Statement of the Hon. Richard Burr, a Representative in Congress from the State of North Carolina

I would like to offer my thanks and praise to the Chairman for calling this hearing on disease management in Medicare.  I have long been committed to providing the best possible services to Medicare beneficiaries and to creating incentives for the development of innovative new medical technologies that will improve care.  Disease management offers the opportunity to do both. 

I have introduced a bill that takes a simple but important first step toward Medicare coverage of emerging remote technologies that play an increasing role in disease management.  The bill would improve patient care while moving forward the modernization of Medicare’s benefit package.  I look forward to working with you on disease management, and enlisting your support for H.R. 3572, the Medicare Remote Monitoring Services Coverage Act.

Emerging Disease Management Approaches Emphasize Technology

Several broad market trends are placing new focus on disease management today. 

• Managed care plans are shifting their focus from tightly controlled access to services to more loosely structured preferred provider organizations, resulting in increased outsourcing of disease management services. 
• A growing sense of self-empowerment among patients with chronic conditions is leading to the development of patient-focused solutions. 
• Finally, advances in telecommunications are facilitating improved interactions between patients and health care professionals.  Data advances that automate information collection and patient tracking are making it easier to identify and treat patients with chronic conditions. 

Emerging disease management vendors are employing technology to enhance their product offerings.  Patient-focused services feature disease assessment surveys, personal action plans, and on-line information and support, while services tailored to clinicians include tools to track patients, frequently asked practice questions, and online clinical care guidelines. 

Among the most significant technology-focused services are those that strengthen the link between patients and physicians.  These services provide for interactive case management and support, “push” surveys that solicit patient information and feedback, live chats with nurses or other health experts, and home monitoring with automatic or manual data transmission.

While traditional disease management approaches have emphasized case management by nurses as a key interaction between patients and clinicians, emerging disease management techniques feature home data monitoring and interactive case management and support, along with nurse case management, to create greater linkages between patients and clinicians.

Analyses by firms that specialize in disease management show that technology-centered approaches reduce hospitalizations and medical costs and lead to greater physical health and patient satisfaction.  The development of new technologies expands the promise of emerging disease management approaches. 

Lack of Medicare Coverage Hinders Broader Adoption of Remote Monitoring

Despite the innovations emerging in disease management, many new clinical information and remote management technologies have failed to diffuse rapidly.  A significant barrier to wider adoption of disease management approaches that utilize remote monitoring services is the lack of payment mechanisms in fee-for-service Medicare to reimburse for remote, non-face-to-face management services provided by a physician.

Consider the implications for an elderly Medicare beneficiary with a heart condition similar to the Vice President’s.  If, for example, the beneficiary receives a shock from her implantable cardioverter defibrillator (ICD) over the weekend when her heart specialist is not in the office, the patient would likely go to the emergency room where there may not be a heart specialist on staff familiar with her condition. 

Yet if the beneficiary had remote monitoring technologies in her home, she could immediately forward information concerning her heart and the ICD securely through the Internet to her physician.  The heart specialist could then decide if the patient should come into the clinic on the next business day or to proceed immediately to an emergency room.  More likely, the patient would be reassured that everything is appropriate, thus saving an often stressful and expensive trip to a hospital emergency room. 

Under existing Medicare payment rules, many physician billing codes are primarily for face-to-face interactions between the physician and patient.  The payments often do not account for the clinician time involved in non-face-to-face interactions that are necessary for interpretation and response to data from remote management technologies.  As a result, the payment systems do not adequately reflect the value of physician services involving remote monitoring services, and serve as an impediment to disease management approaches that involve remote monitoring services.

The Medicare Remote Monitoring Services Coverage Act

To provide greater incentives for the adoption of remote patient management services, changes in Medicare reimbursements are necessary. My bill – H.R. 3572, the Medicare Remote Monitoring Services Coverage Act – takes an initial step toward covering remote monitoring services.  It would create parity between certain face-to-face and remote services.  Under the bill:

• Remote monitoring services that are found to be comparable to face-to-face, encounter-based, monitoring services will be given the same coverage and level of Medicare payment as the comparable encounter-based physician service. 
• Remote monitoring services are defined to be services provided through a system of technology that allows a remote interface to collect and transmit clinical quantitative data between a patient and a provider, for the purposes of clinical review or response by the provider.
• The Secretary of Health and Human Services would have the discretion to determine comparability between face-to-face and remote monitoring services.  The remote monitoring services would be subject to the same frequency guidelines developed now or in the future for the comparable in-office services.
• The provision is designed to be budget-neutral.  We anticipate that remote monitoring services will substitute for the existing in-office services only when appropriate.  In the event utilization increases, the bill includes a mechanism to ensure budget neutrality.

There are several benefits of the legislation.

• It will improve patient access, care, and management, as well as spur the development of new technologies and disease management approaches that will improve services further.  For patients in more rural settings, it may be the most practical means for patient management in order to make timely adjustments in the program of care before a more serious health event occurs. 
• The proposal attaches value to physician time dedicated to remote management technology and will encourage physician use of tools that improve services to patients.  It will also enable enhanced care and real-time feedback that will avoid unnecessary hospitalizations and patient anxiety.
• It ensures that payment will only be provided for services that are comparable to those provided in face-to-face interactions.  The Centers for Medicare and Medicaid Services would retain authority through existing initiatives to monitor the quality of such services.

Conclusion

Madam Chairman, let me once again commend you for your leadership in calling this hearing today.  Advances in technology are expanding the promise of disease management, and Medicare must take advantage of the opportunity to improve care for those with chronic conditions.  My bill provides a simple but important first step toward the coverage of new remote technologies featured in emerging disease management approaches today.  I urge you to join me as a cosponsor of the bill, and I look forward to working with the members of this Committee, as well as with my fellow colleagues on the Energy and Commerce Committee, to passing the bill this year.  Thank you very much for the opportunity to present my views.