Early Friday morning, just hours past the midnight deadline for a government shutdown, Congress took bipartisan action that ushered in big wins for two key HIMSS priorities – expansion of telehealth and passage of a budget vehicle to allow for increased health spending. Let’s break down the key legislative activity on Capitol Hill this week and how it will impact the health IT community.
Raising the Caps
The Senate and House passed a bipartisan, two-year budget deal to raise the spending caps on both defense discretionary and non-defense discretionary (NDD) spending (as opposed to “mandatory” spending programs such as Medicaid, Medicare, and Social Security where funds generally flow automatically). NDD spending includes everything from public health to aging, education, veterans programs, nutrition, and many other areas vital to the welfare of our nation.
From the HIMSS perspective, “raising the caps” allows for Congress, and eventually the federal agencies, to respond to both the growing needs of our military as well as the evolving health needs and threats facing all Americans. Health information and technology can be a key tool in supporting this, by accelerating national priorities, including advancing medical and health services research, responding to infectious disease outbreaks, and combating the opioid crisis.
Advancing Health Policy Priorities
Attached to the budget deal was a continuing resolution (CR) to fund the government through March 23 in order to give appropriators time to develop final FY2018 spending levels based on the new budget parameters. As often occurs, additional priority policies where addressed in the larger package as well, including the CHRONIC Care Act, which passed the Senate by unanimous consent in September 2017.
The CHRONIC Care Act, which HIMSS provided technical feedback on during its development and strongly supports, seeks to modernize Medicare to improve the management of chronic disease, streamline care coordination, and improve quality outcomes. With those goals in mind, the Senate Finance Committee put a marker down by including provisions to expand access to telehealth for Medicare beneficiaries receiving dialysis, patients in need of a neurological consult for stroke, and those enrolled in Medicare Advantage or an Accountable Care Organization. It also extends the Independence at Home Medical Practice Demonstration Program (IAH), which provides a home-based primary care benefit to high-need Medicare beneficiaries with multiple chronic conditions.
Despite the momentum behind telehealth on Capitol Hill in recent years, only a small handful of bills (all narrow in scope) made it over the finish line in each chamber and even fewer ultimately were signed into law. In this case, a more comprehensive set of telehealth policies was able to “hitch a ride” on a spending package that addressed a number of priorities for the health(care) community – funding for Community Health Centers, the National Health Service Corps, and key Medicare programs vital to rural community hospitals, among other critical programs.
Passage of the CHRONIC Care Act telehealth provisions marks an important step forward for connected care. Congress, HHS and the healthcare community have much more work to do to modernize Medicare to increase use of remote patient monitoring (RPM) and set the stage for realizing the potential of the many innovative technologies coming down the pike. Ultimately, as HIMSS has stated in the past, policy should promote, not hinder, better care and healthier outcomes for patients.
No Deal is Perfect
While spending will rise overall under the new budget caps, it’s important to acknowledge that certain key programs were used as offsets to the package. One notable offset is a sizable cut to the Prevention and Public Health Fund, the nation’s first mandatory funding stream dedicated to improving our public health system. This underscores the need to ensure that health appropriations receive a proportional share of the overall non-defense discretionary budget cap increase. In the end, no deal is perfect, but this deal does provide tools, in the form of funding and policy changes, to better enable the health information and technology community to be a strong partner in addressing the many public health and healthcare challenges our nation will face into the future.