[Congressional Record (Bound Edition), Volume 146 (2000), Part 12]
[House]
[Pages 17834-17835]
[From the U.S. Government Publishing Office, www.gpo.gov]



                           RURAL HEALTH CARE

  The SPEAKER pro tempore. Under a previous order of the House, the 
gentleman from South Dakota (Mr. Thune) is recognized for 5 minutes.
  Mr. THUNE. Mr. Speaker, when I was back in South Dakota over the 
August recess, I traveled around the State visiting rural hospitals, 
clinics and nursing homes. I wanted to get a first-hand look at some of 
the challenges that are being faced by rural health care providers. I 
also learned about some of the successes that we have been having.
  I represent the entire State of South Dakota. That is 66 counties and 
77,000 square miles made up primarily of farmland and grassland. When 
the citizens of South Dakota need access to a health care provider, it 
is not uncommon for them to drive 100 miles just to make a regular 
appointment.
  Distance really affects how people get health care in South Dakota. 
If one's elderly mother needs to see the doctor, one may need to take 
off work and make sure the kids are taken care of while one spends all 
day traveling back and forth only to spend 20 minutes with a physician. 
That is when the weather is good. When the weather is bad with the snow 
and the wind, that trip is just not possible. One's mother would have 
to make another appointment several days later and wait to get the 
medical care she needs.

                              {time}  1645

  But in times of tragedy or emergency, rural residents do not have 
that luxury. Take, for instance, the example of the farmer working in 
the field. Farm equipment accidents injure and kill rural residents 
every year. When the accident happens, the victims need medical 
attention and they need it quickly. If they can get the expert trauma 
care in their hometown clinic, there is a much better chance of 
survival. If they cannot get access to the appropriate professionals 
close by, they would have to drive several hours to get to a large 
medical center. Chances of a good outcome are much lower.

[[Page 17835]]

  The health care professionals in my State of South Dakota have been 
coming up with some innovative ways to deal with the distance problem. 
They have been using technology to bring patients and doctors together. 
They call this breakthrough ``telehealth.''
  Telehealth is a method of health care delivery that was at, one time, 
a new concept in health care, a theoretical way to connect people with 
providers. But telehealth is no longer an experiment. This is a service 
being used every day in rural areas across this country.
  I saw some of the most amazing things our health care providers are 
doing with telehealth technology. Lung specialists in Sioux Falls are 
using electronic stethoscopes to treat patients with pneumonia who live 
in Flandreau. Flandreau is a town with just over 2,000 people. They 
cannot get to see a specialist like that unless they travel or the 
specialist travels to them. That is pretty expensive when they start 
adding up gasoline and loss of productivity due to time on the road.
  They are also using telehealth to provide health care on American 
Indian reservations. The Pine Ridge Reservation, which sits in the 
Nation's poorest county per capita, is over 130 miles from the area's 
main medical center in Rapid City. Many residents of Pine Ridge deal 
with depression. They would like to see a mental health professional 
but have to wait 3 months to get an appointment. But using two-way 
interactive video cameras, they can now have access to these 
professionals and get timely and appropriate care.
  Those are just some of the ways that patients are getting the care 
that they need. It is clear that telehealth services have become 
critical for these patients and the providers who care for them. But 
this kind of care is expensive.
  Currently, hospitals are using grants to fund these services. Grants 
are limited and do not last forever. When the grants dry up, patients 
will have to go back to the old ways of doing things. What is needed is 
a more permanent method of paying for these services, and that is where 
Medicare comes in.
  Back in 1997, Congress authorized several telehealth demonstration 
projects to study the impact of telehealth on health care access, 
quality, and cost. The projects have shown that telehealth promotes 
better access and quality and could be used to provide both primary and 
specialty care at a reasonable cost. Given the success of telehealth, 
it is now time for Medicare to begin paying for these services.
  But Medicare has created reimbursement policies that have had the 
effect of excluding these services to those patients who would derive 
the most benefit from them, seniors who are often unable to travel long 
distances for direct health care.
  I thought Medicare was put in place to help our senior citizens get 
the care they need. But that is not the case with telehealth services. 
Medicare covered only six percent of all telehealth visits in 1999 
clearly when Congress intended that Medicare would pay a little bit 
more for these critical services.
  With these facts in mind, I introduced H.R. 4841, the Medicare Access 
to Telehealth Services Act of 2000. This bill tries to eliminate some 
of the reimbursement barriers that prevent hospitals from providing 
these services and seniors from accessing them. It is no longer the 
case that where they live needs to determine what kind of care they 
receive.
  Now, I realize that telehealth is just one piece of the health care 
puzzle. There are many other aspects of the Medicare law that need to 
be revisited. Rural hospitals, clinics, and nursing homes are reeling 
from the effects of the Balanced Budget Act.
  Last year, Congress provided some initial relief with the Balanced 
Budget Refinement Act. That was the first step toward helping our rural 
health providers deliver the kind of care our citizens deserve.
  Now we are poised to take another step. As my colleagues know, 
members of the Committee on Commerce and the Committee on Ways and 
Means are now considering a legislative package that would further 
refine the BBA. Part of that refinement needs to include telehealth 
services. Congress understood the potential of this technology 3 years 
ago. It is time to reduce those barriers that keep it from being used 
effectively.
  I urge the members of the committee to include the provisions of my 
legislation in their add-back bill. Congress has made a commitment to 
modernize Medicare, and reimbursing for telehealth services is one way 
to do that.

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