEWIS, Georgia
DAVID G. REICHERT, Washington RICHARD E. NEAL, Massachusetts
CHARLES W. BOUSTANY, JR., Louisiana XAVIER BECERRA, California
PETER J. ROSKAM, Illinois LLOYD DOGGETT, Texas
TOM PRICE, Georgia MIKE THOMPSON, California
VERN BUCHANAN, Florida JOHN B. LARSON, Connecticut
ADRIAN SMITH, Nebraska EARL BLUMENAUER, Oregon
LYNN JENKINS, Kansas RON KIND, Wisconsin
ERIK PAULSEN, Minnesota BILL PASCRELL, JR., New Jersey
KENNY MARCHANT, Texas JOSEPH CROWLEY, New York
DIANE BLACK, Tennessee DANNY DAVIS, Illinois
TOM REED, New York LINDA SANCHEZ, California
TODD YOUNG, Indiana
MIKE KELLY, Pennsylvania
JIM RENACCI, Ohio
PAT MEEHAN, Pennsylvania
KRISTI NOEM, South Dakota
GEORGE HOLDING, North Carolina
JASON SMITH, Missouri
ROBERT J. DOLD, Illinois
TOM RICE, South Carolina
David Stewart, Staff Director
Nick Gwyn, Minority Chief of Staff
______
SUBCOMMITTEE ON HEALTH
PATRICK J. TIBERI, Ohio, Chairman
SAM JOHNSON, Texas JIM MCDERMOTT, Washington
DEVIN NUNES, California MIKE THOMPSON, California
PETER J. ROSKAM, Illinois RON KIND, Wisconsin
TOM PRICE, Georgia EARL BLUMENAUER, Oregon
VERN BUCHANAN, Florida BILL PASCRELL, JR., New Jersey
ADRIAN SMITH, Nebraska DANNY DAVIS, Illinois
LYNN JENKINS, Kansas JOHN LEWIS, Georgia
KENNY MARCHANT, Texas
DIANE BLACK, Tennessee
ERIK PAULSEN, Minnesota
C O N T E N T S
__________
Page
Advisory of June 8, 2016, announcing the hearing................. 2
WITNESSES
PANEL ONE
The Honorable Charles W. Boustany, Member of Congress,
Washington, D.C................................................ 22
The Honorable Robert J. Dold, Member of Congress, Washington,
D.C............................................................ 16
The Honorable Kristi L. Noem, Member of Congress, Washington,
D.C............................................................ 20
The Honorable David G. Reichert, Member of Congress, Washington,
D.C............................................................ 18
PANEL TWO
The Honorable Joseph Crowley, Member of Congress, Washington,
D.C............................................................ 30
The Honorable John B. Larson, Member of Congress, Washington,
D.C............................................................ 28
The Honorable Patrick Meehan, Member of Congress, Washington,
D.C............................................................ 25
The Honorable James B. Renacci, Member of Congress, Washington,
D.C............................................................ 21
PANEL THREE
The Honorable Alexander X. Mooney, Member of Congress,
Washington, D.C................................................ 26
The Honorable Christopher H. Smith, Member of Congress,
Washington, D.C................................................ 33
The Honorable Lee M. Zeldin, Member of Congress, Washington, D.C. 31
SUBMISSIONS FOR THE RECORD
The Honorable Diane Black, statement............................. 48
The American College of Clinical Pharmacy, and The College of
Psychiatric and Neurologic Pharmacists, statement.............. 50
Lymphedema Advocacy Group, statement............................. 53
Medicare Rights, statement....................................... 59
Property Casualty Insurers Association of America, statement..... 61
LEGISLATION TO IMPROVE AND SUSTAIN THE MEDICARE PROGRAM
----------
WEDNESDAY, JUNE 8, 2016
U.S. House of Representatives,
Committee on Ways and Means,
Subcommittee on Health,
Washington, DC.
The subcommittee met, pursuant to notice, at 2:20 p.m. in
Room 1100 Longworth House Office Building, the Honorable Pat
Tiberi [chairman of the subcommittee] presiding.
[The advisory announcing the hearing follows:]
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Chairman TIBERI. The subcommittee will come to order.
Welcome to the Ways and Means Health Subcommittee Member Day
hearing entitled, ``Legislation to Improve and Sustain the
Medicare Program.'' Today, similar to our last Member Day
hearing on tax-related proposals to improve health care, this
Subcommittee is providing a public platform for any and all
Members of Congress interested to discuss bills that they have
introduced that modify the way health care is assessed and
delivered to more than 55 million seniors who rely on the
Medicare program.
Members have put a lot of work into developing and drafting
these pieces of legislation, and this Member Day hearing is
their opportunity to share with their colleagues and the
American people why these bills are important, and why this
Committee should take them up.
In addition to my colleagues from Ways and Means, I am
excited to hear from Members who serve on other committees who
have worked equally hard on legislation to transform and
improve our Medicare program.
We remain committed to working through regular order. That
includes hearings like the one today from those on and off the
committee.
So how is it going to work? Members will have five minutes
to discuss their Medicare legislative priorities. I would
remind those Members that they are also able to submit written
testimony in support of their legislation.
We thank you all, witnesses and members of this
Subcommittee, for taking the time out of your busy schedules to
be with us today. And I hope, Dr. McDermott, we can build on
the kind words you said about us yesterday. I knew it might
take a little while for you to say kind words about us, and we
accomplished that. So let's build on that, sir.
I yield to the ranking member.
Mr. MCDERMOTT. Thank you, Mr. Chairman. We might as well
start out on a good note. And I think that I want to thank you
for holding this Member Day hearing to improve and sustain
Medicare. I welcome this opportunity to learn more about the
ideas that my colleagues may have, and they will discuss today.
When it comes to Medicare, the policies which were put in
place in 1965, those policies we have made a wide range of
interests--physicians, insurers, hospitals, and many others.
And the most important people affected, however, by Medicare
are the beneficiaries, the 55 million seniors and Americans
with disabilities who depend on Medicare for their health care.
At its core, Medicare is a fulfillment of a commitment to
the health security of the American people. Individuals who
have contributed to the system deserve the peace of mind of
knowing that Medicare's benefits will be there when they need
them. That means that Congress must work to ensure that
Medicare truly strengthens the quality and accessibility of
beneficiaries' health care.
A strong Medicare doesn't mean we turn the program over to
the insurance industry, and it doesn't mean we shift more costs
on to the beneficiaries. A stronger Medicare is a program that
provides comprehensive coverage to beneficiaries at affordable
cost. To make that a reality we have to move the conversation
in Congress away from harmful ideas like privatizing the
program and cutting seniors' benefits toward a more productive
discussion of how to make Medicare work better for
beneficiaries.
To that end, I intend to discuss legislation I have
recently introduced which will provide beneficiaries with
access to comprehensive dental, vision, and hearing services.
This is a popular, long-overdue reform that will improve the
health security of millions of Americans. And I look forward to
talking further about the importance of this during the
hearing.
I also hope to hear from my colleagues about other ideas
that will continue to build upon and expand Medicare. I intend
to carefully scrutinize ideas that may not be in the best
interests of the program or the beneficiaries. Today's hearing
is a part of what must be an ongoing process of careful debate
that will show the American people what Congress is doing or
not doing to improve health security.
When Medicare was put in place, the life expectancy in this
country was about 10 years lower than it is today. So we had
such success in Medicare that we have got a whole lot of new
problems that we didn't have before. It must be followed by
substantive legislative hearings and markups and amendments, so
that we could weed out bad ideas and make sure the ones that
are good can have the passage of this Congress.
Thank you again, Mr. Chairman, for bringing this day
together, and I look forward to hearing the witnesses.
Chairman TIBERI. Thank you, Dr. McDermott. Without
objection, other Members' opening statements will be made part
of the record.
Now we will hear from Members of the Subcommittee on their
priorities to improve Medicare. I am the lead Republican on the
Medicare Home Infusion Site of CARE Act, which we are working
with the Senate and CMS to ensure it will work for all
stakeholders. It is truly an important piece of legislation
that will expand beneficiary access to infusion treatments in
their homes, if that is where they choose to receive their
care, something that private providers already cover.
I look forward to continuing to work on this legislation
that will increase beneficiary access to appropriate and cost-
effective care, and advancing it when it is ready.
Chairman TIBERI. With that, I turn to my left, literally,
to Dr. McDermott once more for the purposes of discussing his
legislation.
Dr. McDermott, you are recognized for five minutes.
Mr. MCDERMOTT. We welcome you on the left. I would like to
ask unanimous consent to enter into the record a letter from
the Medicare Rights organization dated 8 June 2016.
Chairman TIBERI. Without objection. Without objection.
[The information follows: The Honorable Jim McDermott]
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Mr. MCDERMOTT. Mr. Chairman, I have sat here on this
Committee for 25 years and watched lots of things happen. And I
am really glad that we are having a hearing today when we could
put some ideas up on the table that we haven't had before.
I am introducing today a bill called the Medicare Dental,
Vision, and Hearing Act, a bill I introduced, I guess,
yesterday, actually.
The creation of Medicare in 1965 was one of the great
policy achievements in the history of this country. The
benefits that Medicare provided ensured that 55 million
citizens and people with disabilities would enjoy the peace of
mind and the security that comes with having quality health
coverage. The best way to improve and sustain Medicare is by
expanding it and strengthening it because, unfortunately, there
are holes in the program that weaken health security of our
beneficiaries.
One of the largest holes in the Medicare system is that it
does not currently cover most dental, vision, or hearing
expenses. In fact, not only does it not pay for these crucial
health services, they are specifically excluded from coverage
by the statute that was passed in 1965. This is a misguided
policy that, for decades, has had harmful consequences on
beneficiaries.
Doing without dental coverage frequently leads to
preventable health problems. Patients who have poor or no
dental care often find themselves suffering from costly and
potentially fatal conditions such as cardio-vascular disease
and oral cancers. We had recently here in Washington, D.C. a
young kid who didn't have dental care and got encephalitis of
the brain from an infected tooth.
