Senate Appropriations Committee Subcommittee on Labor, Health and Human Services, Education and Related Agencies Holds Hearing on Rural Health
May 15, 2015 03:03 PM
Senator Roy Blunt R-Mo., Chairman of the Senate Appropriations Committee Subcommittee on Labor, Health and Human Services, Education and Related Agencies held a hearing last week to gather testimony from government experts and providers on the unique health care needs of rural communities. In his opening statement Senator Blunt stated, “One of the priorities of the committee and one of my priorities has been to ensure that all Americans have access to quality and affordable health care in their local communities regardless of where they live. The obstacle faced by rural patients and providers are unique and often significantly different from those in urban areas.” Blunt continued, “I think that it is critically important that Washington realize that health care access is essential for the survival and success of rural communities.”
The committee heard testimony from Sean Cavanaugh, deputy administrator and director, Center for Medicare, Centers for Medicare and Medicaid Services; Tom Morris, associate administrator, Federal Office of Rural Health Policy, Health Resources and Services Administration; Tim Wolters, director of Reimbursement, Citizens Memorial Hospital, Bolivar, Mo., and reimbursement specialist, Lake Regional Health System, Osage Beach, Mo.; Kristi Henderson, chief telehealth and innovation officer, University of Mississippi Medical Center, Jackson, Miss.; Julie Peterson, CEO, PMH Medical Center, Prosser, Wash.; and George Stover, CEO, Rice County Hospital District 1, Lyons, Kan.
Many federal programs, including telehealth initiatives, make a significant difference in rural healthcare and should be continued, rural hospital representatives testified during a recent Senate Appropriations subcommittee hearing. Opening statements covered the need to support critical access hospitals and rural health clinics as well a need for the expanded use of telehealth in rural communities. Below are excerpts from their testimony:
Cavanaugh stated, “CMS recognizes the challenges faced by beneficiaries and providers in rural areas. We are helping to address provider shortages through the Critical Access Hospital and Rural Health Clinic programs, and expanding the use of telehealth.”
Morris specified, “Telehealth plays an important role in enhancing the reach of the health care workforce. HRSA is currently funding telehealth projects that bring specialty care to 231 rural and underserved communities in 48 different clinical areas. This initiative has resulted in innovative applications, such as E-emergency care, as well as advances in-home monitoring. Telehealth technology also improves access to and the coordination of mental health services in rural areas, where psychiatrists and psychologists are often scarce.”
Wolters explained, “The complex regulatory environment also affects our physicians. While recruiting physicians to rural areas is a longstanding problem, the complex environment of implementing electronic health records, ICD-10 and various quality reporting programs means most physicians are unwilling to practice in rural areas unless a hospital is willing to manage their practice and ensure income stability.”
Henderson identified the importance of telehealth in rural Mississippi in her testimony. Last fall, the University of Mississippi Medical Center (UMMC) Center for Telehealth developed a research pilot with the ambitious goal of managing 200 uncontrolled diabetics through aggressive in home monitoring and intervention. The centerpiece of the partnership is a population based health care model that leverages telehealth technology delivered over state-of-the-art fixed and mobile broadband connections. Its goal is to improve the health of participants while reducing the total cost of care. Henderson stated, “Of the 93 patients currently enrolled in the pilot, all report that their disease is under control for the first time and that they have lost weight and are feeling better.” The program has cut ER staffing costs by 25 percent, reduced unnecessary transfers by 20 percent “and has produced patient outcomes in rural hospitals that are on par with that of our academic medical center,” Henderson said.
Mississippi’s state government removed barriers and enabled expansion of telemedicine services, Henderson added. Legislation enacted in 2013 mandates that public and private insurers reimburse for telehealth services at the same rates as in-person services. More legislation signed in 2014 requires equal reimbursement for remote patient monitoring services using store-and-forward telemedicine technology. Still, other barriers of telemedicine services remain Henderson explained. The Centers for Medicare and Medicaid Services continues to restrict telehealth reimbursement to patients being treated in a Rural Health Professional Shortage Area or in a county that is not considered part of a Metropolitan Statistical Area. Henderson explained, “Many urban areas also are medically underserved and would benefit greatly from access to telehealth. I would request that CMS consider removing geographic restrictions for telehealth reimbursement.”
“Reimbursement parity for telehealth services works at the state level, and it is time to bring parity to the federal level,” Henderson told senators. “The only way to know if success at the state level can be replicated at the federal level is to test it. Now is the time for CMS to pilot reimbursement parity models for these technologies, especially in-home monitoring, where impact is greatest.”
The hearing provided Senators and rural health advocates the opportunity to identify successful federal programs that should receive support from appropriators because of their focus on rural health initiatives and also acknowledged the gaps that still remain, especially those delivered through telehealth, in supporting the delivery of health care in rural communities.