[Congressional Record Volume 146, Number 54 (Thursday, May 4, 2000)]
[Senate]
[Pages S3519-S3520]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. JEFFORDS (for himself, Mr. Rockefeller, Mr. Grassley, Mr. 
        Breaux, Mr. Murkowski, Mr. Stevens, Mr. Bond, Mr. Inouye, Mr. 
        Harkin, Mr. Roberts, Mr. Thomas, Mr. Bingaman, Mr. Edwards, Mr. 
        Conrad, and Mr. Kerrey):
  S. 2505. A bill to amend title XVIII of the Social Security Act to 
provide increased assess to health care for medical beneficiaries 
through telemedicine; to the Committee on Finance.


          telehealth improvement and modernization act of 2000

  Mr. JEFFORDS. Mr. President, today I am pleased to join with my good 
friend Senator Rockefeller in introducing legislation that will improve 
upon the federal rules for reimbursement for telemedicine and help to 
ensure that all of our citizens have access to our great health care 
system. We are joined by a broad, bipartisan group of senators in this 
effort.

  In many ways we have the best health care system in the world. But 
increasingly fewer and fewer Americans actually have access to it. I 
recently introduced a tax-credit bill that will help some of these 
Americans and I anticipate supporting future measures aimed at 
increasing access to health care services.
  One important area that demands our attention is the problem of 
access for rural Americans. More than 25 percent of our Nation's senior 
citizens live in areas underserved for modern health care services. At 
the same time, telemedicine has come of age. We have moved beyond the 
feasibility stage and proven that this technology can provide real 
benefits to people in rural and underserved regions of our country.
  In my own State of Vermont, nearly 70 per cent live in rural areas. 
This is the highest percentage rural population of any state in the 
nation. In Vermont, specialists in more than twenty-five disciplines 
from Fletcher Allen Health Care in Burlington are made readily 
available to patients even in the most rural areas. I want to see this 
level of service expand and be made available to all Americans.
  We in Washington have made some good faith attempts to allow for the 
development of telehealth technologies but we have fallen short. In an 
effort to restrain the expansion of these programs, the Health Care 
Financing Administration's interpretation of the laws and its 
cumbersome rules for reimbursement have all but guaranteed the demise 
of current programs.
  Federally-funded telemedicine projects exist in almost every State in 
the Nation. These projects have proven that cost-effective, high-
quality care can be delivered using this technology. The provisions in 
this bill will help to ensure that this care will be continued when the 
federal grants end.
  Why is this legislation needed now? Because current HCFA regulations 
concerning payment are unworkable in the real world. Less than 6 
percent of all telemedicine doctor-patient visits last year provided to 
Medicare beneficiaries would qualify for reimbursement under HCFA's 
current guidelines.
  Now that we have more experience and understand better how 
telemedicine can be used, it is time to enact several changes to the 
law so that these programs can thrive and deliver on their promise of 
providing cost-effective, high-quality healthcare where it is needed 
the most.
  Rural healthcare providers and patients are eager for this 
legislation. Norman Wright, President of the Vermont Association of 
Hospitals and Health Systems, recognized the potential of Fletcher 
Allen's telemedicine program by describing it as one that ``provides 
incredible opportunities for rural providers and their patients because 
it links them to a network with access to the region's best authorities 
for any given condition.''

  I have indeed heard an outpouring of support from healthcare 
providers across my own State on this issue. Gerry Davis, Professor of 
Pulmonary and Critical Care Medicine at Fletcher Allen Health Care, 
described ``appropriate and fair third party payment for

[[Page S3520]]

telemedicine'' as ``essential in order to move this process beyond 
education, and to make the service truly useful for patients in remote 
locations.''
  Telemedicine can be used in so many ways. It can be vital to a 
pediatrician from a rural area with a sick baby who needs to consult 
with a neonatologist from a tertiary care hospital in the dead of 
winter and the middle of the night. It can be also be crucial for a 
depressed senior citizen who desperately needs mental health services 
available in their own rural county. And it can be much needed help for 
a frustrated isolated primary care provider who longs to be able to 
provide for access to specialty services for her patients in their own 
community. All of these people need our help.
  While the changes included in this bill are relatively minor in the 
context of the Medicare program, the effect will be far-reaching. This 
legislation will allow us to avoid arbitrarily denying access to health 
care for our senior citizens and persons with disabilities just because 
of where they live. It will allow for fair and reasonable reimbursement 
for services that can be delivered appropriately in this way. It will 
also encourage the incorporation of telehealth technology in the care 
plans of home health agencies, an area that has already shown great 
promise for the future in terms of cost-effective disease management. 
In summary, it will allow us to begin to release the incredible 
potential of telemedicine.
  Mr. President, I urge my colleagues to join us in bringing HCFA's 
approach to the delivery of health care into the 21st Century. Any 
Medicare reform must include progress on telemedicine for our Nation's 
rural areas.
  Mr. ROCKEFELLER. Mr. President, I am extremely pleased to be here 
today to introduce the Telemedicine Improvement and Modernization Act 
with Senator Jeffords and many other of my Senate colleagues. This bill 
incorporates two issues that I care about passionately--health care and 
technology.
  Telemedicine has the potential to bridge the gap that currently 
exists between patients and providers. More than 25% of our Nation's 
senior citizens live in areas where speciality care may not be 
available. In states like my own where there are very few primary care 
or specialty care resources and travel is difficult, telemedicine is 
critical to ensuring that people in remote areas are getting health 
care they need. By expanding access to health care through 
telemedicine, we also improve the quality of care available to people 
living in underserved areas. Personally, I believe that we are just 
beginning to tap the enormous potential of technology to advance 
quality health care, especially in rural areas.
  Yet, Medicare's telemedicine program is inefficient in its current 
form. These inefficiencies threaten the future of telemedicine 
services. When we first created this program, our knowledge of the 
potential of this new technology, or its practical applications was 
very limited. Today we have a much better understanding of how 
telemedicine actually works. With this new knowledge, we can repair the 
inefficiencies of the current system and encourage the use of this 
highly effective health practice. By accomplishing this goal, we can 
ensure that quality health care is available to all seniors and 
disabled Americans regardless of where they live.
  There are 8 main elements of the bill:
  (1) Eliminating the provider ``fee sharing'' requirement;
  (2) Eliminating the requirement for a ``telepresenter'';
  (3) Allowing limited reimbursement for referring clinics to recover 
the cost of their services;
  (4) Expanding telemedicine services to all non-MSAs;
  (5) Expanding telemedicine services to direct patient care, not just 
professional consultations;
  (6) Making all providers eligible for HCFA reimbursement for services 
delivered via telemedicine;
  (7) Creating a federal demonstration project that permits 
telemedicine reimbursement for ``store and forward'' consultations 
(i.e., x-rays that are sent to another facility for consultation); and
  (8) Permitting telehomecare.
  While these changes are relatively minor in the context of the 
Medicare program, the affect will be far-reaching. The modernizations 
we are proposing will dramatically improve access to quality health 
care in rural areas. This legislation will allow us to begin to release 
the incredible potential of telemedicine.
  On a final note, I'd like to thank Karen Edison for her expertise and 
determination in working on this bill. Because Karen is a practicing 
telemedicine physician, she has been invaluable in developing and 
advancing this cause.
  Thank you, Mr. President for your time today. I hope all of my 
colleagues will join with me in passing this important piece of 
legislation.
                                 ______