Now, similar untreated vision disorders substantially
increase the risk of falls among senior citizens. One of the
biggest problems for senior citizens is falling. And if they
have bad vision and don't have glasses, or they got cataracts
or whatever, they are having trouble. These falls can result in
serious injuries and expensive hospitalizations.
Hearing loss, for those of us who grew up in the age of
rock music, and used to stand next to the woofers and the
tweeters at full volume, today have hearing aids because we did
things with our ears that we didn't understand then. There are
lots and lots of seniors who have hearing loss and that is an
isolating event.
When you have no ability to hear, you are cut out of
everything. And that is why it is--if we are having seniors
live longer and longer and longer, into their eighties and
nineties, we are going to see more of the hearing and the
vision loss that we have not dealt with in the past. It is a
widespread--the hearing loss is as widespread among Medicare
beneficiaries, often leading to social isolation, depression,
and cognitive impairments. We wind up treating them for
depression, we treat them for all kinds of other things,
basically, because they can't hear.
Yet research shows that a majority of the elderly who need
hearing aids do not have them, in large part due to cost. That
is why the reforms made by the Medicare Dental, Vision, and
Hearing Benefit Act are so important. This bill modernizes and
strengthens Medicare's benefit package to address the full
spectrum of beneficiaries' health needs. It amends Part B to
provide coverage of important health services, including
routine and major dental care, refractive eye exams, and
hearing exams, and adds coverage for important supplies
including dentures, glasses, and hearing aids. It repeals the
harmful statutory exclusions that prevent Medicare from paying
for these costs.
And to control costs and ease the burden as we implement
these major reforms, it places reasonable limitations on
coverage and provides that new benefits will be phased in
gradually. All too often at this Committee our policy
discussions focus on how much we can cut from Medicare and how
to further shift the costs onto beneficiaries. In the process
we fail to recognize the possibilities before us and the
enormous power we wield.
The truth is that Medicare must be strengthened, not cut,
and benefits must be expanded, not scaled back. As the Ways and
Means Committee, we owe a duty to the American people to
discuss how we can make that happen.
And I yield back the balance of my time. I thank the
chairman.
Chairman TIBERI. Thank you. Thank you, Dr. McDermott. My
phone was ringing and I was thinking it was my mom and dad
calling me about your legislation there.
[Laughter.]
Chairman TIBERI. Very well done. Mr. Roskam is recognized
for five minutes.
Mr. ROSKAM. Thank you, Mr. Chairman and Ranking Member
McDermott. Five minutes, three bills, let me do this quickly.
Buckle up, I think I can do it.
So H.R. 512 is the Disarm Act, and it is designed to
incentivize the development of new antibiotic drugs. The
Administration recognizes that we have an incredible problem
here. The CDC recognizes that we have an incredible problem
here. And the incredible problem is that we have got infections
that are unwilling to yield to some of the antibiotics, and we
don't have enough incentive out there in the private sector to
invest, essentially. And this is a plague.
Let me just give you one quick example. In March and April
in the Midwest 18 people died from 57 inspections in 3 states.
And this is here, it is upon us, and we need to deal with it.
H.R. 512 would address this by reimbursing hospitals for the
cost of acquired new certain agents.
It passed in Chairman Upton's Cures Act. We will see where
that is in the Senate, Mr. Chairman, but in my view, we would
be wise to reclaim jurisdiction here and move it again.
Bill number two, H.R. 3220, the Common Access Card. This is
a bill that I have introduced with Mr. Blumenauer. Some of the
work of the Oversight Subcommittee has shown that the fraud and
erroneous payments rate at Medicare is 12.7 percent. I mean
this is a shocking figure. And, you know, you begin to ask
yourself, ``How is this possible?'' Well, it is possible in
part because you got these flimsy old Medicare cards, and it is
a bunch of nonsense.
And what we are proposing is this, to take the technology
that the Department of Defense uses currently, try a pilot
program, and create a common access card.
Ready for a statistic? February 2016, a few months ago, GAO
revealed that 22 percent of health care fraud cases ultimately
prosecuted by the Federal Government could have been prevented
by use of a smart card--22 percent. Marinate in that for a
second. When we are running around here, grubbing around,
looking for nickels and dimes, thinking about 22 percent,
thinking about 12.7 percent--you take my point.
So here is what we need to do. We need to pass this bill,
number one. But you need to give us good feedback.
I spoke with Secretary Burwell this week. She is committed
to expediting a meeting to get stakeholders together. And I
think we can do a lot of good work here. And, Dr. McDermott, I
am looking to you to get on this bill.
And then finally, the H.R. 4853 is the SAFE Act. And in a
nutshell, this legislation provides CMS with additional
flexibility to permit approved private-sector accreditors to
use their own updated standards and survey processes for
hospital accreditation. So, in other words, we have got the
private sector that is doing a fabulous job, we have got a
statute that basically tethers us to an old system. So let's
dump the loser stuff, pick up the things that work, and let's
adopt it so that these hospitals can move forward on that
basis, to allow accrediting bodies to use assessment methods
that incorporated the latest, best practices in health care
delivery to ensure hospitals adhere to high-quality standards
and patient safety.
And Mr. Chairman, who doesn't love that? And I yield back.
Chairman TIBERI. Well done, Mr. Roskam, thank you very
much.
Before I yield to Mr. Davis for five minutes, I just want
to thank him for coming down to the floor yesterday and his
kind words on the bill that originated in this Subcommittee,
and thank all the Members for their input on a bill that passed
the floor unanimously yesterday.
So with that, Mr. Davis, you are recognized for five
minutes.
Mr. DAVIS. Thank you, Mr. Chairman. And I shall discuss
H.R. 2124, the Resident Physician Shortage Reduction Act,
introduced by Representatives Crowley and Boustany.
Mr. Chairman and Ranking Member, the Illinois 7th
Congressional District, which I represent, contains the most
hospital beds of any congressional district in the nation, and
is also home to four major academic medical centers. Given our
nation's growing and aging population, coupled with the
coverage expansion contained in the Affordable Care Act, the
demand for health care continues to increase, especially for
those with complex health care needs, such as the fastest-
growing population in the nation of those aged 75 and older.
Recent studies show that our nation will need as many as
90,000 new physicians over the next decade, and as many as
63,000 of which will need to be specialists.
Clearly, today more than ever, Congress should maintain and
enhance our nation's investment in training tomorrow's
physician workforce. Given that it takes anywhere from 5 to 10
years to train a physician, the question facing Congress is
what are we doing to ensure that our nation is physician
workforce ready to meet our nation's health care needs both
today and in the future?
The teaching hospitals in my district are incurring the
costs of these programs significantly greater than the direct
and indirect graduate medical education payments they received.
In fact, most of the major teaching hospitals in Chicago are
training in excess of 100 doctors over the residency cap, which
costs tens of millions of dollars that will never be reimbursed
to those institutions for training more physicians to address
the growing shortages in primary care and acute surgical
specialties.
Medical schools and teaching hospitals are also working to
ensure that new doctors coming into the system are trained to
serve in new delivery models that focus on care coordination
and quality improvement. According to the latest physician
workforce projections, roughly two-thirds of the shortage in
coming years will be in specialty practice areas such as
neurology, pediatrics, subspecialties, geriatrics, and
oncology.
We need more doctors and allied health professionals to
assist a health care system that for decades was not adequately
addressed in health disparities among millions of racial and
ethnic minority Americans. Many of our minorities are
disproportionately more likely to suffer deleterious health
just because they are low-income wage owners, poor in health,
and suffer worse health outcomes, and are more likely to die
prematurely and often from preventable causes compared to other
members of the population.
This bill provides a greatly needed opportunity to train
the physicians that we need throughout our country. I am
delighted that Representative Crowley and Representative
Boustany have collaborated to pass it. And I would urge all of
my colleagues, certainly, to be in support of it.
And Mr. Chairman, I thank you and yield back the balance of
my time.
Chairman TIBERI. Thank you, Mr. Davis.
Dr. Price, you are recognized for five minutes.
Mr. PRICE. Thank you, Mr. Chairman, and I appreciate the
opportunity to discuss bills relating to a very important
subject, and that is the issue of saving and strengthening and
securing Medicare. The demographic challenges that we have in
this country are huge, and Medicare is running out of
resources, as you well know. That is according to their own
trustees.
The challenge that we have right now is that CMS is saving
money, according to them, by decreasing services and limiting
access to care. And it is happening right now, it is not
happening just in a fictitious way potentially in the future.
I want to talk about three pieces of legislation. The first
is H.R. 5210, which deals with durable medical equipment,
patient access to durable medical equipment. CMS instituted
what is called a competitive bidding program for suppliers of
durable medical equipment that is not either competitive and
isn't bidding, and it isn't because it doesn't hold bidders
accountable, it doesn't ensure that bidders are qualified to
provide the products in the bid markets, and it produces bid
rates that are financially unsustainable.
Mr. Chairman, this literally is harming lives, as we speak.
Essential services, including oxygen, are being denied to
patients because of difficulty gaining those services. In rural
areas it is a huge, huge problem. Many areas, many rural areas
of the country, the amount paid for these services doesn't even
cover the costs. So you get decreased availability.
In Georgia, for example, 20 percent decrease in the number
of DME suppliers in the last three years, and a nearly 40
percent reduction in medical equipment supply stores in our
state, just in the last 3 years. Patients' lives are literally
at risk.
The National Minority Quality Forum has data that
demonstrates it is driving up costs by avoidable hospital bills
and increasing out-of-pocket payments by patients. It has led
to increased mortality--that means death and hospitalizations
and a higher cost for Medicare beneficiaries. The OIG for
Medicare itself said that CMS paid over $1 million to 63
suppliers for product categories they weren't even licensed to
provide in their state, over $1 million.
