“Examining Legislative Proposals to Reform Medicare Provider Payment and Bolster Health Care Cybersecurity.”
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House Energy and Commerce Subcommittee on Health U.S. House of Representatives
Ihren Sitzungen folgenLizzie Fletcher
And we've already seen providers across the country begin to lay off staff, reduce healthcare services, and even close their doors altogether. It's expected that these cuts to jobs and healthcare services will become even more drastic once more of the provisions in that so-called one big beautiful bill take effect. They haven't all taken effect yet. But we know that since it was signed into law, the Trump administration has issued a series of rules to implement the provisions of the bill that go even further than the statutory requirements in the bill, further reducing access to care and placing even more strain on healthcare providers and our healthcare infrastructure overall. And with providers forced to cut services and staff, this means that it's not only those who are on Medicaid or who received the enhanced premium tax credits who will lose access to care or see their healthcare costs increase.
It will be more difficult for all Americans to access the care that they need. This will likely result in many Americans delaying or foregoing care altogether. And when people delay or forego care, that is harmful for their health and for the health of our communities. And physician after physician has told me this, public health expert after public health expert has told us this. It's time for us to respond to it.
For an administration that claims it wants to make America healthy again, the actions prove the opposite, that it is doing everything but that and not making us healthier, but making it more difficult and more expensive to access healthcare.
So I welcome the discussion today on pieces of legislation that will protect and expand access to care for Americans all across the country. But we on this committee also need to address the ways that policies that have been recently enacted have cut off access to care and have driven up healthcare costs for millions of Americans, and I hope that the committee will take the opportunity to do that in future hearings.
H. Griffith
Gentlelady yields back, now recognize the chairman of the full committee, the gentleman from Kentucky, Mr. Guthrie.
Brett Guthrie
Thank you, thank you, Mr. Chairman. Thank you, Chair Griffith, for holding this hearing. I'll be brief, as the committee has already done extensive work examining the provider landscape and subsequent payment reform. Earlier this year, we heard from witnesses as part of our affordability series, followed by a hearing this spring focused on Medicare physician payment reforms. Today, we will build on that work by considering a range of legislative proposals aimed at strengthening the ability of our nation's providers to deliver enhanced care for Americans.
Additionally, we are considering two pieces of legislation to address cybersecurity threats in the public and private health sectors and pose serious risks to patient safety and privacy. H.R. 9908, the Rural Hospital Cybersecurity Enhancement Act, led by my colleagues, Representative Houchin and Schrier, Representatives Houchin and Schrier, would support rural hospitals' critical cybersecurity infrastructure by requiring HHS to establish a comprehensive workforce development strategy that addresses the need for cybersecurity professionals in rural hospitals. The bill also requires HHS to publicly publish materials for rural hospitals to train their staff. Similarly, the Healthcare Cybersecurity and Resiliency Act of 2026 would expand resources for preventing and responding to cybersecurity incidents across the healthcare system, require healthcare providers and plans to include the number of individuals affected when notifying them of a breach. I thank all of our witnesses for being here today.
I look forward to hearing from your testimony. I thank the chairman, and I will yield back.
H. Griffith
Gentleman yields back, I now recognize the ranking member of the full committee, Representative Pallone, for five minutes for an opening statement and a point of personal privilege over and above the five minutes. Mr. Pallone.
Frank Pallone
Thank you. It's good to see you today. I don't know, you've been chairman of two committees since I saw you last, Rules and here today. But this is our last Health Subcommittee hearing before House Republicans send us back to our districts until after the election. And it's important, as we discuss these legislative proposals today, that we not forget the Republicans' big ugly bill cut American health cut American healthcare by more than a trillion dollars, the largest cut in our nation's history.
And these massive cuts will result in 15 million people losing their health insurance. Insurance premiums spike for 20 million people in the beginning of the year because Republicans refused to extend the ACA tax credits. And while Republicans are holding a hearing to discuss the challenges that providers face in the Medicare physician fee schedule, hospitals and clinics are closing in record numbers across the nation because of Republicans' healthcare cuts. Approximately 10,000 healthcare workers have already been laid off, and another 300 hospitals, clinics, and home care providers are closing down altogether or reducing services. So that's the healthcare environment that we face today.
It's a disaster, in my opinion. But let me get to the bills that we're considering today. We'll discuss a number of bills that would reform and modernize the Medicare physician fee schedule. When Congress passed the Medicare Access and CHIP Reauthorization Act, or MACRA, there was hope that it would stop that rollercoaster of payment cuts and create a system for reliable Medicare payments to healthcare providers based on the quality of care that patients received.
A fundamental portion of MACRA was the Merit-based Incentive Payment System. That system was intended to provide better pay for healthcare providers who provide better care. In reality, this system has appeared to create additional administrative burdens for providers without producing significant improvements in patient care, in my opinion. I believe any reforms to the Medicare physician payment system needs to ensure that Medicare remains viable while ensuring that patients receive quality care and doctors receive fair compensation. Any changes to the payment system should also improve how we evaluate the quality of care seniors receive without imposing burdensome administrative requirements on physicians.
At the end of the day, Congress must prioritize access to high-quality care for all Medicare beneficiaries when and where they need it, and we must ensure any changes that we are considering today do not result in increases in Medicare beneficiaries' premiums or out-of-pocket costs. We will also consider legislation that would require Medicare coverage of Alzheimer's disease early detection screening tests. These tests have the potential to offer a transformative approach to early Alzheimer's screening. Any further change to this bill must ensure it does not hinder the Center for Medicare and Medicaid Services' ability to collect data and real-world evidence, real-world evidence, in order to inform coverage determinations and must also treat all Medicare beneficiaries equally. We're also considering two healthcare cybersecurity bills.
They are intended to enhance healthcare privacy and better protect our healthcare infrastructure from cyberattacks and intrusions. And I continue to believe that we should address online privacy holistically, look at this holistically, of which healthcare privacy is an integral and essential aspect of these efforts, but I'm looking forward to the discussion today and I believe we must find bipartisan solutions on this issue. I also believe that Medicare beneficiaries should have access to routine services they need in the most accessible locations, including their local pharmacies, and I believe that H.R. 3164 can help us to do that. Now turning to public health, we'll consider a bill that would help prepare rural providers to handle obstetrics emergencies and another bill that would help develop a comprehensive strategy to prevent, diagnose, treat, and cure epilepsy, one of the most common neurological conditions that we have here in the United States. So, I thank Mr. Chairman Griffith.
Let me just add if I could, I know I'm going over time here, but I wanted to take a moment to thank Una Lee for her more than 11 years here at the Energy and Commerce Committee, most of those years serving as Chief Counsel for the Health Subcommittee. She's played a critical role in every major healthcare bill that has been signed into law during that time. That includes the American Rescue Plan during the COVID pandemic and the bipartisan No Surprises Act, which ended the practice of surprise medical bills for patients. Una has also led the health team during passage of the Inflation Reduction Act, which finally empowered Medicare to negotiate lower prescription drug prices for America's seniors. And this legislation is saving seniors billions of dollars on the drugs that have already been negotiated, and there'll be more negotiations this year and in years to come building on those savings.
So Una has been a trusted advisor. She's going to be missed here at the committee, very seriously missed. And I wish her nothing but the best in her future endeavors. I wish she wasn't leaving, but I usually say that about anybody leaving who's good, but in her case it's even more of that I wish she wasn't leaving. But I wish her best in her future endeavors and congratulate her for her tremendous work of making healthcare more affordable and accessible for every American.
So all the best, Una, and thank you for everything you've done. Thank you, Mr. Chairman, I yield back.
H. Griffith
Thank you, and I would be remiss if I didn't say that and I think most people who watch us know, but without the team behind us, we couldn't get anything done.
It's very helpful to have their input, their knowledge, and their advice. So thank you. All right. We want the, oops, skipped a paragraph. We now conclude with member opening statements.
The chair would like to remind members that pursuant to the committee rules, all members' opening statements will be made a part of the record. We want to thank our witnesses for taking their time to be with us today and to testify before this subcommittee. Although it is not the practice of this subcommittee to swear in witnesses, I will remind our witnesses that knowingly and willfully making materially false statements to the legislative branch is against the law under Title 18, Section 1001 of the United States Code. You will have an opportunity to give an opening statement followed by questions from members. Our witnesses today are Mr. Greg Garcia, Executive Director for Cybersecurity, Healthcare and Public Health Sector Coordinating Council, HSCC; Dr. Anthony Pudlo, PharmD, MBA, MS, Chief Executive Officer of the Tennessee Pharmacists Association, TPA, and are you keeping Ms. Harshbarger in line?
