April 27, 2018

House Committee Explores Health Care Innovation

Innovation and telehealth, as well as the potential need for greater government intervention to reduce barriers to their expansion, remain key focal points for the House Ways and Means Health Subcommittee following an April 26 hearing entitled “Innovation in Health Care.”

With technological advancements increasingly affecting numerous aspects of American life, Subcommittee Chairman Peter Roskam (R-IL) invited witnesses to describe innovative ways their medical practices or companies are helping to revolutionize health care. They included:

  • Matthew S. Philip, M.D. Physician, Breakthrough Care Center, DuPage Medical Group
  • Paul F. Merrick, M.D., President, DuPage Medical Group
  • Oliver Kharraz, M.D., Chief Executive Officer and Founder, ZocDoc
  • Dan Paoletti, Chief Executive Officer, The Ohio Health Information Partnership
  • Sean Cavanaugh, Chief Administrative Officer, Aledade andBecki Hafner-Fogarty, M.D., Senior Vice President, Policy and Strategy, Zipnosis, Inc

The hearing served as an information-gathering session for the subcommittee with witnesses outlining their local efforts to modernize health care. For example, Philip highlighted how DuPage Medical Group’s Intensive Outpatient Clinic witnessed improved patient outcomes and satisfaction rates following efforts to simplify treatment for individuals suffering from complex medical conditions. Philip and his colleagues found great success by reviewing the entirety of their patients’ care rather than limiting their examinations to isolated organs or diseases.

Kharraz described ZocDoc’s goal of improving patient satisfaction rates by assisting individuals to easily schedule appointments with in-network primary care providers within 24 hours. ZocDoc’s innovative software helps physicians fill vacant appointment slots opened by last-minute patient cancellations thereby eliminating inherent inefficiencies in the traditional health care system.
In addition, Paoletti described the Ohio Health Information Partnership’s work with electronic health records, specifically efforts to combat information-blocking and creating greater patient access to individual records.

Cavanaugh’s testimony provided strong support for Accountable Care Organizations (ACOs) and other forms of risk-based alternative payment models (APMs) to transform health care. Subcommittee members probed his work with Aledade, a company dedicated to partnering with independent primary care physicians to facilitate a positive transition to value-based care models. They also asked him to draw upon his prior experience with the Centers for Medicare and Medicaid Services (CMS) to provide guidance for how the government can help nurture health care innovation. Before joining Aledade, Cavanaugh served as deputy administrator for the Center for Medicare, as well as the deputy director of the Center for Medicare and Medicaid Innovation (CMMI), a government agency created by the Patient Protection and Affordable Care Act to test innovative care models.

Cavanaugh urged lawmakers to impose site-neutral payments to reduce economic incentives for independent physician practices to merge with hospitals. In addition, the former CMS employee encouraged the federal government to phase out “one-sided ACOs,” which are APMs that are immune from financial losses but can retain a percentage of the savings associated with greater care coordination. Cavanaugh believes requiring physicians to become fully responsible for the cost of care via two-sided ACOs is the principle way to move the American health care system away from the antiquated fee-for-service model.

While the ACR supports the movement toward ACOs and other forms of risk-based APMs, the College steadfastly opposes the imposition of site-neutral payments or equal reimbursement for imaging services regardless of the care setting.

Hafner-Fogarty highlighted numerous changes to existing Medicare statutes as essential for Zipnosis, a telehealth software company that licenses its software product to large health systems, clinics and individual physicians. More specifically, Hafner-Fogarty urged federal lawmakers to eliminate the Medicare requirement that telehealth only be delivered to patients who reside in a rural health areas or provider shortage areas. The Zipnosis executive also favored either broadening the statutory definition of originating sites or places where it’s permissible to receive telehealth services, to include a patient’s home or to eliminate the policy concept altogether. Hafner-Fogarty also favored eliminating the current system of state-based medical licensure in favor of a national license.

Although generally supportive of telehealth, the ACR views localized care as the key to ensuring patients retain access to high quality advanced imaging services. Any expansion of telehealth cannot come at the expense of patient safety or access to high-quality local radiologists. In addition, the College strongly supports the existing system of state-based licensure.

To date, no comprehensive legislation has been introduced to address all the concepts discussed in the hearing. The ACR’s government relations staff will continue to monitor efforts to facilitate greater health care innovation and will alert members of any pending developments.