So, H.R. 5210 would simply delay the onset of this
competitive bidding program and expanding the onset of the
program, and that is a bipartisan-supported bill.
Second is H.R. 4848, the Healthy Inpatient Procedures Act,
called the HIP Act. As an orthopedic surgeon, I bear some
familiarity with this area. This is talking about the
comprehensive care joint replacement, or CJR, model. This is
something that CMS put in place to try to decrease amount of
resources spent on lower-extremity joint replacements. The
problem is they have gotten it all wrong. It is what they call
a demonstration product, but it is the first mandatory
demonstration product.
So, how it could be a demonstration product and be
mandatory is beyond me. Sixty percent of the hospitals, as
estimated, will be penalized because of this. Decreasing
resources available for patients to utilize for lower-extremity
joint replacement. So what happens? Medicare CMS limits access,
limits choice, increases consolidation of services, and
therefore, increases prices.
What does this mean to patients? As a formerly practicing
orthopedic surgeon, I would talk to patients about what kind of
replacement they ought to have. And Medicare may or may not
agree with that. The problem with this is that, if Medicare
doesn't agree with it, then guess who doesn't get the joint
replacement that they need? It is the patient.
So the H.R. 4848 would delay onset of this program until
January 2018. Again, it is a bipartisan support, it would
simply give docs time to get ready for it and give us an
opportunity to modify this program.
And then, finally, H.R. 5001. Everybody has heard from
their docs about the issue of electronic medical records. It is
a disaster for physicians back home. The amount of time that
they are having to spend on this to simply comply with
regulations that don't increase the quality of care to patients
is astounding.
What Medicare did this year is to change the meaningful use
reporting period from a 90-day period, rolling 90-day period
where docs would have to comply, to 365 days, which means the
entire year, which means you can't have your server go down,
you can't have any problem at all throughout the course of the
year, or you get dinged by Medicare for not having what they
believe is the appropriate electronic medical record. This bill
would simply return it to the 90-day reporting period that we
have had in the past. Again, common sense, bipartisan.
I appreciate the opportunity to present these, and look
forward to them passing.
Chairman TIBERI. Thank you, Doc. With that, Representative
Buchanan of Florida is recognized for five minutes.
Mr. BUCHANAN. Thank you, Mr. Chairman, for holding this
important hearing. Before discussing my legislation I would
like to mention the importance of examining medical competitive
bidding also, as Dr. Price has clearly taken the lead on this,
but has a huge impact on my region in Florida, especially
Sarasota, but all through Florida. A lot of diabetics are very
concerned about the impact it is going to have on them going
forward.
So I appreciate, Dr. Price, your leadership. And hopefully
this is something we can get done quickly.
Now, as for my legislation, along with my good friend,
Congressman Pascrell, I introduced the Preserving Patient Act
[sic] to Post-Acute Hospital Care, H.R. 4650.
Right now, tens of thousands of Medicare patients rely on
access to highly specialized care facilities known as long-term
acute care hospitals, or LTACs after they are released from
intensive care units. These facilities are uniquely equipped to
care for chronically ill patients over an extended period of
time. And unless Congress acts, the allowable caseload for
these facilities will be cut in half January 1, 2017.
So in six months it would be cut in half. This means people
will either remain stuck in the hospital ICU longer than they
want to, or be forced to move to another place, away from their
homes and families, to find care that they need.
My bill prevents this cut from taking place, and Congress
has approved similar measures several times over the last
decade. We need to act soon. The cut takes effect at the end of
the year, but these facilities need time to plan for their
patients' care. If we fail to pass this bill, more than 100,000
seniors could be denied vital care at their local ATAC
hospital.
With that, I yield back.
Chairman TIBERI. Thank you, Mr. Buchanan, and thank you for
bringing up Dr. Price's bill. I too share that concern with
respect to the durable medical goods issue, and have had
constituents in my region of Ohio express concern. So I look
forward to working with you on that, Dr. Price.
Ms. Jenkins, CPA Jenkins, you are recognized for five
minutes.
Ms. JENKINS. Thank you, Mr. Chairman, and thank you for
holding this important hearing and allowing me an opportunity
to speak on bipartisan legislation that I am proud to advocate
for that will allow more beneficiaries to access vital care in
rural areas, save Medicare patients in the system money, and
ensure its stability for generations to come.
H.R. 1202, the Medicare Patient Access to Hospice Act,
which I introduced with Congressman Thompson, will allow
physician assistants to receive reimbursement from Medicare as
the attending physician in a hospice setting. Hospice care is
incredibly important in my district because of the lack of
hospitals and doctors' offices that urban districts have with
large health systems.
Along with allowing physician assistants the ability to
perform cost-saving medical care in hospice setting, H.R. 1784,
the MEND Act, which I introduced with Congressman Tonka, will
bring about an out-of-date CMS regulation in line with the
accreditation body that allows hospital-based nursing programs
to produce nurses and shore up critical shortage in the
Medicare system.
A third bill, H.R. 2138, the Medicare Access To Rural
Anesthesia Act, which I introduced with Congressman Cleaver,
will pay anesthesiologists in certain rural hospitals under
Medicare Part A for their services at the rate paid to a
certified registered nurse anesthetist in those hospitals for
the same services.
As I pointed out with H.R. 1202, Medicare beneficiaries in
Kansas must use entire days sometimes to travel to certain
hospitals to get care. Many of those hospitals can't afford a
full-time anesthesiologist, so those folks are then forced to
travel somewhere else to get care. H.R. 2138 will help
eliminate that burden and allow more rural hospitals to hire
and keep anesthesiologists on staff.
Similarly to that bill, H.R. 3355, which I introduced with
Congressman Lewis, will allow physician assistants, nurse
practitioners, and clinical nurse specialists to supervise
cardiac intensive care and pulmonary rehabilitation programs.
Again, this will allow critical access and rural hospitals to
hire and keep these vital staff members and provide needed care
to rural parts of Kansas and the United States. Americans
living on farms and ranches and those rural areas have the same
need for medical services as those living in urban areas. And
this legislation will give them more adequate service and keep
costs down for the patients and the whole system.
I will continue to work to give rural Medicare
beneficiaries better access to care and save the entire
Medicare system precious dollars so they can stay solvent and
effective for generations to come. These four bills will make
it much easier for Medicare beneficiaries to access and afford
the care that they need, especially in rural parts of the
states.
I strongly encourage my colleagues to support these pieces
of legislation and help me bring them to the House floor.
I thank you, Mr. Chairman, and I will yield back.
Chairman TIBERI. Thank you, Ms. Jenkins. Representative
Marchant is recognized for five minutes.
Mr. MARCHANT. Thank you, Mr. Chairman. Thanks for having
this hearing and allowing us to put forward our ideas.
I introduced H.R. 3288 with my friend and colleague, Dr.
Boustany, last year. This legislation amends Title XVIII of the
Social Security Act to change the method of determining
disproportionate share hospital payments under the Medicare
program. As the members of this Committee are aware, DSH
payments compensate hospitals for the above-average operating
costs they incur in treating a large share of low-income
patients.
Mr. Chairman, 19 states have decided not to adopt Medicaid
expansion. DSH hospitals in each of these states such as Texas,
Florida, Tennessee, Kansas, and Georgia, are financially
disadvantaged by this. Though it is not our job to make state-
level decisions, it is our job to ensure our hospitals have the
resources necessary to care for our constituents.
My bill would help ease the burden these hospitals are
facing. Patient care is not a partisan issue, and I urge all of
my colleagues on this Committee to cosponsor this non-partisan,
no-cost policy.
Mr. Chairman, once again I appreciate the effort being made
here today and for the forum to speak on ideas to sustain
Medicare, and look forward to continuing to work with you and
the committee to advance the policy and strengthen the DSH
program.
Thank you, and I yield back.
Chairman TIBERI. Thank you, Mr. Marchant.
Representative Paulsen from Minnesota, you are recognized
for five minutes.
Mr. PAULSEN. Thank you, Mr. Chairman also for holding this
hearing. I have two bills that I have introduced that I would
like to touch on today that have bipartisan support and would
benefit seniors on Medicare.
The first is H.R. 5075, the Accelerating Innovation in
Medicine Act, also known as the AIM Act, which I introduced
with Representative Ron Kind. Currently, patients and providers
are having trouble accessing the newest, most innovative
medical technologies and more and more barriers and coming from
CMS, rather than from the FDA. And we, as a committee, need to
take a serious look at the CMS coding, coverage, and
reimbursement process to examine how the agency is functioning,
its impact on the biomedical ecosystem, and its effect on
ensuring that patients will have access to the next generations
of advanced therapies.
Currently, the process of receiving a CMS code alone can
take as long as three years. National coverage decisions are
typically time consuming and cumbersome, and some new therapies
must go through a process of convincing each local carrier to
provide coverage before a patient or a senior can get access.
This process delays patient access to ground-breaking
treatments.
My bill, the AIM Act, would focus on the front end of this
process by increasing patient access to the new--to new FDA-
approved medical devices and procedures, and speeding up the
collection of data needed for Medicare coverage decisions. The
AIM Act does this by allowing a manufacturer to place FDA-
approved devices and treatments on a list, where they are
available for Medicare beneficiaries that self-pay.
By agreeing to not seek Medicare reimbursement for three
years, the devices then will be available without government
red tape, paperwork, and administrative costs. And during that
three-year period the manufacturer could collect patient data
that will help streamline a future Medicare coverage decision.
The current system is expensive, it is inefficient, and it
gives providers, patients, and manufacturers uncertainty. And
we need legislation like the AIM Act so that we can ensure the
continued development of new treatments to improve Medicare
outcomes, efficiencies, and lower costs.
And then, Mr. Chairman, the second bill is H.R. 2404, the
Treat and Reduce Obesity Act that I have also introduced with
Representative Ron Kind. Obesity is now an epidemic and a
public health crisis that needs to be addressed. Over 40
percent of seniors are obese. This disease takes both a
physical and an emotional toll on an individual, and often is
the cause of many other chronic conditions like diabetes, heart
disease, stroke, and others.