I'm just saying. Yeah. Dr. Miraat Alam, MD, MSCI, MBA, FAAD, President, American Academy of Dermatology Associates, AADA; Dr. Rebecca Andrews, MS, MD, MACP, Immediate Past Chair, Board of Regents, American College of Physicians, ACP; and Dr. Eileen Atwood, MD, MPH, Immediate Past Chair of the Committee on Health Economics and Coding, American College of Obstetricians and Gynecologists, ACOG; and Ms. Gabby Konneker, MPH, Co-Founder and Executive Director, Decoding Developmental Epilepsies. Per committee custom, each witness will have the opportunity for a five-minute opening statement followed by a round of questions from the members. The light on the timer in front of you will turn from green to yellow when you have one minute left.
I now recognize Mr. Greg Garcia for his five minutes to give an opening statement. Mr. Garcia.
Greg Garcia
Thank you, Mr. Chairman and members of the committee. Thank you for inviting me to testify. Today, I will discuss cyber threats to the healthcare system and patient safety and what we can do about it. The Health Sector Cybersecurity Working Group is an industry-led advisory council of almost 500 healthcare organizations and government agencies, and we work together to identify and mitigate systemic threats and vulnerabilities that affect the delivery and support of healthcare. At the heart of this work is the guiding principle that cyber safety is patient safety.
25 years ago last Friday, the United States suffered the worst attack on American soil in the nation's history. It resulted in the deaths of more than 3,000 people on that day and in its aftermath. While I watched archival news coverage of that event last weekend, I pondered how many souls, how many more souls might have been lost had those terrorists added to their arsenal with simultaneous cyberattacks on the neighboring hospitals. This blended attack could have disabled clinical IT systems and medical devices and providers' ability to care for the many people burned and injured on that day. You should harbor no doubts that this is a very real scenario.
Five years after those September 11 attacks, 20 years ago this coming Friday in fact, I was appointed as the nation's first DHS Assistant Secretary for Cybersecurity. This new role was created in part to counter the prospect of that kind of devastating blended attack. In reminding me last week about the linkage between those two September days, a colleague made a trenchant observation. She told me, you know, since your appointment, the same technology that has put a cardiologist beside a patient's heart hundreds of miles away has also handed a criminal on another continent a weapon to hold for ransom her life support. This is the challenge before us in the health sector and before this committee.
For our part, the many cybersecurity professionals in our membership have since 2019 produced almost 40 healthcare cybersecurity best practices by the sector, for the sector, and some jointly published with HHS. I would commend to my clinical colleagues here, we also have produced a cybersecurity for the clinician video training series, 40 minutes of your time well spent, and that's available free on our website. Implementation of these tools will measurably improve the security and resiliency of the nation's healthcare system if we can get them to the stakeholders who need them with the government's help at scale. And this is especially important for the nation's rural and resource-constrained health providers. They are the most vulnerable to evolving malicious cyber threats, and this calls for a concerted multi-pronged combination of government programs, assistance, and funding coupled with market-based mutual support, community defense, and a safe harbor when they take appropriate steps to protect themselves but still get attacked.
Today the committee has two cybersecurity bills pending before you, and while the HSCC has not formally considered these bills, I can say that they represent a welcome indication of this committee's attention to this complex and evolving challenge. Together these bills direct cybersecurity coordination across HHS, CISA, and the healthcare sector and provide specific targeted assistance to the nation's small, rural, and resource-constrained health providers. I can also say that where clarifications and refinements are needed in certain provisions, we stand ready to work with the committee to consider appropriate recommendations. Some of our suggestions would include the need to, one, direct HHS and CISA to formally involve the council in cybersecurity deliberations, threat information sharing, and incident response advisories to the community. Two, clarify section four of the Cyber Resilience Act to require that the HHS designee for internal and external cybersecurity coordination be at the deputy assistant secretary level or above with the appropriate authority to influence policy and programmatic decisions.
Three, ensure that grant funding is available to the broadest community of resource-constrained health providers and allow use of those funds to replace legacy medical devices that are too old to secure. And finally, four, avoid congressionally prescribed technical solutions such as multi-factor authentication and encryption. These might be correct today, but technology is constantly evolving in ways that will change the meaning, the implementation, and effectiveness of technical products and methods. Such technical guidance in our view is better left to evolving industry security frameworks that are widely recognized and referenced in law and operation. Mr. Chairman, that concludes my remarks and I'll be happy to answer any questions.
H. Griffith
Appreciate it, and the gentleman yields back. Now recognize Dr. Anthony Pudlo for his five-minute opening statement.
Anthony Pudlo
Thank you Chairman Griffith, Ranking Member Fletcher, Vice Chair Harshbarger and members of the subcommittee. Thank you for the opportunity to testify today. I especially want to thank Vice Chair Harshbarger, a fellow Tennessean and pharmacist, for her leadership in expanding access to timely, affordable healthcare. My name is Anthony Pudlo and I serve as the Chief Executive Officer of the Tennessee Pharmacists Association. Today, I'm here because too many seniors are still being denied timely access to care that may be available just minutes from their homes.
You have a bill before you to address this issue that has strong bipartisan support among members of this committee, with 38 cosponsors among its members, including 20 Republicans and 18 Democrats. Now, picture a senior who wakes up on a Saturday morning struggling with respiratory conditions. Her physician's office is closed. Obtaining a timely appointment may be difficult, whether she lives in a rural community or a busy urban area. And waiting could allow a manageable illness to become far more serious.
But her trusted pharmacy is open. Her local pharmacist is nearby, trained, and authorized by state law to provide the care she needs. Yet, because she relies on Medicare, coverage for those services may not be available. That is the gap HR 3164, the Ensuring Community Access to Pharmacist Services Act, or ECAPS, would help close. Throughout my career, I've viewed healthcare from many perspectives: as a practicing pharmacist caring directly for patient care, as a leader developing innovative pharmacy practice models, and as an advocate working with policymakers and other healthcare professionals.
All those experiences reinforced a simple truth: pharmacists are among the most accessible healthcare professionals in a patient's life. For many seniors, the pharmacy is more than a place just to pick up a prescription. It is often the most accessible point of entry into the healthcare system. Patients trust their pharmacist because of relationships built over years and often decades of care. Now consider the Medicare beneficiary in rural Strawberry Plains, Tennessee, who wakes up with those respiratory symptoms but cannot reach a physician office who might be miles away.
Or consider the senior in an urban neighborhood of Memphis, Tennessee, who may live near medical facilities but still cannot obtain a timely appointment or easily travel across the city for care, even though that trusted community pharmacist is nearby and available. Too often, these seniors are faced with a difficult choice: wait and hope that they get better, or seek care in a higher-cost setting such as an emergency department. In Tennessee, pharmacists are authorized under state law to order testing and provide treatment for common respiratory illnesses. Tennessee, along with 27 other states, already authorize their Medicaid and commercial health plans to cover such services. Medicare beneficiaries, however, they are often the only patients unable to access coverage for the same pharmacist-provided services.
ECAPS would address this disparity by covering pharmacist-provided services under Medicare Part B for common respiratory conditions, under state scope of practice and as part of the patient's healthcare team. America's pharmacists are ready. On behalf of the seniors, families, and caregivers who should not have to wait until a manageable illness becomes a medical emergency, I respectfully urge this committee to swiftly advance the Ensuring Community Access to Pharmacist Services Act, and let us give seniors access to the care that is already close to home and help them remain where they most want to be: healthy, independent, and with the people they love. Thank you for your leadership and for the opportunity to testify, and I welcome your questions.
H. Griffith
Thank you very much. Now recognize Dr. Murad Alam for his five minutes of opening statement.
Murad Alam
Thank you, Chairmen Guthrie and Griffith, Ranking Members Pallone and Fletcher, members of the subcommittee. My name is Dr. Murad Alam and I'm president of the American Academy of Dermatology, which represents 18,000 physicians nationwide. I'm also the vice chair and a professor in the Department of Dermatology at Northwestern University Feinberg School of Medicine in Chicago. In my practice, which focuses on skin cancer care, I treat patients who travel from far away, including rural areas and adjoining states, because they cannot find care closer to home. Many of these patients return again and again because they depend upon me to catch cancerous spots.
