[Congressional Record Volume 166, Number 135 (Thursday, July 30, 2020)]
[Senate]
[Pages S4635-S4637]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTION
By Mr. ALEXANDER:
S. 4375. A bill to amend title XVIII of the Social Security Act to
make permanent certain telehealth flexibilities under the Medicare
program related to the COVID-19 public health emergency; to the
Committee on Finance.
Mr. ALEXANDER. Mr. President, I want to speak for a few minutes about
the changes to telehealth during the last five months--one of the most
dramatic developments in the delivery of medical services ever--and why
we in Congress should make many of those changes permanent.
I recently heard from a psychiatric nurse practitioner in Nashville
who has been seeing patients during the COVID-19 pandemic using
telehealth--which means she uses the Internet to see her patients over
video or she calls them on the telephone.
She told me about one of her elderly patients who, before the COVID-
19 pandemic, got to her appointments by walking from her high-rise
apartment to Gallatin Road, catching a bus, and then walking from the
bus stop to the clinic.
When the patient got to the clinic, she had to wait for her
appointment. Then, when the appointment was over, she had to do all of
these steps in reverse to get back home.
Because of telehealth, this nurse said that her patient was in tears
out of appreciation that she could now have appointments from her own
home. She had access to health care without the long journey, and she
could still receive her medications.
The nurse said that several of her other elderly patients have had
similar experiences and have asked if they could continue to have
access to telehealth in the future, even after the pandemic.
Because of COVID-19, the health care sector and federal and state
governments have been forced to cram 10 years' worth of telehealth
experience into almost 5 months. In 2016, there were almost 884 million
visits nationwide between patients and physicians, according to the
Center for Disease Control and Prevention. Almost all of them were in
person--online or remote visits were rare.
During the last four months, the number of online or remote visits
virtually exploded. According to Vanderbilt University Medical Center,
Vanderbilt went from 10 telehealth visits a
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day before the pandemic to more than 2,000 telehealth visits a day
across specialties, including primary care, pediatrics, and behavioral
health. In less than 3 months, Vanderbilt has provided more than
100,000 telehealth visits.
Before COVID-19, approximately 13,000 Americans enrolled in the
traditional Medicare program received telehealth services in an average
week. In the last week of April, nearly 1.7 million Americans enrolled
in traditional Medicare received telehealth services.
In total, over 9 million Americans in traditional Medicare received a
telehealth service between mid-March and mid-June.
The Nashville Journal reports that Tennessee's Centerstone, which
provides treatment for mental health and substance use disorders, says
it is providing nearly 2,500 telehealth visits per day and 30 percent
more of patients are keeping their appointments, which is key to
treating these disorders. According to Bob Vero, Centerstone's CEO,
``We've taken away a lot of the reasons people don't follow through
with their care.''
Tim Adams, the CEO of Ascension Saint Thomas Health, which has 9
hospitals in Middle Tennessee and employs over 800 physicians, told me
that he predicts that 15-20 percent of the system's visits between
patients and physicians will be conducted through telehealth in the
future.
In that 15 to 20 percent holds true across the Nation because of
telehealth expansion during COVID-19--it would produce a massive change
in our health care system.
Congress and the administration reacted to the pandemic by creating a
regulatory environment that made the current telehealth boom possible
by allowing: in-home virtual visits; telehealth for patients in rural
areas at rural health clinics; telehealth from physical therapists,
speech language pathologists and other providers; telehealth for many
more services including emergency department visits; and allowing
Medicare hospice and home dialysis patients to start their care with a
virtual visit.
Now Congress is beginning to build on what we've learned and make
those changes permanent. Here are three steps Congress should take now,
as a part of the COVID-19 legislation that we are working on:
Step One is to pass the COVID-19 HEALS Act legislation that was
introduced Monday, which:
Provides telehealth access to part-time and hourly employees; extends
the administration's telehealth flexibilities and waivers through the
end of the Public Health Emergency, or through 2021; and allows Rural
Health Clinics and Federally Qualified Health Centers to continue to
provide telehealth to Medicare beneficiaries for 5 years beyond the
public health emergency.
Step Two is to pass the CONNECT for Health Act. That legislation
explores ways to expand telehealth services and begins to permanently
remove some of the restrictions on where a patient needs to be for
telehealth access. The bill is already supported by a broad coalition
in the Senate and the House.
Here in the Senate, the CONNECT for Health Act has been led by
Senators Roger Wicker (R-MS), Brian Schatz (D-HI), Cindy Hyde-Smith (R-
MS), Ben Cardin (D-MD), John Thune (R-SD), and Mark Warner (D-VA)--and
today the bill has 38 cosponsors in the Senate.
This bill was first introduced in 2016 and these senators deserve
great credit for seeing the need to expand permanently telehealth
services even before the pandemic forced a massive change in how
Americans receive health care from their doctors.
Step Three would be to pass the bill I'm introducing today which
would go further than either of those first two steps and would make
permanent in-home visits and rural telehealth access. The bill would
also give the Secretary authority to make permanent other changes that
the Administration has made over the last few months.