Nearly 20 percent of the increase in our health care
spending over the last 2 decades was caused by obesity. And
this disease directly costs Medicare more than $50 billion a
year, and that number will continue to increase over the coming
years. This is bad for our seniors and it is bad for Medicare.
Unfortunately, there are limitations in place preventing
patients from accessing important treatments and providers that
can help them combat obesity. The Treat and Reduce Obesity Act
would remove these barriers by giving patients access to FDA-
approved obesity drugs under Medicare Part D, and allowing
additional qualified health care practitioners to provide
intensive behavioral therapy services. Patients and clinicians
require access to the full range of proven, safe, and effective
therapies for the treatment of obesity.
We have the ability to save the health care system billions
of dollars and, at the same time, make the lives of patients
significantly better. And that is why this bill has nearly 150
bipartisan cosponsors. We can't solve this problem overnight.
But by taking action now we will help us solve our obesity
crisis over the long term.
And finally, Mr. Chairman, I just want to touch on another
issue that I am working on. I recently held a roundtable in
Minnesota with some hospitals, and they are concerned about the
direction that Medicare is going in terms of too much
regulation, too many requirements, and the reimbursement system
being very unpredictable. Hospitals, providers, and patients
all recognize that we need fundamental reforms to the system.
Otherwise, the system will collapse and seniors will suffer.
Thankfully, there are providers, health plans, and states
out there that are now trying to find ways to make our health
care system more efficient and effective. They are not trying
to tie the health care system up in knots with duplicative
process measures that may or not yield the best results [sic].
But they are focusing on outcomes, high impact, clinically
credible outcomes that we can focus providers around to achieve
substantive and sustainable improvements for patients. And we
can learn a lot from these state and local initiatives to
strengthen Medicare.
I look forward to working with you, Mr. Chairman, and my
colleagues on those efforts to do just that. Those are just
several of the ideas that I have for reforming Medicare, and I
look forward to working with the chairman in the future on
these bipartisan ideas. I yield back.
Chairman TIBERI. Thank you, Mr. Paulsen. We are now to be
joined by members of the full committee who have some ideas of
their own on health care.
Welcome, everybody. How is it down there? Not bad?
Well, let's start with the gentleman to my far left, Mr.
Dold.
You are recognized for five minutes to share your ideas
with us.
STATEMENT OF THE HONORABLE ROBERT DOLD, A REPRE-
SENTATIVE IN CONGRESS FROM THE STATE OF ILLINOIS
Mr. DOLD. Thank you, Mr. Chairman. I appreciate the
comments from my colleagues down here--your comments.
[Laughter.]
Mr. DOLD. But anyway, Mr. Chairman, I thank you for the
opportunity to testify before you today on two bills that I
think will make some critically necessary reforms to Medicare.
The first I would like to speak about is H.R. 5122, a bill
that I helped introduce alongside my colleagues, Dr. Bucshon,
Dr. Boustany, Dr. Price, and Representative Shimkus. This
legislation would prevent CMS from finalizing, implementing, or
enforcing the demonstration program they proposed on March 8th
of 2016. The proposal will dramatically alter the way Medicare
Part B reimburses physicians for medications they administer to
seniors in outpatient settings. The resulting cuts could
disrupt access to medications for our most vulnerable seniors,
including those with cancer, arthritis, and other very serious
diseases.
As you are all aware, this proposed demonstration was
developed by the Center for Medicare and Medicaid Innovation
with very little transparency and limited input from patients
and physicians. Unlike previous CMMI demonstrations, all Part B
providers are required to participate. As a direct result of
the demonstration, by phase two, 75 percent of all providers
will see drastic cuts to their reimbursements when providing
Part B-covered medicines to patients.
It also appears that CMS has failed to fully model how this
demonstration will interact with other programs, especially the
implementation of macro-legislation passed to repeal the SGR.
Thanks to the ingenuity and perseverance of incredible
researchers, our modern medical system has moved away from a
one-size-fits-all treatment and has progressed into an era of
precision medicine where treatments are highly personalized for
each individual patient.
The proposed demo, or demonstration project, directly
contradicts this progress by incentivizing doctors to provide
older, less advanced treatments, rather than newer, more
innovative options. By allowing this demonstration to proceed,
we are putting physicians in a very difficult position that not
only is unfair, but detrimental to patient care. This will be
especially true for providers working in small clinics serving
rural areas.
When the Federal Government created Medicare 50 years ago,
Congress made a commitment to America's seniors, and the cuts
embedded in this demonstration project are a betrayal of that
commitment. We must stop this ill-conceived proposal, and
uphold our commitment to protect health care for seniors.
I would also like to speak with you today about another
bill that will ensure seniors receive the best care possible.
It is H.R. 1178, the Ensuring Equal Access to Treatments Act,
sponsored by my friends, Representative Reed and Representative
Kind. It improves the way that CMS pays for certain diagnostic
procedures that have a discretionary drug component by altering
the current one-size-fits-all approach which does not allow
seniors to receive the personalized care that best meets their
needs.
In 2014 outpatient prospective payment system had a rule
that CMS redefined in terms of packaged payments for certain
drugs administered with corresponding procedure. Rather than
reimbursing for the drugs and the procedure separately, CMS now
uses one package payment, which includes the drugs and all
other services and supplies associated with the procedure.
Unfortunately, since the package payment is the same
whether or not the drug is used, the new payment structure has
the effect of encouraging health care providers to choose
treatments which may not result in the best long-term outcome
for the patient. H.R. 1178 corrects the problem by requiring
CMS to create two separate payment codes, one for when the
diagnostic procedure is performed with drugs, and another when
it is performed without drugs.
We have already seen cases where 2014 packaged payments is
negatively impacting vulnerable seniors. One example concerns
the diagnostic of coronary heart disease. Providers have two
options to raise a patient's heart rate to a specific target: a
stress test on a treadmill or a stress test by an induced drug,
which may be needed for those that are unable to get on a
treadmill to raise their heart rate.
The current package payment system provides an incentive
for providers to choose the free treadmill test over the drug,
even if the drug may be more appropriate. I believe we have an
obligation to correct this misaligned incentive, so that
patients receive the most appropriate care necessary. We have
seen a similar problem when physicians choose whether to
diagnose bladder cancer with the new, innovative procedure
known as a blue light cystostopy, or an older, less advanced
white light test.
We made a commitment to provide America's seniors with
high-quality health care through Medicare programs. I look
forward to working with all of you on H.R. 5122 and H.R. 1178,
and the other bills that have been presented here today, in
order to ensure that we maintain our commitment to our seniors.
I thank you.
Chairman TIBERI. Thank you, Mr. Dold. Thank you for your
leadership in trying to stop that Part B demonstration program
being proposed. It is important for us to try to do that. Look
forward to working with you in that attempt.
With that, Sheriff Reichert, you are recognized for five
minutes.
STATEMENT OF THE HONORABLE DAVID G. REICHERT, A REPRESENTATIVE
IN CONGRESS FROM THE STATE OF WASHINGTON
Mr. REICHERT. Thank you, Mr. Chairman. And I want to thank
Chairman Tiberi and Ranking Member McDermott for being here
today and holding this hearing and listening to our initiatives
that we have been working on. I would like to talk about a
couple of bills.
First I would like to talk about H.R. 2649. And this bill
was introduced with Representative Mike Thompson, and it is
assisting Medicare beneficiaries who have been injured on the
job, filed a claim for workers compensation, and settled their
claims. In these settlements an amount must be set aside to
cover Medicare's share of future medical expenses related to
the injury.
The problem is that there are no statutory or regulatory
provisions defining how these set-aside amounts should be
determined. And the current procedure used by CMS has been
subject to change without reasonable notice to the parties
involved. This broken process results in delays and hardships
for injured workers.
My bill establishes a clear, predictable process. A few
ways it accomplishes this is by setting up timeframes for CMS
to review set-asides, providing an appeals process and also
offering individuals the option to pay the total set-aside
amount directly to CMS.
So I look forward to working with you on this bill in
advance. It is one of the priorities that we have been
discussing, both on the D and the R side.
The next bill is one that, Mr. Chairman, you and I have
talked about. It is the Lymphedema Treatment Act. This is 1608.
I introduced this bill with Mr. Blumenauer. Lymphedema causes
painful swelling in parts of the body where the lymph nodes or
vessels have been damaged. While there are many causes, damage
from cancer treatment is probably the most common. While there
is no known cure for lymphedema, it is treatable.
But sadly, Mr. Chairman, current Medicare law leaves
patients without access to treatment items they need to manage
the swelling and prevent further health complication. My bill
will fix this by providing coverage of doctor-prescribed
compression supplies. This will not only save lives, but
improve patients' health. But it also will strengthen Medicare
program by reducing costly hospital stays.
For example, Sarah from Ohio. When she was diagnosed with
lymphedema she was on the verge of losing her mobility and
suffered frequent episodes of cellulitis. Between 2002 and 2004
she was hospitalized more than 10 times. In 2005 she was
prescribed her first pair of compression garments. And by
wearing these garments on a daily basis, she was able to
maintain the progress she has made through treatment, manage
her lymphedema so well that she has not been to the hospital in
over a decade. In over a decade.
Bob, from New York. In 2000 he was hospitalized twice with
potentially fatal cellulitis infections. Later that year he was
diagnosed with lymphedema. He received treatment and was
prescribed the compression garments. In the 16 years since he
has not had another cellulitis attack and has not been to the
hospital.
Now, we can talk about whether or not this is expensive,
because that is what, of course, the Administration's argument
is, and Medicare's argument is. But we are saving a lot of
money by providing these garments to these patients who have
suffered through and survived cancer, saving money at the back
end on other treatments and hospital stays. And not only that,
it is the right thing to do for these patients.