Perhaps it is a new growth on their back that the patient cannot see or a suspicious sore on their nose that the patient isn't quite sure was there before. Skin cancer is the most common cancer in the United States, with most skin cancer patients 65 or older. Dermatologists are expert at evaluating skin lesions, distinguishing benign from malignant disease, and treating skin cancer when it is localized and most treatable. Most of this care is in private practices rather than in hospitals. Prevention, early detection, and access to high-quality dermatologic care is particularly important for Medicare beneficiaries given their elevated risk of skin cancer.
When detected early, 99% of skin cancers can be cured, commonly with a single in-office procedure. When detected later, skin cancers that have advanced or spread typically require treatment with expensive and toxic medications and only 35% of patients survive. A disheartening part of practicing medicine is discovering a lesion that had it been found earlier could have been treated more easily. We saw this repeatedly during the pandemic. I told my staff I know you are scared, but we have to see patients.
We cannot let time pass without them being checked. We stayed open and we prevented suffering and likely saved lives. Unfortunately, between Medicare physician payment cuts and mounting administrative burden, physicians are facing death by a thousand cuts, a slow erosion that is driving burnout and threatening patient access to care. Every closed practice, every delay in care, every unfilled position that further hampers care delivery threatens the long-term utility of Medicare. While I continue to encourage my medical residents and fellows to start independent practices in underserved areas, it is increasingly difficult to make that case.
Between payment cuts, consolidation, and administrative burdens, they fear they cannot survive on their own even when the desire to serve these communities is there. Congress must act to reform Medicare physician payment by establishing a positive annual inflation adjustment and increasing the budget neutrality threshold. In addition to the expiration of the 2.5% update Congress provided only for 2026, CMS's proposed rule for the 2027 Medicare physician fee schedule includes cuts of 11% for dermatology's medically necessary services, cuts that cumulatively rise to at least 16% when fully phased in, thereby further destabilizing private independent practices. These proposed reductions directly threaten skin cancer prevention and treatment.
If these cuts become reality, physicians would be forced to reduce staffing and limit the number of Medicare beneficiaries they can serve. We extend our gratitude to Representatives John Joyce, Greg Murphy, and Kim Schrier for their leadership in introducing H.R. 9693, the Patients First Act. While physicians have long advocated for inflation updates tied to the full Medicare Economic Index, the inflationary update policy in the Patients First Act would be a vital building block towards long-term sustainable and predictable annual adjustments. I thank you for holding this hearing and for your commitment to ensuring patient access to life-changing dermatologic care. We must stop draconian cuts to Medicare physician payment.
The price of delaying critical legislation like the Patients First Act is lives. The Academy looks forward to working with the committee as it considers the challenges facing physician private practices. Thank you.
H. Griffith
Thanks the gentleman for his testimony and now recognize Dr. Rebecca Andrews for her five-minute opening statement.
Rebecca Andrews
Good morning, Chairman Griffith and Ranking Member Fletcher, the distinguished members of the subcommittee, and thank you for the opportunity to testify today. Who will take care of me? That was a question that I never thought of 10 years ago, but now I worry almost daily when I imagine my future health. I'm Dr. Rebecca Andrews, an internal medicine physician, primary care, and the immediate past chair of the Board of Regents for the American College of Physicians. We represent more than 163,000 physicians, nearly half of the nation's primary care physicians, along with those in hospital medicine and the internal medicine subspecialties.
Primary care is the foundation of every high-functioning health system. A primary care physician is your health guide over the course of your life, and the longitudinal relationships that we build produce the trust for better outcomes. Yet somehow, the U.S. health outcomes still trail other nations. My testimony today is a tale of numbers. One-third of our country, 100 million people, do not have a primary care physician.
In my home state, it takes a year to get a new primary care physician. Of my 60 graduating residents each year, very few choose primary care. This year it was six. That was a good year. And while the average medical student debt when they graduate is $223,000, Medicare payments have declined by 33% since 2001 when you account for inflation.
This has hit primary care the hardest since we lack the procedural revenue that cushions other specialties from the same cuts. Medical students and residents must weigh their school debt against their significantly lower earning potential in primary care compared to other many other subspecialties. In other words, they simply cannot afford to go into primary care. Two years into practice, I personally saw the tangible evidence of the power of primary care. A 29-year-old woman called me concerned about a breast lump, so I made her patient number 26 that day.
And I have now cared for her for 20 years through her cancer treatment, its recurrence, and her second remission. It took me 10 years to convince her to treat her depression, but that allowed her to go back to work. For the past five years, I've treated her diabetes, and just two weeks ago, with the help of my resident, after years of discussion, I finally convinced her to take a medicine that would protect her against heart disease. This is primary care. The comprehensive care that is undervalued and built over years that produces the health outcomes we all want.
Adding 10 primary care physicians to every 100,000 patients adds an average of two years of life expectancy. And for all of you, adding 10 primary care physicians means that your constituents will double their life expectancy by adding them compared to any other type of physician. And yet, we're losing this practice area. Still, I'm buoyed by hope. The Patients First Act of 2026 is part of that hope, and I thank Doctors Joyce, Murphy, and Schrier for leading the effort.
Our written testimony has more detail, but I want to highlight the potential. A permanent inflationary update would ensure physician payment never again goes three decades without an increase. A five-year hybrid payment pilot would provide independent primary care practices, in addition to fee-for-service, a per-member fee, recognizing that primary care happens on the phone, through care coordination, and certainly beyond the office visit. I use a similar model in my practice, and we are able to have integrated social work, behavioral health, and a pharmacy team. But this must not be offset by broad cuts or cost-sharing by patients.
So who will care for me in the future? To get more medical students and residents into primary care, invest in primary care through a mechanism not beholden to budget neutrality, support coding policies that appropriately value and recognize the time to provide longitudinal, comprehensive care, use quality measures that are evidence-based, such as the Quality Reform Task Force and the Patients First Act, and build safeguards against physicians so they're not penalized for their patient complexity and social risks. Friday, my resident asked me about the future of medicine. He wants to go into primary care. The future doctors are watching what you decide.
But with input from physicians and professional medical organizations, you have the power to build a system that puts the physician in front of the patient rather than behind mountains of paperwork. Thank you for the opportunity to testify. I look forward to your questions.
H. Griffith
Thank you very much, and now recognize Dr. Eileen Atwood for her five-minute opening statement.
Eileen Atwood
Chairman Griffith, Ranking Member Fletcher, and distinguished members of the subcommittee, thank you for inviting me to speak with you today on behalf of the American College of Obstetricians and Gynecologists. My name is Dr. Eileen Atwood. I'm a practicing OB-GYN in Providence, Rhode Island, where I also serve as the co-medical director of the emergency department of my primary hospital, as well as hold privileges and work clinically at two other low obstetric volume hospitals in the state. I am also the immediate past chair of ACOG's Committee on Health Economics and Coding. ACOG, with more than 60,000 members, is the leading physician organization dedicated to advancing women's health.
Our mission is to support our members to improve the lives of our patients, their families, and communities. Key to realizing that mission is ensuring sustainability of physician practice and patient access to affordable, high-quality, and safe healthcare. One in three US counties have no obstetric clinicians or birthing facilities. More than 2.5 million women of reproductive age live in these communities, and nearly 150 rural hospitals have stopped or plan to stop providing obstetric services between 2020 and the end of this year. This rapid increase in closure has reached crisis levels.
In rural areas, loss of hospital-based obstetric services is associated with higher rates of out-of-hospital and preterm birth, as well as lower rates of prenatal care, with the maternal mortality rate in the United States remaining unacceptably high, with notable disparities by both race and rurality. This is why ACOG is proud to support H.R. 1254, the Rural Obstetrics Readiness Act. This bill would create an obstetric readiness training program for rural facilities without a dedicated labor and delivery unit, provide new federal grants for those facilities to purchase the necessary equipment, and create a pilot program to support a warmline connecting OB-GYNs with clinicians in rural facilities in need of urgent teleconsultation. And this work is not just theoretical. We have done it informally in Rhode Island and with significant positive effect.