Here's what the bill being introduced today does:
Ensures that patients can access telehealth anywhere by permanently
removing Medicare's so-called ``geographic and originating site''
restrictions, which required both that the patient live in a rural area
and use telehealth at a doctor's office or clinic.
Congress temporarily ended these restrictions in the Coronavirus
Preparedness and Response Supplemental Appropriations Act that was
signed into law on March 6, allowing millions of Americans to talk with
their doctor virtually during the pandemic.
Making this change permanent will ensure Medicare beneficiaries do
not lose that ability when the pandemic ends.
Protects access to telehealth for patients in rural areas. The bill
makes permanent a change allowing Medicare beneficiaries to continue
receiving telehealth services from Rural Health Clinics or Federally
Qualified Health Centers.
Telehealth access is especially important for patients in rural and
other medically underserved areas because they no longer have to travel
to see their primary care doctor.
Those are two changes that this bill would make permanent.
Then it would give the Secretary of Health and Human Services new
authorities to do these three things:
Help patients continue to access telehealth from physical therapists,
speech language pathologists, and other health care providers.
The bill gives authority to the Secretary of Health and Human
Services to allow Medicare to permanently expand the types of health
care providers that can offer telehealth services.
Before COVID-19, only doctors, nurse practitioners, physician
assistants, and certain other practitioners could deliver telehealth
services.
Today a much wider range of health practitioners are providing
telehealth services.
Help give Medicare recipients many more telehealth services.
The bill gives authority to the HHS Secretary to give Medicare the
flexibility to reimburse for more telehealth services.
During the pandemic, Medicare has been reimbursing for 135 telehealth
services, more than doubling the number of telehealth services covered
before COVID-19. Examples include emergency department visits, home
visits, and physical, occupational and speech therapy services. Help
Medicare hospice and home dialysis patients begin receiving care
through a telehealth appointment.
Medicare requires a face-to-face visit when a patient begins hospice
and home dialysis care, and this change would provide authority to the
HHS Secretary to allow a telehealth visit to fulfill the requirement
for an in-person visit. This will provide flexibility to improve access
for these patients and account for individual circumstances. This
legislation is the result of the Senate Health, Education, Labor and
Pensions Committee hearing on June 17, during which senators asked
health care experts about the 31 temporary Federal policy changes made
in response to the COVID-19 pandemic.
The legislation I am introducing today incorporates the
recommendations of those experts to make permanent 5 of the most
important changes--and helps to ensure that patients do not lose the
benefits that they have gained from using telehealth during the COVID-
19 pandemic.
This bill would make permanent the telehealth changes in the
legislation introduced Monday as well as the CONNECT for Health Act.
The best result for the American people would be for Congress to
approve all three steps--the changes in the HEALS Act, the CONNECT for
Health Act, and my legislation--in the next COVID-19 package so we
don't miss the opportunity to support and encourage one of the most
important changes in the delivery of medical services ever.
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By Mr. KAINE:
S. 4390. A bill to establish a grant program to support schools of
medicine and schools of osteopathic medicine in underserved areas; to
the Committee on Health, Education, Labor, and Pensions.
Mr. KAINE. Mr. President, communities of color and those living in
rural and underserved area face significant barriers to healthcare,
including physician shortages. Unfortunately, in many communities of
color and rural areas, there are few pathways to enter the medical
profession. Recent data shows that while medical school enrollment
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is up by 30 percent, the number of students from rural areas entering
medical school declined by 28 percent between 2002 and 2017, with only
4.3 percent of all incoming medical students coming from rural areas in
2017. Similarly, Black, Hispanic/Latino, and Native American students
face several barriers to matriculate and graduate from medical school.
This exacerbates the barriers to care and the disparities in health
outcomes that these communities experience. It is critical that we
expand the diversity of our physician workforce to tackle the rampant
disparities and systemic biases within our healthcare system.
This is why I am introducing the Expanding Medical Education Act,
which aims to tackle the lack of representation of rural students,
underserved students, and students of color in the physician pipeline
by encouraging the recruitment, enrollment, and retention of students
from disadvantaged backgrounds. The bill would provide grants through
the Health Resources and Services Administration, HRSA to colleges and
universities to establish or expand allopathic or osteopathic medical
schools in underserved areas or at minority-serving institutions,
including historically Black colleges and universities, HBCU. These
grants can be used for planning and construction of a medical school in
an area in which no other school is based; hiring diverse faculty and
staff; recruitment, enrollment, and retention of students; and other
purposes to ensure increased representation of rural students,
underserved students, and students of color in our physician workforce.
Our rural communities and communities of color face significant
challenges in access to healthcare. It is time our physician workforce
reflected these communities. We need to diversify our physician
pipeline and change the disparity in representation, and this bill will
help get us there. I hope the Senate passes this legislation quickly to
expand the diversity of the medical profession and to take a step
towards improved access to care for our marginalized communities.
____________________