So I want to thank Members here today who have already
cosponsored this bill. I would like to recognize the patient
advocates who have taken the time to meet with their Members
and share their stories. Thanks to their tireless efforts, the
bill now enjoys, Mr. Chairman, over 230 bipartisan cosponsors.
And now we are working to even get more.
And I ask, Mr. Chairman, unanimous consent to enter into
the record a statement from the lymphedema advocacy group.
Chairman TIBERI. Without objection.
Mr. REICHERT. The bottom line here is these are not defined
by Medicare as medical devices because they don't fall within
the definition of long-term, durable devices, which is three
years, because in most cases the patients have to have new
garments every six months. They are not disposable medical
devices because they keep them six months and not a few weeks
or a few days. This is ridiculous, a ridiculous rule, Mr.
Chairman, and this bipartisan piece of legislation changes this
rule and helps these patients get the treatment they so
desperately need.
Thank you, I yield back.
Chairman TIBERI. Thank you, Sheriff. Now, representing the
entire South Dakota delegation in the House, Representative
Kristi Noem.
Mrs. NOEM. That is a big job.
Chairman TIBERI. Thank you for being here.
STATEMENT OF THE HONORABLE KRISTI NOEM, A REPRE-
SENTATIVE IN CONGRESS FROM THE STATE OF SOUTH
DAKOTA
Mrs. NOEM. Thank you, Mr. Chairman. And thank you Ranking
Member McDermott and Members of the Subcommittee, for holding
this hearing and allowing me to talk about a Medicare bill that
I am promoting.
I am here to discuss H.R. 4277, the Medicare Mental Health
Access Act. I introduced this bipartisan bill with my
Democratic representative, Jan Schakowsky, who has been a
leader on mental health care policy. She is a member of the E&C
committee. And I want to thank her and her staff for all of
their hard work on this issue, as well.
As you know, millions of Americans lack adequate access to
mental heath services. And it is especially true for thousands
of seniors who age into Medicare every day. The Federal
Government should be working to improve access for these
individuals. But sadly, current law does exactly the opposite.
In fact, it presents significant barriers to American seniors
who seek mental health services.
The problem is that seniors have to go through a middle-man
to get care, and that is because Medicare requires that many
services provided by clinical psychologists must be prescribed
and monitored by a medical doctor, a doctor who may or may not
have any experience or training in mental health care. This
supervision requirement is outdated and it stands in stark
contrast to the private sector, in which clinical psychologists
are largely allowed to provide treatment independently.
That requirement also fails to respect clinical
psychologists' rigorous training and licensure requirements,
which includes years of study in obtaining a Ph.D. This
requirement is especially harmful for rural and under-served
areas like South Dakota. When a physician is not available to
oversee a clinical psychologists's treatment program, the
services are simply not offered.
My bill, H.R. 4277, makes it easier for seniors to obtain
mental health care services that they need, and it puts
clinical psychologists on equal footing with other non-
physician providers like chiropractors and optometrists. They
are easily accessible by Medicare beneficiaries.
In short, the Medicare Mental Health Access Act amends
Medicare's definition of ``physician.'' It includes clinical
psychologists. This would have the effect of removing the
middle-man from the process of seeking mental health services
and allowing seniors to go directly to clinical psychologists.
It is also important to note that, while this adds clinical
psychologists to the physician definition, it would not allow
clinical psychologists to become medical doctors. Rather, it
would simply allow them to practice in a more independent way
by removing that physician supervision requirement.
I would like to thank Mr. Nunes, Mr. Kind, Mr. Blumenauer,
the subcommittee members who have already cosponsored this
important bill. I urge the rest of you to join them because the
Medical Mental Health Access Act represents a huge opportunity
for us. It will tear down barriers for mental health care
access for our seniors where, in states like South Dakota, we
see it being a real issue for them getting the kind of care
that they need.
I sincerely hope the committee will take up this bill as
soon as possible. And again, Mr. Chairman, I thank you for the
opportunity to testify today.
Chairman TIBERI. Thank you for your leadership on these
important issues.
Mr. Renacci, thank you for your leadership on the
readmissions issue that became part of a bill that we passed
unanimously on the floor last night. And we recognize you for
five minutes.
STATEMENT OF THE HONORABLE JIM RENACCI, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF OHIO
Mr. RENACCI. Thank you, Mr. Chairman, for holding this
hearing. I am grateful for the many bills that my colleagues
have and will present today. Indeed, I am a proud cosponsor of
many of them. I also think it is important we are here today
presenting proposals, and continuing the conversation on how we
can improve the delivery of services through Medicare and
health care systems in general.
When it comes to seniors, for instance, too often they
decide not to seek the care they need because of the price, the
inconvenience, or the bureaucratic red tape which gets in the
way. There are so many burdensome and confusing regulations
which many times leave Medicare beneficiaries waiting for a
level of care they need or potentially facing extremely large
bills they thought Medicare was covering.
For example, under current Medicare payment policy, even if
a physician knows the proper care setting for a beneficiary is
a skilled nursing facility, beneficiary must be admitted to a
hospital, stay at least three days as an inpatient, in order
for Medicare to cover the cost of the beneficiary's stay in a
skilled nursing facility. Many times the beneficiary's personal
doctor is also on staff at that same hospital, and certainly
knows the level of care needed before they are admitted.
Even more concerning is that often times patients are not
actually admitted as an inpatient, and are only admitted under
observation stay. Despite most not knowing their status, most
beneficiaries actually see no difference in care while at the
hospital, but are penalized for non-payment if later admitted
to a skilled facility.
Unlike other post-acute care settings, Medicare requires a
three-day inpatient hospital stay to qualify for skilled care,
causing confusion for beneficiaries. According to an OIG report
in 2012, beneficiaries had over 600,000 hospital stays that
lasted 3 nights or more, but did not qualify them for skilled
nursing facilities, meaning these individuals were either
outpatient or observation status during the hospital stay.
Because they did not have the three days of inpatient care, as
confusing as it sounds, they did not qualify for skilled
nursing care, due to the inpatient requirement, and they are
left incurring tens of thousands of dollars of costs that are
not reimbursed by Medicare if they end up going to a skilled
facility.
In order to protect access to rehabilitation services, I
have introduced a bipartisan bill, H.R. 290, the Creating
Access to Rehabilitation for Every Senior. It is called the
CARES Act. It waives the three-day inpatient stay requirement
for skilled nursing facilities that meet certain quality
measures.
Here is an interesting fact. The average three-day
inpatient hospital stay in many cases is equal to or sometimes
more costly than the average 27-day stay in a skilled nursing
facility. And we burden our Medicare system with both levels of
cost. Even private insurance companies have already eliminated
this unnecessary and duplicative expense, the three-day
requirement.
Therefore, by eliminating the three-day inpatient
requirement, Congress can save both the beneficiary and the
Medicare system money by reducing unnecessary hospitalizations.
I understand this issue. I operated skilled nursing
facilities for over 28 years. Just like many of the bills that
passed the full House yesterday, I believe this is one more
common-sense reform which will minimize hospital over-
utilization, cut down on unnecessary red tape, eliminate
unnecessary costs to Medicare program, and focus on what is
best for the patient.
Why should a beneficiary have to go to a hospital, have a
doctor diagnose the need for nursing home care, all while
remaining in the hospital, costing the system thousands of
dollars? The CARES Act fixes this one step, let's doctors
decide the best care delivery system without burdening the cost
of a three-day hospital stay, and helps protect the solvency of
Medicare.
And I look forward to working with my colleagues on both
sides of the aisle to try and move this legislation. Thank you,
Mr. Chairman, and I yield back.
Chairman TIBERI. Thank you, Mr. Renacci.
Dr. Boustany, you are recognized for five minutes. Thanks
for your leadership in health care.
STATEMENT OF THE HONORABLE CHARLES BOUSTANY, A REPRESENTATIVE
IN CONGRESS FROM THE STATE OF LOUISIANA
Mr. BOUSTANY. Thank you, Mr. Chairman. I want to thank you
and fellow members of the Ways and Means Committee, the Health
Subcommittee, for holding this hearing and for hearing our
priorities through a regular legislative order. I think this is
really important, and especially with an emphasis now on
strengthening the Medicare program, which is a vital program.
As you all know, the Medicare program was established in
1965 to provide reliable health coverage for America's seniors,
and we all know there are significant challenges ahead to
preserve and strengthen this program. And I am convinced that
we cannot really truthfully and effectively solve the problems
with Medicare unless we fully embrace innovation and the latest
technology that comes online to improve the health and the
lifespan and the quality of life for our seniors.
I could tell you, as a long-time practicing cardio-vascular
surgeon, I saw an explosion of new technology, just in the time
I was in practice, that made major differences, huge
differences in the lives of seniors, and that continues today.
I am proud to join my Ways and Means colleague, Richie
Neal, as well as colleagues on the Energy and Commerce
Committee, Gus Bilirakis and Tony Cardenas, to introduce H.R.
5009, called the Ensuring Patient Access to Critical
Breakthrough Products Act. This legislation provides an
accelerated route to FDA approval and subsequent limited
coverage under Medicare in order to stimulate the development
of important new diagnostics and treatments that address
currently unmet medical needs.
For instance, following FDA approval it can take upwards of
three years to receive a reimbursement code under Medicare,
delaying patient access to groundbreaking technology. This is
just unacceptable. We can do better. And while this legislation
continues to allow CMS to remain the final arbiter for
extending permanent coverage of this limited universal medical
device technology, this legislation is a very important step to
enhancing access on the front end to this cutting edge
diagnostic and treatment technology for America's seniors.
Many examples exist. I have talked to a number of our
companies, particularly the heart valve technology arena, where
they move to advance technology now--for instance, instead of
having to cut open the chest and spread the ribs and the
sternum, they can do this through percutaneous technology to
save lives and morbidity, and truly help people who might not
have even been candidates for open heart surgery because of
other existing co-morbidities. That is just one example of the
many advances.