Whether working in the emergency department or as serving as the hospital's perinatal safety officer, I am frequently on the receiving end of obstetric emergency transfers, including those from facilities without a dedicated labor and delivery unit. For example, I recently took a call from a regional hospital that had a patient in her second trimester present to their emergency department with dangerously high blood pressure. Through our phone consultation, I was able to recommend the appropriate medications to minimize her risk of stroke or seizure and help determine if they could safely transport the patient to our facility, nearly an hour away, where we have the necessary resources for this patient and her baby. Additionally, we have grown our emergency department training programs with other specialties, including emergency and family medicine. We work alongside non-OB-GYN residents and faculty to become more comfortable with obstetric emergencies that may present to their local and rural hospitals, to become more agile in safely managing these patients locally and best practices when transferring to a higher level of care.
With this in mind, we urge Congress to pass the Rural Obstetrics Readiness Act this year. I also want to express my support for efforts to fix the flawed Medicare physician payment system. More than 80% of OB-GYNs accept Medicare, affirming the role we play in caring for patients across the lifespan. Medicare patient payment policies reach beyond the Medicare program, with Medicaid, TRICARE, and private insurers often following Medicare's lead on physician payment rates. The current system is not sustainable and has contributed to the consolidation of physician practice.
As you just heard, adjusted for inflation, Medicare physician payment has declined nearly 33% over the last 25 years. The lack of inflationary update, the outdated budget neutrality threshold, and the recent misguided efficiency adjustment policy threatens not only the future of private practice, but access to care writ large. We need a payment system that recognizes the value and complexity of surgical care as well as primary care and adjusts for inflation to ensure that payment reflects the cost of providing that care, that updates the budget neutrality cap, and that allows for adjustments based on actual utilization. We are urging Congress to pass both the Provider Reimbursement Sustainability Act and the Patients First Act. Together these bills will add much-needed stability to the Medicare program and preserve the low-volume threshold necessary to enable OB-GYNs like me to remain in the program while maintaining the shared priority of advancing access to high-quality care.
We are nearing the end of this Congress, but there is still time to pass these important bills to improve access to high-quality care for patients, to support the long-term sustainability of physician practice, and to elevate obstetric readiness of rural hospitals across our nation. Thank you for the opportunity to join you today, and I welcome your questions.
H. Griffith
Thank you very much, and now recognize Ms. Gabi Konacker for her five-minute opening statement.
Gabi Konacker
Thank you so much, Chairman Guthrie and Ranking Member Fletcher and members of the subcommittee. My name is Gabi Konacker, and I'm the co-founder and executive director of the Epilepsy, excuse me, Decoding Developmental Epilepsies and serve as a founding member of the Epilepsies Action Network.
But most importantly, I am Elliot's mother, a child with a rare and catastrophic epilepsy who joins me today along with his sister Vega and my mother Jetta. Epilepsy is always a family matter. I am here today to ask you to pass the National Plan for Epilepsy Act HR 1189, which has generated significant bipartisan support with 97 representatives and 28 senators who have co-sponsored the National Plan for Epilepsy Act, and the Senate recently unanimously passed a modified version. Nearly 3.4 million Americans live with epilepsy and roughly half a million of those are children. We have made extraordinary scientific progress, but our system has not kept pace.
We need a national plan to translate that progress into better care and outcomes for those living with epilepsy. My son Elliot began having seizures within days of being born. They were dismissed for months and we were delayed in accessing a neurologist. What followed was a year and a half diagnostic odyssey with more than a dozen doctors, spinal taps, skin biopsies, MRIs, EEGs, hundreds and hundreds of seizures, and many, many hospitalizations. In 2014, genetic testing revealed that my son has an SCN8A-related disorder, a rare genetic condition that wreaks havoc on every system in his body.
I speak on his behalf and for the countless others who cannot. Elliot is 13 and he is my pride, my joy, but he suffers immensely. Elliot cannot hold up his head independently, grasp a toy, eat by mouth, tell me why he's hurting or what he likes. Every day I live in fear that that day could be our last. And despite everything we know now, after about a decade since the discovery of the disorder, he has tried and failed nearly every anti-seizure medication.
And, excuse me, he has failed nearly every seizure medication that he has tried and his treatment is still largely trial and error. Elliot's story is one of a catastrophic rare epilepsy disorder, but there are so many others who live with profound effects of epilepsy. The veterans who have suffered TBIs, elder-onset epilepsy, those with epilepsy that cannot get pregnant or live in deep depression. For far too many children, I've seen pass away from drowning, respiratory distress, multi-system organ failure. In fact, one of every thousand people who live with epilepsy will pass away quietly in the night from SUDEP, sudden unexpected death in epilepsy.
The terrible reality is that one in 26 people will develop epilepsy in their lifetime. That equates to roughly one child in every classroom. Families across the country are navigating delayed diagnoses, disconnected care, inadequate data, and treatments that far too often remain guesswork. As you all likely know, more than a dozen federal agencies are currently working in epilepsy: NIH, CMS, CDC, FDA, Department of Education, Veterans Affairs. We have made incredible, incredible progress in epilepsy research and there's incredible work happening in this country, yet too little of that knowledge is really translating into quickly available treatments and outcomes for patients.
At least one-third of adults who live with epilepsy do not gain seizure control, about a quarter of children, and for with a disorder like SCN8A that my son has, more than 60% of those children never gain seizure control. We do not systematically track enough patients, their care, and outcomes to meaningfully learn from each person. As we've heard repeatedly today, clinicians are under strain. They are managing complex lifelong conditions amid workforce shortages, administrative burdens, and limited tools to predict what treatments will work and when.
And as we know, precision medicines are on the horizon, but uncoordinated systems are delaying the promise of these life-saving opportunities. This fragmentation also has consequences for affordability. Uncontrolled epilepsy drives significant healthcare costs, and it is estimated that the total healthcare burden for those living with epilepsy is at least 54 billion dollars. Better coordination can help us get patients to the right diagnosis and treatments sooner, improving outcomes, reducing avoidable costs, and giving healthcare providers better information and tools to care for their patients. Families like mine should not have to build the infrastructure ourselves to find patients, collect data, develop guidelines, and push science toward treatments.
The good news is that the epilepsy community has come together. 150 organizations have endorsed the legislation, and we have already come together to develop consensus priorities for what could be included in a national plan for epilepsy. And when it is passed, we stand by ready to support Congress and the Secretary to advance this life-saving work. In the world of epilepsy, I'm almost done, I promise, there is a saying which is that time is brain. The longer we wait, the more damage that is done.
It may already be too late for my son, but we have the chance with the National Plan for Epilepsy Act to take a historic step toward ending decades of fragmentation and ensuring that scientific progress more rapidly reaches the people who are desperately in need. We need Congress to act now. And on behalf of Elliot, my family, and the millions of Americans and their families who live with epilepsy on a daily basis, I respectfully ask you to pass HR 1189 this year to give families like mine a future defined not by fear and lost potential, but by progress and possibility. Thank you.
H. Griffith
Thank you. Thank you for your testimony today. We will now begin questioning. I'd ask that members not begin a new question to our witnesses as their five minutes is about to expire, and would encourage members to submit written questions for the record. I now recognize myself for five minutes of questioning.
First, I would ask for unanimous consent to present for the record a letter from Congresswoman Jen Kiggans, a nurse practitioner who writes in support of HR 1616, the Promoting Access to Diabetic Shoes Act. Without objection, so ordered. All right, Dr. Atwood. In my district, we have a limited number of OB-GYN specialists, and many areas are considered maternal healthcare deserts. Outside of payment stability, what are some other ways we can look to build the maternal health workforce pipeline, especially in rural communities, where a lot of times it's not that the hospital's not willing, they just don't have providers?
Eileen Atwood
Absolutely, thank you for that question. I think this is actually one of the unique opportunities that I have in my current workplace where we work very closely with various trainees and other specialties and other clinicians. We work with family medicine residents, emergency medicine residents, women's health nurse practitioners, certified nurse midwives, multiple people who work out in the community and are able to take the training that we do in our emergency department for obstetric emergencies and be able to take that back locally. I was actually just working with a resident this past Sunday on call who looks forward to returning to where she grew up in Wyoming or potentially in West Virginia. Actually, we had this conversation to be able to take the training that she has gotten out of our emergency department specifically for obstetric emergency care and take that back.
She was so thankful that we have developed this program, and that's really what we're looking to be able to do on a national level formally through the Rural Obstetrics Readiness Act.
H. Griffith
Thank you very much. Dr. Andrews, from a provider perspective, how would a bill like the Alzheimer's Screening and Prevention Act change care for Medicare beneficiaries? Do you think that the bill would save costs for both patient and healthcare systems as a whole if individuals had access to these screenings with proper safeguards?
Rebecca Andrews
Thank you for that question. I think of Alzheimer's like any chronic condition. The sooner we can diagnose it, the more we can treat it upfront and prevent some downstream adverse effects of that condition. In particular for something like Alzheimer's, it provides time for the family to plan. I have a family, there are three daughters and one wonderful mother who is my patient.
They managed to keep her at home for her entire diagnosis because we did cognitive screening and it was prior to having ways to diagnose it, but we did cognitive screening, we knew it was coming, we got an aide in the house, we safeguarded her, and they did an amazing job as a family taking care of her. But those are the types of changes that early diagnosis can help with. Additionally, as a patient, her being able to figure out her financial will and other conditions helped pay for those so that it didn't burden the system with costly unexpected admissions and other, you know, downstream effects. So I think it would be great to diagnose all conditions as early as possible.
H. Griffith
Thank you. Dr. Pudlo, in Virginia, we have a statewide protocol that allows pharmacists to test and treat certain illnesses. From your experience in Tennessee, what impact have you seen these services have on senior patient health outcomes, particularly in rural areas like the ones that both Representative Harshbarger and I represent?
Anthony Pudlo
Yeah, thank you for the question, Chairman. You know, I think it's a really great question. What HR 3164 is really focused about is that access. And I think amongst the states like Tennessee, like Virginia, that already have that authority, it continues to provide not just the access to care like we've talked about, but I think it continues to show that we are triaging and helping getting patients into the health care system when there is limited access to care in a rural area in both your all's cases. But ultimately, I do think that that access alone, it's not necessarily reducing disparities by any means.
We continue to try to build that trust and that's what I think statewide protocols and other authorities that are granted at the state level do.
H. Griffith
Thank you. Dr. Andrews, back to you. We heard a little bit on this in the openers, but the way that physicians are reimbursed by CMS is complex and confusing and it requires budget neutrality. Can you briefly explain how this works in reality and mainly, I know you touched on it in your opening, but dumb it down for me and folks back home.
Rebecca Andrews
I think it's actually pretty simple. You can't run a business, even if that business is a social need, if you have no idea how you're going to get paid three months, 12 months later. And the instability makes it very difficult to plan, to recruit for the staffing and interdisciplinary team you need. In particular, if our country wants to move to making real change for health outcomes, we have to be able to innovate and to innovate you have to be creative and it takes time to make sure it's working. And with unstable reimbursement, it's just not possible.
Thank you.
H. Griffith
Thank you. And my time is up, so I will yield back and now recognize Ms. Fletcher for her five minutes of questioning.
Lizzie Fletcher
Well, thank you, Mr. Chairman, and thank you to our witnesses for your time and your testimony here today. Picking up where Chairman Griffith left off, I represent a lot of physicians in my district in Houston who have for years faced declining Medicare payment reimbursement because the current reimbursement rates haven't kept pace with inflation or rising practice costs.
And since 2001, Medicare physician payment has fallen about 33% when adjusted for inflation. The decreasing reimbursement rate is unsustainable. And it really threatens access for all patients to get access to care. So that's been an important focus for me in Congress. And I, while I'm glad that Congress has stepped in to provide some temporary and short-term solutions in the past, it's really critical that Congress focus on providing a long-term reform for Medicare physician payments.
And so I'm grateful to my colleague Representative Schrier for introducing the Patient First Act to provide this long-term reform to Medicare physician payments. And I was glad to co-sponsor this important legislation. And I hope that we will consider it in a markup this Congress. One of the other bills that we're talking about in this hearing that I want to highlight is the Rural Obstetrics Readiness Act. We have heard it before in this committee, but it really bears repeating that the United States of America has the highest maternal mortality rate of all developed countries.
And it's important that we work to address the disparities in maternal health outcomes. And things are getting worse. Just last week, for example, a new report showed that the number of women who have died from ectopic pregnancies has nearly doubled in the last five years. So this bill is an important step in this work. But as I mentioned earlier, the provisions in the so-called One Big Beautiful Bill Act decreased Medicaid reimbursement rates for hospitals.
And that is also having a huge impact on access to obstetric care. And without getting into the details, I think everyone understands that it's created a financial strain on hospitals. And that when hospitals have constraints and they're looking for departments and areas that they can cut funding, the maternity ward is often the first and easiest option for hospitals that need to cut costs. And that's especially true in rural and underserved hospitals. It's just a fact that even before this bill last year, hospitals were already struggling to keep their maternity wards open.
From 2010 to 2024, more than 700 hospitals closed their maternity wards. And since the passage of the bill last year, more than 50 maternity wards have closed or announced plans to close. Experts are warning they're expecting even more of those. And so it's an issue that's particularly concerning to me. In Texas, almost half of the 254 counties currently lack any access to maternity care.
Texas already has the highest uninsured rate in the country, and it's expected to increase. And 50% of the births in Texas are covered by Medicaid. And right now, the Trump administration is currently withholding about $9.8 billion for Texas's fiscal year 2027 Medicaid supplemental payment. 50%. Texas hospitals are losing $27 million a day in Medicaid funding.
So between all of these factors, I am concerned that more hospitals across Texas and across the country will close their maternity wards. So Dr. Atwood, with the time I have left, I just want to ask you how maternity wards closing in hospitals will impact patient access to care and at the same time your views on what those closures will mean for health outcomes for expectant mothers and the maternal mortality crisis that we are experiencing.
Eileen Atwood
Thank you very much. And, you know, as you noted, hospitals are closing at an alarming rate and OB-GYN or labor and delivery units in particular are closing even faster than that. And the more we see labor and delivery units close, the harder it is to access that really important high-quality safe labor and delivery or obstetrics care. Which means our patients are driving further, driving through potentially difficult conditions, needing to get a place in just as we heard from our colleague time is brain.
Time is really important for our patients. We need them to be able to see their OB-GYN to get their safe care as quickly as possible. And so we do worry the more that these labor and delivery units close, the harder that care is to access. But that is also why the Rural Obstetrics Readiness Act is so important, to also be able to mitigate some of those changes so that we have the tools and supplies for our colleagues in those rural hospitals to be able to diagnose, evaluate, treat, and safely transfer those patients in the process of getting them to where they can see an OB-GYN like me.
Redner 17
Well, thank you. I'm at the end of my time, so I have additional questions for you that I will submit for the record, and with that, I will yield back.
H. Griffith
Thank you very much. I now recognize the gentlelady vice chair of this subcommittee from Tennessee, Mrs. Harshbarger.
Diana Harshbarger
Thank you, Mr. Chairman. And thank you to the witnesses for being here today. And I'm happy to see my fellow Tennessean here, Anthony, and thank you for being here. We've worked together for a lot of different legislation, and I appreciate your hard work. You know, today's hearing covers several important bills, including one of my bills, it's H.R. 5737, it's the Radiology Outpatient Ordering Transition Act, and I won't say that only once.
It's called the ROOT Act, and it's expected to save approximately 2 billion in reduced Medicare spending and produce 1.5 billion in savings for Medicare beneficiary over 10 years. Since 2023, the AUC program has been indefinitely paused because it became clear its requirements were not working as intended. The ROOT Act will make the necessary fixes to address these problems so providers will have the clinical support tools at the point of care, strengthening appropriate imaging utilization and provide meaningful program evaluation for future improvements. And Mr. Chairman, I'd like to ask unanimous consent to enter the statement of the American College of Radiology into today's hearing record.
Without objection, so ordered.
Diana Harshbarger
Thank you, sir. Now I'm going to focus on H.R. 3164, that's the ECAPS bill, the Ensuring Community Access to Pharmacists Act. And we'll start with Mr. Pudlo. Tennessee has taken significant steps to expand the role of pharmacists in patient care. And you know, I live in a rural district, our chairman lives in a rural district, it's just, when you have distressed and at-risk counties, it's hard to access care sometimes.
So one point we don't discuss often enough is cost. So how can pharmacists providing care reduce costs and help reduce that avoidable healthcare spending for both Medicare and taxpayers when you do the testing, treatment, or other clinical services closer to home?
Anthony Pudlo
Thank you for the question, Congresswoman. And I think to continue to emphasize the points that not just in my verbal comments but written is that we continue to see pharmacists by providing such services for testing and treating for respiratory illnesses, we're really helping that patient, preventing them from having to go to a higher cost location. And I think even in my days as a practicing pharmacist, I saw the same thing. We were able to help navigate the complexities of our healthcare system and help that patient figure out where is the best source for them to get access to treatment.
Diana Harshbarger
That's true. You know, I've been doing this for 40 years, and as a pharmacist, they come in and we triage them. We send them to where they need to go, whether it's physician or other outpatient facility. So let me turn my questioning to Dr. Andrews. You mentioned that only six of approximately 60 internal medicine residents in your program chose primary care.
Do you believe Medicare's payment system is contributing to that workforce problem, and could the Patients First Act help with that?
Rebecca Andrews
When I have a third-year resident asking me what I think about the 2027 Medicare proposed fee rule, yes. I think that the reimbursement plays a significant role, just listening to the amount of debt they have and trying to pay for that. I think stabilization, you know, catching up on the 30 years of inflation and then stabilization of payments, including the Patients First Act is going to stabilize APM payments for another three years. People who are in the midst of trying to provide higher quality care can then get reimbursed and rely on that. I think all of that is really important to quite savvy medical residents who are thinking about how to survive and open their own practice.
Diana Harshbarger
Yeah, because that's an anomaly to have your own practice, isn't it?
It is now.
Diana Harshbarger
It is an anomaly. And I see a lot of docs now going out of their practice to do cash-based practices because of some of these things. Now I'll go back to Mr. Pedlow, based on your experience working with pharmacists across Tennessee, what would it mean to seniors if Congress passed H.R. 3164 and allowed Medicare to better align with the services that we can offer at the pharmacy counter?
Anthony Pudlo
Thank you for the question. I would say it means the world to pharmacists. There's so many pharmacists right now that are already providing such services and they're seeing compensation, whether it's for a commercial health plan or our TennCare program, but then the majority of patients that come to a pharmacy are Medicare beneficiaries. And so it's really difficult for a pharmacy to completely transition their workflow and their practice model to do that. So to me, it would be a very big benefit.
Diana Harshbarger
Gentlelady yields back, now recognize Dr. Ruiz for his five minutes of questioning.
Raul Ruiz
Yes, thank you. Thank you so much. Let me just get my notes here. Today's hearing provides an important opportunity to improve access to care for our seniors and ensure that Medicare providers can deliver the care their patients deserve and depend on. For seniors on fixed incomes, where they receive services is not just a matter of convenience, but it directly affects their ability to afford and access healthcare.
Millions of Medicare beneficiaries, especially those with serious chronic conditions, rely on office-based settings and ambulatory surgical centers for timely, affordable treatment. But reimbursement differences between these care settings, particularly for services requiring high-cost medical supplies, can push certain procedures out of the most convenient, affordable options for seniors. In my district, the Imperial Valley has some of the fewest hospitals and surgical centers per capita in the country, meaning seniors often drive an hour or more for care. When reimbursements make a procedure uneconomical for local provider, patients face added travel, missed workdays, and delayed treatment with real consequences for their health. That is why I introduced the Promoting Fairness for Medicare Providers Act alongside my colleague Representative Bilirakis.
So this bill would correct this by aligning Medicare payment rates across care settings for procedures with high supply costs. Modernizing reimbursements and restoring payment parity would let seniors keep care with their trusted providers without disrupting their treatment. Dr. Andrews, beyond this legislation, what specific changes to Medicare's payment policy should be implemented to restore payment parity across care settings and what impact do these payment disparities have on beneficiaries' out-of-pocket costs?
Rebecca Andrews
Thank you for that question. I think being able to catch up the office-based environment with inflationary increases compared to hospitals and nursing facilities who have had that all along is really important to keeping the care outpatient and independent practices, especially as we've all talked about today in rural environments, open.
Some other things that are really helpful, the five-year hybrid payment pilot that's in the Patients First Act, that could truly stabilize the ability to innovate care, but do the kind of care that we're talking about with phone calls, collaborating with pharmacy, with OB-GYN and other folks.
Raul Ruiz
Thank you, thank you. You know, we also know that Medicare is a lifeline for seniors. We know that seniors rely on Medicare, but the reimbursements for physicians have not been keeping pace with the cost of providing that care and with the inflation. And plus you have fluctuation costs, cuts that are happening as we speak, proposed rules. So we need to do a better job at expanding Medicare access to seniors.
We need to end these end-of-year cuts and we need to pay providers a fair reimbursement rate so they can keep their doors open, because if they close their doors, seniors can't see them. And that's a senior access issue. And that's why we need to tie the reimbursements to the full MEI. All the other providers have full parity, full MEI reimbursements. And so that's why, you know, I introduced the Protecting Medicare for Patients and Providers Act to tie the reimbursements to the full MEI.
Representative Bilirakis is a lead cosponsor of that bill as well. You know, there's a lot of great things in the Patients First Act, but I'm a little worried that we're shortchanging physicians. We're shortchanging providers and trying to call it a doc fix when it's not a doc fix. It's got to be able to, doctors have got to be able to keep their doors open and the most simple way of reimbursing physicians for fairness is by fully matching the full MEI, just like all other providers, to have parity for physicians. So Dr. Andrews, would you prefer a full MEI reimbursement?
I think everybody would, however...
Thank you. So I want to ask Dr. Aland, would you prefer a full MEI reimbursement?
Murad Alam
Yes, sir, but we feel the Patients First Act is a good first step and we thank you very much for your leadership in pushing for a full MEI adjustment.
Raul Ruiz
Great. Well, I just want to make it clear that this is going to leave an unsatisfactory sentiment amongst the provider organizations. I agree this is a good next step, but this isn't the fix. We can't stop until we have the full MEI parity. With that, I yield back.
H. Griffith
Gentleman yields back. Now recognizes the gentleman from Pennsylvania, Dr. Joyce, for his questions.
John Joyce
Thank you for yielding, Mr. Chairman, and for holding today's hearing on such a critical topic. Extensive consolidation in our healthcare system has left the American patient facing skyrocketing costs and less access to doctors. This is driven in no small part by the death of the private practice in this country. Today, only one in five doctors is not an employee of a major health system or a large corporate entity.
We have left far too many seniors without access to a primary care provider and pushed more care delivery into more expensive settings through decades of declining reimbursement under the Medicare physician fee schedule. To address these issues, both the GOP Doctors Caucus and the Democrat Doctors Caucus have delivered bipartisan reform to alleviate these issues, to ensure better primary care access for seniors, to create stability for smaller and rural practices. HR 9633, the Patients First Act, authored by me, Dr. Schrier, and Dr. Murphy, is a necessary first step, and I am pleased to see that it is included in today's hearing. Dr. Alum, we're going to make this very simple for the first three questions. First of all, thank you for being here today.
Just very simply, yes or no, are private practice doctors the most cost-effective access points to our healthcare in America?
John Joyce
Dr. Alum, do you believe that consolidation reduces options for patients to receive personalized care from a doctor that they know and a doctor that they trust?
John Joyce
And finally, Dr. Alum, what do you hear from the doctors that you work with about the challenges that they face on a daily basis to remain independent, and how does the Patients First Act address their concerns?
Murad Alam
The Patients First Act is critical in our opinion. The biggest concern we hear from our member physicians is that Medicare reimbursement cuts are impairing their ability to see patients in a timely manner and provide necessary care. Right now, 99% of skin cancers are curable. If that number, because of delay, decreased by even a single percent to 98%, the increased number of deaths would be comparable to the number of lives saved by the use of seatbelts and airbags in the entire country. Now, none of us would be happy having our family travel in a car without seatbelts or airbags, and certainly none of us would deliberately disable those protections if that were an option.
In that context, the Patient First Act is critical. It is critical because while it doesn't provide a full inflationary update, it takes a big step in the right direction at MEI minus one. It also provides for change in budget neutrality, so that if some services in the healthcare system are paid at a higher price, someone else doesn't have to take a pay cut that is unrealistic. And finally, it mitigates the extreme administrative burden on patients and physicians of things like MIPS, which cause doctors to be distracted with paperwork when they could be taking care of patients. We are grateful for your leadership in supporting the Patients First Act and in authoring the Patients First Act, and we are hopeful that Congress will consider this as a necessary step in improving our healthcare system.
Thank you.
John Joyce
Thank you, Dr. Alum. I would also like to thank the committee for considering legislation today from Dr. Miller-Meeks that also deals with the failing MIPS system that you just mentioned, and for Mr. Bilirakis for his work on HR 7863, which helps support office-based providers on keeping services with costly supplies out of the hospital setting. We must all continue to work and build on these reforms and advance them by the end of the year. The annual year-end patchwork needs to stop. We must pass the comprehensive reforms contained in the Patients First Act and others that we are considering as well to ensure access to the highest quality of care that all of Americans deserve and that all of Americans want.
Redner 24
Thank the gentleman, yields back, and now recognize the gentlelady, Ms. Kelly, for her five minutes.
Robin Kelly
Thank you, Chair Griffith, for convening this hearing, and thank you to all the witnesses. As the committee considers ways in which we can strengthen our healthcare system through provider payment reform and protect our health infrastructure, I would like to focus on the question of whether patients in this country can actually access the care they need in the first place. Maternal care has constantly been treated as an afterthought in this country, and every day women pay the price. The United States is facing a severe maternal mortality crisis, and as hundreds of women die every year from mostly preventable pregnancy-related complications, labor and delivery units are being closed. Between 2010 and 2024 alone, over 700 hospitals across the country closed their obstetrics units.
These closures have mostly impacted rural areas, have most impact rural areas, and as a result, 58% of rural counties lack obstetric clinicians. Pregnant and postpartum women living in these counties are left stranded, forced to travel long distances to access the critical care they need. I had a farmer tell me he had to drive 60 miles for his wife to have her baby, and she wasn't ready, drove 60 miles back, then she was ready, 60 miles back. In emergency situations, every minute that care is delayed can result in catastrophic consequences. Dr. Atwood, you are a practicing OB-GYN, and you have handled emergency obstetrics care directly.
Firstly, I would like to thank you for your critical work and thank you for your testimony today. In your experience, when an obstetric unit closes, what is the impact on the surrounding communities?
Eileen Atwood
Yeah, thank you for the question and thank you for your leadership, Congresswoman. It is a very real experience for both patients and clinicians and OB-GYNs when this happens. If I can use an example actually just from this past weekend as well. So we have many hospitals in our area that do not have labor and delivery units and do not have OB-GYN providers within the hospital. But patients don't always know that, right?
They think it's the closest hospital to their house, that's where they go. So we had a patient who presented in her early third trimester, did not know she was pregnant, and had abdominal pain. Ultimately speaking, the emergency medicine clinician there very quickly realized we're concerned about preterm labor and we're concerned this baby is going to deliver in a place that's not going to be suitable for that baby to come out and to be the most safe for the mom. So they were able to call us and say, hey, how can we help, what can we do? We talked them through an evaluation, we talked them through the necessary medications to help prevent infection for the infant, to help slow the contractions in order to help her safely travel to our institution, to give the medications to help that baby's lung mature if it were to deliver.
In the end, ultimately, the mom was transferred to us and the baby was safely not delivered and she was able to stay pregnant because we had all of those tools at our disposal, including the warmline that they were able to call. And so whereas we of course would always like our patients to have the fastest access to OB-GYNs, we know that's not always the case, and the Rural Obstetrics Readiness Act really helps bridge that gap to be able to provide that care when needed.
Robin Kelly
Thank you. I introduced the bipartisan Rural Obstetrics Readiness Act alongside my colleagues Reps Schrier, Kim, and Musser to work to address the widening gap in maternity care. As you noted in your testimony, in areas where there's no obstetric services, emergency departments and other healthcare facilities play a vital role in maternal and infant health, but they are not always equipped to take on the most severe cases. So for facilities in rural areas without obstetric units, how can training and equipment help bridge the gap to stabilize an obstetrics emergency?
Eileen Atwood
Yeah, it's training is so important and having the necessary equipment is also really an really important piece of that puzzle. And so being able to work directly with the trainees in emergency medicine, family medicine, nurse practitioners like I stated earlier is the first step. And then making sure they have the tools in their institution. These tools might be hemorrhage cart materials or to manage infant warmers, a bedside ultrasound they might not have or might not have the training to have, teaching them to be able to locate where is that baby, what is the heart rate, can we safely deliver this baby? You know, other important things like specialized anesthesia equipment, which is not always the same for a pregnant mom.
You know, emergency delivery equipment, even beds that support delivery in an emergency department, which most places don't have. Making sure we have that available so when those patients do present in acute settings that we have the supplies they need to be safely managed prior to transfer.
Robin Kelly
Thank you. While this is just one step in the right direction in addressing the US maternal mortality crisis, access to these resources can mean life or death for rural moms. And I urge my colleagues to please, please, please help me push this legislation forward. And just wanted to give my support for HR 9693. Thank you and I yield back.
Redner 28
Thank you. Appreciate it. Now recognize the gentleman from Oregon, Mr. Bentz, for his five minutes.
Cliff Bentz
Thank you, Mr. Chair. I also want to talk about HR 1254. We in my second largest district that's not a state in the United States, 70,000 square miles, have a huge challenge when it comes to obstetrics. And in fact in little Baker City, Oregon, we've just lost our obstetrics department, which means that anyone presenting there has to drive 45 miles to the closest place and perhaps further if you go the other direction. So this this legislation is of incredible interest to me for those for those or those reasons and others across the district.
One of the I'm a lawyer and I represented hospitals and and doctors in medical malpractice suits. And the the cost of obstetric coverage is a lot, about $150,000 a year. So I am curious, Doctor Atwood, the the challenge of training people up is one thing, but it's quite another then to have the money to pay for the coverage necessary. Can you share your thoughts on what we might do in in being able to actually afford to have people try to practice obstetrics when they're trained up but not really a doctor?
Eileen Atwood
Yeah, thank you for that. You know, it was mentioned earlier about the number of patients who are having deliveries that are paid for by Medicaid. It's about a little over 40% in the United States of births are paid for by Medicaid. And ultimately we know that Medicare informs the Medicaid pay rates. So one of the key parts of keeping labor and delivery unit closures, and this is a multifactorial problem with lots of financial pressures, right?
As you the costs are difficult to cover, there's the high cost of malpractice insurance as you mentioned, lower birth rates in rural areas. Ultimately it's very difficult and costly for around the clock OB OB staffing. That if we can help to stabilize in all honesty the Medicare payment, that will hopefully help to influence and inform the Medicaid payment rates that will ideally be one of the many solutions we can have to keeping these labor and delivery units open across our nation.
Cliff Bentz
Actually the the question that I've had and when I was in the Oregon legislature we addressed this issue never successfully was in some fashion trying to provide protection to the OBs that were that were that were practicing in these spaces and saying, hey, these risks are extremely difficult to manage, particularly if you don't have an OB physician on staff and particularly if you're trying to hold the situation stable as you're driving literally not necessarily hundreds of miles, but but it's possible.
Redner 27
And then this brings us to the the attempts that we've made in the in the big beautiful bill to put millions of dollars into these rural hospitals to to try to help. But we've created different situations in our tort law that makes the the error that may occur in that process extremely attractive to lawyers and frankly the damage is so great when a little newborn is harmed that it's it's difficult to even recognize how in the world one's going to pay those bills. What I'm trying to get at here is, is this enough that we train these people up or do we need to broaden the scope of this bill or add to it after I hope it passes to to address this tort liability problem?
Eileen Atwood
You know, I appreciate the the emphasis on the importance of the Rural Obstetrics Readiness Act and how it really does help to provide fill in the gap of when there's not an OBGYN available and certainly we want more obstetric providers across the country to be able to be in those spaces to be able to work in those hospitals. We want to work with our colleagues across the House of Medicine to be able to safely manage obstetric emergencies and we want to to work with Congress to be able to get this bill across the finish line.
Redner 27
The the bill also contains a pilot program for teleconsultation and this has been something that's coming up again and again in rural areas in all kinds of practice areas. But the challenge always is who is the doctor going to be on the that's going to be called to opine over the line so to speak. So what's your thought there? Should we be addressing more than merely the the provision of the equipment? Because I know it does say you have to have qualified physicians on providing the information over the line, but would you as a as a doctor want to be opening yourself up to liability as the one who instructs folks over the line so to speak?
Eileen Atwood
Well certainly teleconsultation has been done in other settings, for example telestroke is available for stroke patients and so there's opportunities to look at this. I mean in Rhode Island we have functionally a literal phone that everyone knows that they can call to that perinatal safety officer that they can get them 24/7 to be able to move that patient and get a hold of that. So I think as you develop those relationships and we develop the training programs it's an important part of how we think through the operations and the implementation of this bill when we get to that point hopefully.
Thank you so much, yield back.
Redner 22
Gentleman yields back, now recognize the gentlelady Dr. Schrier for her five minutes.
Kim Schrier
Thank you Mr. Chairman, ranking member and witnesses. I am excited about several bills today. The first I want to talk about is that the bill that I lead with Congresswoman Kelly, HR 1254, the Rural Obstetrics Readiness Act. It is included in today's hearing and I'll tell you that in the wake of the one trillion dollar cut to Medicaid, rural hospitals are going to be pushed to the brink of closure. Many of them are already there and the first thing to close is labor and delivery and this bill is critical to keeping those moms and babies safe.
Now I want to pivot to the Patients First Act as you I'm sure are not surprised. I am so thrilled that this committee is considering my bill, the Patients First Act. For the last year or over a year Congressman John Joyce and I have been working together on this bipartisan Medicare physician reimbursement package that stabilizes Medicare payment, invests in primary care and reduces administrative burden for doctors. This is long overdue.
I've heard criticism in this hearing that this doesn't go far enough. But this is a great bill, and what we do here in Washington, D.C. is all about the art of the possible. This product is the result of consensus between Democrats and Republicans, doctors, specialty physicians, primary care doctors, consumer groups, patients, and more. We have broad support from bipartisan members on this committee and in Ways and Means. We've been able to gain this support for a simple reason: fair reimbursement respects the work that physicians do and keeps practices open and available to patients so that seniors can get the care they need.
And our bill tackles more than just stabilizing payment. We invest in the desperately needed primary care that is so foundational to wellness and managing chronic diseases, and we also reduce administrative burden in the MIPS quality program. Thank you, Dr. Andrews, for your work and for painting such a beautiful picture of what primary care physicians do for our patients over decades. Quality metrics, known as MIPS, were really well-intentioned. But they have led to overwhelmingly burdensome administrative responsibilities, like 53 hours and almost $13,000 per physician per year to do this paperwork, and yet with no clear improvements in outcomes.
And if the doctors don't meet those metrics, they get penalized. And unsurprisingly, if you're a small practice in a rural area and you can't take on the administrative burden that a big hospital can, then you get penalized, and then that makes them more likely to get gobbled up by a giant system or private equity. Dr. Alam, can you speak to the MIPS measures just briefly that exist for dermatology and whether they even apply to your specialty or measure actual quality?
Murad Alam
Thank you for that question. I think the simple answer is they do not. I think many measures are developed because they're simple to measure or because some organization thought they might be a good idea, but the doctors involved who are dealing with patients on a daily basis are very seldom consulted. And while we expend a lot of time tracking these measures and reporting them like you said, it doesn't really help patients get better care.
Kim Schrier
That's right. And we hear that across the board. And that's why this bill makes sure that it's the physicians who are determining what are the best metrics to measure quality and that those are reevaluated frequently. That's so critical. I just want to say it is time for Congress to finally right this ship and to enact long-term reform to physician payment.
We can't pass yet another short-term fix and leave everybody on edge till the end of the year like we've done for so many years. Without patients-first physician practices will continue to close or be bought out by large hospital systems, private equity, or insurance companies, and that just raises the cost of care for everyone. And without support for primary care, we can expect to see fewer and fewer medical students pursue that path. I urge this committee to move this legislation straight to markup. We need to pass the Patients First Act immediately.
Thank you. I yield back.
Troy Balderson
Gentlelady yields back. And I would now recognize the gentleman from Ohio, Mr. Balderson.
How are you this morning, sir? Thank you, Mr. Chairman, and thank you all for being here today. It's afternoon now. I am a proud cosponsor of H.R. 3164, the Ensuring Community Access to Pharmaceutical Services Act. My first question's for Dr. Pitlow.
In many rural communities, the local pharmacy is the closest and most accessible place to receive care. This bill would allow Medicare to cover tests for respiratory illnesses like RSV and strep throat when permitted by state law. How would this common sense change help seniors get care sooner and avoid unnecessary trips to the emergency room?
Anthony Pudlo
Excuse me, thank you for your question, Congressman. I would completely agree with your assumption in what we're trying to do with the piece of legislation. H.R. 3164 is about giving seniors access first and foremost. Pharmacists already are, especially in Tennessee and multiple other states, already have this authority. We're just needing to make sure there's a payment mechanism behind it.
And so right now we see pharmacists doing this on a regular basis across this country and it is about helping them go through a more convenient location instead of going through a more higher cost location, say like an emergency department.
Troy Balderson
Thank you, and my rural pharmacists love this too, as you would assume. My next question's for Dr. Alam. Dr., good to see you here. My next question's for you, sir. You noted in your testimony significant concerns about MIPS and the administrative burdens it places on physicians.
What reforms could Congress consider to improve the program for specialists?
Murad Alam
I think to improve the program for specialists, the specialists should be involved in the process of developing the measures and better understanding, first of all, more research into understanding what does improve quality and then finding ways to incorporate that in the routine delivery of care. I think the current system is predicated on a simple solution to a difficult problem, which is how to improve quality, and while it is well-intentioned, as Congresswoman Schrier indicated, it's not meeting those goals. So I think we have to go back to the beginning, involve patients from different specialties, say, what is it that would make your patients healthier? How could we get them more effective care and then implement that?
Troy Balderson
Thank you very much, sir. Follow up to that, what roles could clinical data registries play in these reforms?
Murad Alam
Clinical data registries are very important not only for reporting MIPS as it currently stands, but also for understanding better the quality of care that's delivered and doing research into understanding what works. In dermatology, we have such a registry called DataDerm that's been around since 2016 and has about 70 million encounters, and many other specialties have these as well. Using those as a building block to better understand what works for our patients will be very helpful in developing better measures.
Troy Balderson
Thank you very much, sir. My next question is for Dr. Andrews. Good afternoon, Dr. Andrews. H.R. 6130, the Alzheimer's Screening and Prevention Act, would provide Medicare coverage for blood-based tests that detect Alzheimer's disease and related dementias at an early stage. How can Congress balance investments in early detection with continued funding for research into effective treatments and a cure?
Rebecca Andrews
Thank you and good afternoon. I think that Alzheimer's, you know, the American College of Physicians, we treat all chronic conditions, and diagnosing them as early as possible and finding treatments that work for them are an investment that, as you said, needs to be balanced. But when we're preventing downstream effects, whether it's leaving a patient without access or causing high-cost admissions because we haven't diagnosed the cause of something, the Patients First Act, along with looking at, as my colleague Dr. Alam said, what works for patients, what kind of quality outcomes do we have, would be a way to balance that.
So making sure that treatments do what they're supposed to do, and that we can get them to patients as early as possible with diagnosis.
Troy Balderson
Thank you very much. My last question is for Mr. Garcia, and we have about 30 seconds, sir. Rural and smaller hospitals, excuse me, face serious cyber threats, but often lack the staff and resources of the larger healthcare systems. How can Congress help these hospitals strengthen their cybersecurity without imposing unnecessary requirements?
Greg Garcia
I think that's a very good question, Congressman. I think congressional funding to assist the nation's rural hospitals for the kinds of workforce and technology needs that will help secure them, and also building mutual assistance support across communities in rural areas. I think there is strength in numbers, and we produced a report called On the Edge, which interviewed 40 executives in rural providers across 30 states. And really workforce was probably their number one need. They knew what needed to be done, they know what needs to be done in cybersecurity, but they don't have the expertise, the resources, and the people.
Thank you very much. Mr. Chairman, I yield back.
H. Griffith
Gentleman yields back, now recognize Mr. