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Chairman Smith Opening Statement – Hearing on Enhancing Access to Care at Home in Rural and Underserved Communities

March 12, 2024

“For patients in rural and underserved communities, bringing health care home is a lifesaver.”

As prepared for delivery.

“Today, millions of Americans are able to get access to quality health care right in their home because of technological advancements and new flexibilities implemented by hospitals and doctors for the patients they treat. 

“Over 3.2 million patients across America choose to receive infusion therapy at home. One in four adults use telehealth every month, and nearly 50 million Americans use some sort of remote monitoring service. 

“These technologies are helping providers coordinate care across different health settings and bring quality care from your doctor’s office, and even hospital, to your living room. The results show that at-home care can be better for patients’ health and wallets. 

“At-home dialysis has been a game changer for patients. Those patients have a 40 percent lower mortality rate, and they recover faster than those treated at a physical dialysis center. At-home infusion can cost up to 60 percent less than infusion performed in a hospital or doctor’s office. 

“Not surprisingly, at-home care is massively popular with patients. More than 90 percent of Medicare Advantage enrollees using telehealth have a favorable opinion. Over 90 percent are satisfied with their remote patient monitoring care and assistance. 

“Where someone lives, works, or raises a family should not be a barrier to getting top of the line health care. One of our priorities on this Committee is helping every American get health care in their community. 

“For patients in rural and underserved communities, bringing health care home is a lifesaver. These communities struggle with access to health care, which results in worse health outcomes compared to wealthy urban areas. Americans living in small towns often have fewer health services close by, and rural Americans have to drive farther to get critical care. 

“We’re already seeing these patients take advantage of care-at-home options. Rural ESRD patients, for example, are 22 percent more likely to receive dialysis at home compared with their urban counterparts. Audio-only telehealth increases access for rural and underserved Americans who lack reliable internet.

“In the 28 counties I represent back in Missouri, there are plenty of spots that have bad Internet. You can forget about a Zoom call with your doctor. And I know I’m not the only person on this Committee who can say that. 

“We’re here to discuss the benefits of these advancements for our constituents, while recognizing that the Medicare telehealth and Hospital at Home flexibilities that make at-home care possible are both set to expire at the end of this year. 

“The consequences of these policies expiring would wreak havoc for patients and doctors now accustomed to providing care at home. Medicare patients would no longer be able to receive telehealth care from home, and patients receiving hospital at home care will have to go back to the hospital, limiting bed availability for other patients. Doctors and providers will yet again face more uncertainty and be left scrambling to figure out the best way to take care of these patients. 

“At the same time, we cannot accept the same tired approaches that have not made a meaningful difference for enough patients. 

“Before today’s hearing, I had the chance, along with members of this Committee, to see some of the cutting-edge technology that could help better address the unique needs of rural and underserved communities and expand access to care through innovation. 

“We have to explore new approaches that have the potential to help make Americans healthier and allow rural Americans to get care when and where they need it. Home dialysis, infusions, and remote patient monitoring can be better utilized by investing in patient assistance and examining provider reimbursement. Additionally, meaningful patient and taxpayer protections should be considered to ensure robust access, demonstrate value, and prevent waste, fraud, and abuse. 

“Importantly, health at home should be considered a supplement to quality in-person care. Hospitals and doctors’ offices are, and will always remain, critical pieces of our health care system that millions of patients rely on and we are happy to have their support in leveraging this new technology. 

“Still, Congress must help patients who want more control and flexibility over their health care, especially those with chronic conditions or living in rural areas. I look forward to working with my colleagues to find ways we can preserve and protect health at home options that serve families and seniors across our country.”