But if we are caught whereby, after going through a lengthy
FDA process CMS delays the implementation and the use of this
technology because there is no reimbursement code, then, I
mean, this technology sits there and it is not accessible for
seniors.
This legislation is a modest approach to addressing this
logjam and helping to move this technology forward, and so I
look forward to working with the committee, and hope we can
mark up this bill.
Thank you, Mr. Chairman, I yield back.
Chairman TIBERI. Thank you, Dr. Boustany, for your
leadership. With that, the gentleman from New Jersey, my
friend, Mr. Pascrell, a member of the subcommittee, is
recognized for five minutes.
STATEMENT OF THE HONORABLE BILL PASCRELL, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF NEW JERSEY
Mr. PASCRELL. Thanks, Mr. Chairman, and thanks for putting
this together. There are some things we disagree with, there
are a lot of things we do have in common, though. So today I
want to touch three subjects, if I may.
Huntington's Disease Parity Act, H.R. 842, the Huntington's
Disease Parity Act, with my friend, Congressman Adam Kinzinger
from Illinois. Today the bill has 253 bipartisan cosponsors, 15
from our committee alone, and of itself, makes this bill, I
think, worthy of consideration.
Huntington's Disease, or HD, is a genetic neuro-
degenerative disease that causes total physical and mental
deterioration over a 10 to 25-year period. Because it is a
genetic disorder, HD profoundly affects the lives of entire
families emotionally, socially, financially, like a lot of
other diseases, too. This devastating disease has no treatment
or cure, and slowly diminishes an individual's ability to walk,
to talk, to reason.
Today I will focus on the one provision of the bill which
would waive the two-year Medicare waiting period for
individuals with HD. Under current law, once a person with HD
is deemed eligible for disability benefits--which is a
challenge in itself--they are then forced to wait two more
years before they can receive Medicare benefits. This means
that while people are in the grips of a terrible, all-
consuming, degenerative disease they can often not access the
range of health care services they desperately need. This is
simply unacceptable, Mr. Chairman.
I thank all of my colleagues on the Ways and Means who
joined with me on this legislation.
Second thing is Reserving Patient Access to Post-Acute
Hospital Care Act. I would like to highlight H.R. 4650, the
Preserving Patient Access to Close Acute Hospital Care Act,
which I introduced with my friend, Congressman Vern Buchanan.
As the co-founder and co-chair of the Congressional Brain
Injury Task Force, I understand the important role that long-
term care hospitals play in the recovery of many individuals
who suffer moderate to severe traumatic brain injuries, or
TBIs.
If there is one thing that I have learned about TBI in the
16 years I have been working on this issue, it is that recovery
looks different for everyone. That is why we must preserve
access to all post-acute care options, so patients can receive
the individualized care that they need.
H.R. 4650 would provide an additional 2 years of relief
from the full implementation of the 25 percent rule for long-
term care hospitals. I would also note that the industry has
offered to extend the current moratorium for a long-term care
hospital to help offset the cost of the bill, which is
something that I hope the committee would consider.
And my final point is this, Mr. Chairman, something you
have heard me speak about too many times, probably, and that is
the UDI and claims. More than a few times. I just want to touch
briefly on it being included in the unique device identifiers,
the UDIs, in health insurance claims.
This is an important patient safety measure that would
improve post-market surveillance of medical devices to help
identify problems with devices more quickly and help improve
Medicare program integrity. I was very pleased last month when
CMS Acting Administrator Andy Slavitt expressed support for the
important policy.
I look forward to working with you, Mr. Chairman, Mr.
Ranking Member, to get this done. And I thank you, and I yield
back, Mr. Chairman. Thank you.
Chairman TIBERI. Thank you, Mr. Pascrell. We will go from
Jersey to Philly.
Representative Meehan, you are recognized for five minutes.
Mr. MEEHAN. It is a great route, isn't it, Mr. Pascrell?
STATEMENT OF THE HONORABLE PATRICK MEEHAN, A REPRESENTATIVE IN
CONGRESS FROM THE COMMONWEALTH OF PENNSYLVANIA
Mr. MEEHAN. Thank you, Mr. Chairman and the full committee,
for your participation and allowing us to take this
opportunity. And I appreciate the opportunity to speak about
H.R. 4212, which is the Community-Based Independence for
Seniors Act of 2015, which I introduced with our colleague,
Representative Linda Sanchez.
The bill would authorize community-based institutional
special needs plan demonstration program to provide home and
community-based long-term services and supports to low-income
Medicare beneficiaries who need assistance with at least two
activities of daily living.
Under current law, Medicare does not typically provide
coverage for community-based, long-term care services and
supports, which include medical and personal care, such as
assistance with bathing or managing medications. And one study
found that 13 percent of seniors spent down their savings in
order to qualify for Medicaid.
The demonstration program is designed to eliminate the need
for Medicare beneficiaries who receive a low-income subsidy to
spend their savings and become dependent on Medicaid. Many
seniors prefer to remain in their homes--in fact, they are more
healthy as a result of it--to receive the care that they need.
And home and community-based care holds the promise of keeping
seniors healthy and avoiding costly care.
The demonstration offers up to five Medicare Advantage
plans to provide coverage for long-term care services. The
plans will receive a per-month payment not to exceed $400 for
providing these services, and eligible Medicare beneficiaries
with CBI in their area have the option to enroll in the plan.
HHS will evaluate whether providing home and community-
based services to Medicare beneficiaries reduces state and
Federal Government health care spending through delaying
Medicaid eligibility for low-income seniors and reducing the
need for acute care. The demand for long-term care services and
supports continue to increase. The population of seniors 85
years and older is estimated to more than triple by 2050, and
this group is 4 times more likely to use long-term services and
supports compared to seniors age 65 to 84.
This program is one step towards reforming long-term
service and supports that can generate savings while allowing
seniors to remain healthy at home. A similar version of my
legislation was reported out of the Senate Finance Committee
last year, and I ask for the Chairman's support in advance of
H.R. 4212.
I also want to highlight the arbitrary and capricious
manner in which CMS is making decisions regarding eligibility
to participate in Medicare programs as a hospital. CMS must not
establish or change a substantive legal standard governing the
eligibility of organizations to furnish services or benefits,
unless the agency uses notice and comment rulemaking. However,
CMS has done just that in a ruling that will make a
determination that Wills Eye Hospital is not eligible to
participate in Medicare as a hospital.
In contrast, the Pennsylvania Department of Health in the
state of Pennsylvania, the survey agency determined that the
hospital satisfied the Medicare conditions of participation and
should be licensed under Pennsylvania laws an inpatient
hospital. And I ask the chairman to work with me to ensure that
CMS is using known standards in making determinations regarding
hospital status for purposes of the Medicare reimbursement.
And lastly, I want to note that I am working with Ranking
Member McDermott on the Beneficiary Enrollment Notification and
Eligibility Simplification Act, also known as the BENES Act.
And as many of you know, Medicare enrollment rules are complex,
and seniors do not receive notice from CMS regarding their
responsibility to enroll. And because of these confusing rules,
seniors may find themselves subject to a late enrollment
penalty.
The Part B late enrollment penalty permanently increases a
beneficiary's premium by 10 percent for every 12-month period
the beneficiary could have had Part B coverage but did not.
Others are paying for private coverage that is a secondary
coverage to Medicare. But without enrolling in Medicare, these
seniors will find themselves responsible for significant out-
of-pocket costs. Part of the solution is to require CMS, in
cooperation with the Social Security Administration and the
IRS, to issue notifications to individuals approaching
eligibility about the enrollment rules and the coordination of
Medicare coverage with other health insurance coverage.
I appreciate the consideration of my colleagues, and I
thank you, Mr. Chairman.
Chairman TIBERI. Thank you, Mr. Meehan.
Welcome to the Ways and Means Committee room, Mr. Mooney
from West Virginia. You are recognized for five minutes.
Turn on your--thank you.
STATEMENT OF THE HONORABLE ALEX MOONEY, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF WEST VIRGINIA
Mr. MOONEY. All right. There you go. Thank you, Mr.
Chairman. I do appreciate the opportunity to testify about my
bipartisan bill, the Promoting Responsible Opioid Prescribing
Act, or the PROP Act.
My home state of West Virginia has the highest rate of
opioid overdose deaths in the country, more than double the
national average. This drug abuse epidemic is a tragedy crying
out for action. Addictions ravage our communities, rips
families apart, stunts the development of our youth, and harms
our economy.
The House has already taken some important steps to address
this epidemic, but much more remains to be done. One solution
is my bipartisan bill, the PROP Act, H.R. 4499. This bipartisan
bill removes a harmful provision of the Affordable Care Act
that places unnecessary pressure on doctors and hospitals to
prescribe narcotic pain medication, regardless of whether the
patient actually needs it.
This problem was first brought to my attention by a group
of doctors in Charleston, West Virginia, and I thank them for
that. These doctors, many of whom serve Medicare patients,
describe the dilemma they face when treating pain: either
prescribe narcotic pain medicine to patients who do not need
it, or risk receiving a low patient satisfaction score and a
subsequent cut to the reimbursement rates. This dilemma is a
result of a well-intentioned policy that is having unintended
negative consequences.
In 2006 the Center for Medicare and Medicaid Services, CMS,
and the Department of Health and Human Services, HHS, developed
a survey called the ``Hospital Consumer Survey of Health Care
Providers and Systems.'' We know it as HCAPS. HCAPS is a
standardized survey used to measure patient perspectives and
satisfaction on the care they receive in hospital settings. At
first hospitals used this survey on an optional basis. However,
when the Affordable Care Act became law in 2010, it put in
place ``paid performance provisions'' that use these survey
results as a factor in calculating Medicare reimbursement rates
for physicians and hospitals on ``quality measures.''
The survey includes three questions related to pain
management, including one that asks whether patients feel that
their caretakers did ``everything they could to help'' with
pain. While these questions are clearly intended to help
patients, doctors tell me that these questions pressure the
doctors to over-use prescription pain narcotics when treating
patients.
At a time when prescription pain abuse is rampant, this is
deeply concerning. Doctors, not the Federal Government, know
best how to treat patients. And that includes the question of
how best to use narcotic pain medicine. The PROP Act would
remove the three pain management questions from consideration
only when CMS is conducting reimbursement analysis. However,
the patient will still answer the pain management questions in
the HCAPS survey, so hospitals can monitor how they are doing.
By severing the relationship between HCAPS question on the
pain management and reimbursement, we can remove undue pressure
on doctors to prescribe unnecessary opioid medications. This
simple change will reduce access to narcotic pain medication
for patients who do not need it, thereby reducing the risk of
addiction.
According to the National Institute on Drug Abuse, people
who abuse opioid pain killers are 19 times more likely to start
using heroine than people who do not abuse those painkillers.
In addition, CMS is fully able to implement the PROP Act.
The agency has already provided my staff and this Committee
with technical assistance on the bill. If the bill passes, CMS
will simply remove the questions from reimbursement
calculations during the next rulemaking session. I would like
to thank the staff from this Committee for their help with
that.
The PROP Act is also broadly supported by groups active in
this field, including the American Hospital Association, the
American Medical Association, Physicians for Responsible Opioid
Prescribing, Association of American Medical Colleges, and
America's Essentials Hospitals. It has also been introduced in
the Senate by Senators Johnson, Manchin, Capito, Barrasso,
Blumenthal, Markey, Toomey, Ayotte, and King.
Finally, I want to thank many members of the Ways and Means
Committee who are already cosponsoring the PROP Act: Tom Price,
Diane Black, Tom Rice, Pat Meehan, Earl Blumenauer, and Bill
Pascrell.
Thank you, Mr. Chairman, for your consideration.
Chairman TIBERI. Thank you, Mr. Mooney, for your leadership
on the PROP Act. It is one that I have heard about, too, back
in my district in Ohio, as we have talked about. So I look
forward to working with you.
Mr. MOONEY. Thank you.
Chairman TIBERI. Thanks for being here.
Mr. MOONEY. Sure.
Chairman TIBERI. Before I turn to Mr. Larson for five
minutes, I wish to inform him that a member of this
Subcommittee was going to object to you being here, but I don't
see him right now. So be prepared if he comes back in the room.
Mr. CROWLEY. Mr. Chairman? Mr. Chairman?
Chairman TIBERI. Mr. Crowley?
Mr. CROWLEY. On behalf of Mr. Pascrell, I would like to
object.
[Laughter.]
Chairman TIBERI. Mr. Larson, you are recognized for five
minutes. Can you turn on your microphone? Thank you.
Mr. LARSON. I thank the chairman for interceding on my
behalf. We were just on one of Mr. Pascrell's shows.
Chairman TIBERI. I heard.
Mr. LARSON. He is perplexed after that show.
STATEMENT OF THE HONORABLE JOHN LARSON, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF CONNECTICUT
Mr. LARSON. So, in keeping with the spirit of the meeting,
let me first start by thanking Cathy McMorris Rodgers, as well
as our colleagues, Tom Reed and Kurt Schrader, on introducing
H.R. 3244, which is Providing Innovative Care for Complex Cases
Demonstration Act of 2016.
Mr. Chairman, this bill would create a demonstration
program in Medicare that would allow for contracts in several
different parts of our country to be awarded with either a
high-quality Medicare Advantage plan or physician organization
ACO to provide an innovative care plan for the highest cost
Medicare beneficiaries in this area.
As the chairman knows more keenly than most, that the
hardest-to-serve population at the end of stages in their life
is the most costly that we face, in terms of the Medicare
programs that serve this nation so well. What this bill does,
in short, is to provide more benefits, lower out-of-pocket
costs, provide an integrated care model, and set high-quality
standards.
What it does, in short, too, Mr. Chairman, is something I
believe this Committee should always subscribe to, and that is
combining the very best that public health and the government
side of the ledger can bring to bear, along with the innovation
and technology of the private sector and academic research
organizations that we have to lower the cost of health care in
a way that is most efficient and productive.
It is no mistake that when we were looking at the
Affordable Care Act that there is somewhere between 700 and
$800 billion annually in fraud, abuse, and overlap of
responsibilities that take place within the health care system.
This can be eliminated.
We know this can happen, in large part, because of, well,
innovators like the Aetna in my district, in Hartford,
Connecticut, where we are fortunate to have an individual who
is the CEO who is a visionary and way ahead of his time, a
person who recognizes that what we want to do is make sure that
we are able to keep people in their own homes, that they are
able to stay there and provide for the needs. It is a place
that they all want to be.
And in the process, if we can keep them out of the
hospital, nobody wants their loved one to acquire a staff
infection while in the hospital. Nobody wants to have to be
readmitted after a hospital stay because of a lack of follow-up
care. No one who has a loved one with a chronic health
condition like heart disease or diabetes wants their health to
be compromised because of a lack of coordination amongst health
care providers.
What this bill will do is provide innovations. What it will
provide is an opportunity for us to keep people in their homes
in an integrated fashion by coordinating their care in a
systemic manner that will allow us to impact the cost and also
provide the patient with the best possible outcomes, Mr.
Chairman.
I am proud to be a sponsor of this, and I think this is a
prime example of how we can work together across the aisle by
sharing the vitality of ideas in everything that technology and
innovation and, frankly, that the public health system can
bring to bear. And then, from a human standpoint, recognizing
what the citizen and what the people want. In the final stages
of life they want to be in their homes. And we ought to be able
to come up with the innovation and way to do it.
Mark Bertolini, the CEO of the Aetna, recognizes this and
is one of the leading thought thinkers with respect to
innovative health care designed to reduce these costs so we get
away from the near 20 percent of our gross domestic product
that health care ends up costing.
So, Mr. Chairman, I again want to congratulate my
cosponsors, especially Cathy McMorris Rodgers, our colleague,
Tom Reed, and also Mr. Schrader for their support of this bill,
and I thank you for the opportunity to testify before your
committee, and hope it will be taken up during this brief
session.
Chairman TIBERI. Thank you. I thank the gentleman from
Connecticut. I have heard a little about that. Aetna has a
large presence in Ohio. And I am kind of surprised that you
promoted a gentleman with an Italian last name as being
intelligent and thoughtworthy.
Mr. LARSON. Well, unlike Mr. Pascrell, he has a vowel at
the end of his name.
[Laughter.]
Mr. LARSON. But thank you, Mr. Chairman.
Chairman TIBERI. I thank the gentleman. The gentleman from
New York is recognized for five minutes.
STATEMENT OF THE HONORABLE JOSEPH CROWLEY, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF NEW YORK
Mr. CROWLEY. I believe Mr. Pascrell also objected to my
testimony today, as well. So on his behalf I would like to
object to my testimony. But thank you, Mr. Chairman and Mr.
McDermott, for this opportunity to join you today as we hear
proposals to strengthen the Medicare program.
I am glad to have the opportunity to talk about legislation
I put forward to address what must be a priority within the
Medicare program: training the doctors we need to meet the
health care needs for tomorrow. And I thank Mr. Davis, who I
believe spoke earlier about this particular bill.
This is not something we could take lightly. Estimates
indicate that by 2025 we will have a shortage of up to 95,000
doctors, both primary care doctors and specialists in the
United States. Our health care needs are only growing, with a
greater importance on preventative care and comprehensive
health in an aging population. Ten thousand Americans turn 65
every day, so it is clear we need to have doctors available to
treat them and Americans of all ages.
Important steps have been taken. Medical schools have
worked to increase their enrollment and their graduating
classes. But what a lot of people don't realize is that once
those students graduate, they need to complete another stage of
training by doing a residency program at one of the nation's
teaching hospitals. Without completing their residency, they
cannot become licensed to practice medicine.
Unfortunately, growing numbers of smart, well-prepared
medical school graduates are fighting for a stagnant number of
residency slots. We are not just facing a physician shortage,
we are facing a physician bottleneck.
But there is a clear path forward. For generations,
training doctors has been a shared responsibility of the
Federal Government and teaching hospitals, and that is because
it is a shared benefit. The whole country benefits from more
well-trained doctors. Congress has long recognized the value of
investing in doctor training. And as a result, the Medicare
program helps to support doctor training programs by funding
residency slots around the country.
However, there was an arbitrary cap on the number of
residency slots that Medicare will support. And this cap hasn't
been raised in nearly two decades. Teaching hospitals have done
their part in stretching their funds as far as they can go to
help fund additional residency positions, even beyond that
which Medicare covers. But they cannot do this alone. We must
act and act soon to raise the Medicare cap on residency slots.
There is no way to create more doctors overnight, but we
can make the changes now that will open up the doctor training
pipeline. I have put forward bipartisan, common-sense
legislation, the Resident Physician Shortage Reduction Act, to
increase the number of Medicare-supported residency slots by
15,000 over 5 years. And I am pleased to have been joined in
this effort by Dr. Charles Boustany, a member of this
Committee, and someone who I think all of us respect for his
experience. After all, who better to stress the importance of
medical training than a cardio-vascular surgeon?
Over 125 Members of the House, including many members of
this Committee, have joined us as cosponsors of this bill. This
bill would further address our doctor shortage issues by
directing half of the new slots to go to specialists that are
determined to be running a shortage. And it makes a decisive
statement that we need to make a strong investment in our
doctor training program. That is particularly important if we
should seek continued proposals to cut or weaken the impact of
graduate medical education funding.
Far from being a luxury, teaching hospitals depend on this
funding to fulfill their mission. It is an investment, not just
in dollars and cents of running a teaching hospital, but in the
highly complex and costly patient care missions that teaching
hospitals undertake. They run advanced trauma centers and burn
units. They see more complex patient cases. They treat patients
with rare and difficult disease, like Ebola. And that helps
train future doctors in all those areas.
Graduate medical education payments were designed by
Congress to reflect and encourage and reward all those efforts.
And in a time of changing health care, teaching hospitals are
doing more to train residents in community care settings and to
give residents the skills for exactly the kind of coordinated
care that our system is moving toward. So I urge all my
colleagues on the committee to allow our teaching hospitals to
continue to thrive in the mission of training the next
generation of physicians. That means maintaining our investment
in graduate medical education funding.
And in what I hope will be a priority for this Committee,
it means lifting the outdated cap on residency slots, Mr.
Chairman. It is not exaggerating to say the future of our
health care system depends on just that.
And with that I yield back.
Chairman TIBERI. Thank you, Mr. Crowley. I appreciate your
testimony today and bringing the matter to our attention.
We will stay in the State of New York and recognize and
welcome to the committee room, the Ways and Means Committee
room, Mr. Zeldin for five minutes.
STATEMENT OF THE HONORABLE LEE ZELDIN, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF NEW YORK
Mr. ZELDIN. Thank you, Mr. Chairman. And thank you for the
opportunity to present my bill, H.R. 3229, to provide for the
non-application of Medicare competitive acquisition rates to
complex rehabilitative wheelchairs and accessories, an
important piece of legislation which would have a significant
impact on individuals with severe disabilities.
Complex power and manual rehabilitative wheelchairs and
related accessories are mostly utilized by a small percentage
of individuals who suffer from significant disabilities such as
ALS, cerebral palsy, multiple sclerosis, muscular dystrophy,
spinal cord injury, traumatic brain injury, and many more.
Within the Medicare program these individuals represent less
than 10 percent of all Medicare beneficiaries who use
wheelchairs, making them an extremely vulnerable group of
people suffering from significant disabilities.
The specialized equipment these individuals rely upon for
daily life is provided through a clinical team model and
requires evaluation, configuration, fitting, adjustment, or
programming before it can be properly used. This small
population of individuals has the highest level of disabilities
and requires these individually-configured wheelchairs and
critical related accessories to meet their medical needs and
maximize their function in independence.
In 2008 Congress passed and the President signed into law
the Medicare Improvements for Patients and Providers Act,
MIPPA, which established a fixed price schedule for complex
rehab technology, CRT, and related accessories. Under MIPPA,
CRT devices would be excluded from CMS's competitive bidding
program to ensure consistent and fair prices for consumers.
Excluded devices include power wheelchairs and related
accessories, which are the fundamental parts of the products
that make them useful and beneficial to people with progressed
disabilities such as recline tilt systems, specialty controls,
and seatback cushions.
In November 2014, however, CMS issued a ruling contrary to
MIPPA which stated that, beginning in January of 2016,
accessories that are used on complex rehabilitative wheelchairs
will no longer be a part of the fixed-fee schedule, but will
now be subject to competitive bidding prices, which will
decrease access to the individually-configured wheelchairs and
accessories relied on by adults and children with disabilities.
While Congress acted to temporarily delay this measure
until 2017, further action is needed to permanently address
this issue. My legislation, H.R. 3229, seeks to codify the 2008
MIPPA regulations, and excludes power and manual wheelchairs
and their related accessories from the competitive bidding
process.
In addition to the significant support from groups such as
the ALS Association, Muscular Dystrophy Association, National
Multiple Sclerosis Society, Paralyzed Veterans of America, Vets
First, the United Spinal Association, and the Christopher Reeve
Foundation, just this past week the Government Accountability
Office issued a report to Congress regarding the benefits of
this legislation. This GAO report focused on utilization
expenditures for Medicare wheelchairs and accessories, and how
the 2016 competitive bidding program adjusted payment rates for
accessories, and how those rates compared to the 2016
unadjusted fee schedule payment rates for the same items.
In addition to recognizing that CRT wheelchairs and
accessories are required by individuals with high levels of
disabilities, the report also details that these wheelchairs
and accessories are not standard wheelchairs, and they are
individually configured to each person utilizing this
technology to meet their specific needs.
The report further states that the information CMS is
relying upon to shift these wheelchairs and accessories from a
fixed price schedule to the competitive bidding process is
based on limited information from only 9 of 109 total bidding
areas, which is clearly insufficient, in order to nationally
shift policy. In fact, the report shows that this shift will
bring about significant payment cuts, ranging from 10 to 34
percent, which will only result in increased costs which are
passed along to the consumer.
My legislation is a common-sense approach to addressing one
of the significant issues currently affecting the Medicare
system. This broadly bipartisan legislation is supported by
well over 100 Members in the House and its companion bill,
Senate Bill 2196, also enjoys significant bipartisan support in
the Senate.
This legislation ensures that those who are in need of the
most assistance are not unfairly impacted by this new policy
shift.
Mr. Chairman, thank you again for the opportunity to
testify on behalf of this essential piece of legislation. And I
yield back the balance of my time.
Chairman TIBERI. Thank you, Representative Zeldin. Glad you
have you here.
And last, but not least, welcome to the Ways and Means
Committee Room--I think the dean of the New Jersey delegation--
Representative Chris Smith.
STATEMENT OF THE HONORABLE CHRIS SMITH, A REPRE-SENTATIVE IN
CONGRESS FROM THE STATE OF NEW JERSEY
Mr. SMITH of New Jersey. Mr. Chairman----
Chairman TIBERI. You are recognized for five minutes.
Mr. SMITH of New Jersey [continuing]. Thank you very much.
Thank you, Ranking Member. As co-founder with Ed Markey some 16
years ago of the Congressional Alzheimer's Task Force, and as
co-chair for the past 16 years, I am very grateful to you for
providing me with the opportunity to speak about my bill, H.R.
1559, the Health Outcomes Planning and Education for
Alzheimer's Act, which now has 286 cosponsors, including many
members of this Subcommittee.
It is very appropriate that we are discussing hope today,
as June is Alzheimer's and Brain Awareness Month. As I am sure
you are aware, well over five million Americans suffer from
Alzheimer's or related dementia. And as the Baby Boom
population ages, that number is expected to skyrocket unless we
find a cure or at least delay onset.
This disease is devastating. We all know people who have
had it--and friends and family members--to both the patient and
family, alike. Shockingly, many Alzheimer's patients do not
receive an accurate diagnosis, especially in the early years.
And, according to the Alzheimer's Association, fewer than half
of individuals with Alzheimer's are even told of their
diagnosis. The 200,000 Americans now affected with early onset
Alzheimer's are especially likely to get an inaccurate
diagnosis.
Alzheimer's is also the most expensive disease in America.
It incurs catastrophic cost to Medicaid and to Medicare:
approximately $236 billion in 2016, alone. On average, Medicare
spends three times more on seniors with Alzheimer's than those
without. That is to say about $22,000 for seniors with
Alzheimer's per year. To ensure that optimum care to every
Alzheimer's patient is provided, we need to find innovative
ways to improve the quality of care. Occasionally, such
initiatives will actually reduce--I say again, reduce--Medicare
spending.
The HOPE Act would amend the Social Security Act to add an
additional one-time benefit for care planning services for
Medicare beneficiaries newly diagnosed with Alzheimer's disease
and related dementia. This one-time comprehensive care planning
session will arm patients and caregivers alike with the facts,
prognosis, and options for the most efficacious treatment plan
that they might pursue. Comprehensive care planning will
mitigate huge, unnecessary costs associated with preventable
trips to the hospital and the emergency rooms.
As far back as 10 years ago an article in the Journal of
American Medical Association entitled, ``Effectiveness of
Collaborative Care for Older Adults with Alzheimer's Disease in
Primary Care,'' Christopher Callahan wrote that there was a
savings in a healthy aging brain center study that found a
$3,500 net Medicare savings when it included such a care
planning session. So if people know the facts, they are more
likely to get the care they need earlier, rather than later,
again averting hospital stays and also taking drugs that might
have adverse impacts because of drug interaction.
I would just give you one example that many people are not
aware of. Aricept, which is prescribed to treat symptoms of
Alzheimer's, can be rendered ineffective when used with over-
the-counter medicines such as Sudafed. Very often that is not
known. And again, the drug is not having its positive impact
that we would hope that it would have.
Chairman TIBERI. Without objection.
[The information follows: The Honorable Chris Smith]
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Mr. SMITH of New Jersey. SPIREN, a Washington, D.C.-based
health care consulting firm, conducted a cost estimate for
HOPE. They did it at the behest of the Alzheimer's Association.
And they found that a result of this legislation net federal
health spending would decrease by $692 million over a 10-year
period. And again, most of those savings to Medicare would be
the result of reduced hospitalizations and emergency room
visits, as well as better medication management and better
management of comorbidity, which of course is a major problem
with people suffering with Alzheimer's.
I do hope the committee will consider the bill. It already
has a huge majority of the House supporting it. And I yield
back the balance of my time, and I thank you.
Chairman TIBERI. Thank you, Congressman Smith, for your
leadership not only on this bill, but for your leadership on
the issue over the years, over the last 16 years.
Mr. SMITH of New Jersey. Thank you, Mr. Chairman.
Chairman TIBERI. There is hope out there.
So, what a great day, Dr. McDermott. Some great ideas, some
fascinating testimony. And I would like to get back to you on
that. I would like to thank all the colleagues who came before
us today, both from the committee and outside the committee.
I appreciate all the time and work that they have done,
that their staffs have done, that our staffs have done, as we
have started this robust conversation about how we can
modernize our health care system, including reforms to improve
and to strengthen our Medicare system.
And I am happy we have had the time, once again, to pursue
regular order and make the public record--make a public record
of the efforts that can help us achieve that goal.
So please be advised that Members will have two weeks to
submit written questions that can be answered later in writing.
These questions and answers will be made part of the formal
record.
With that, the subcommittee stands adjourned.
[Whereupon, at 3:55 p.m., the subcommittee was adjourned.]
[Submissions for the record follow:]
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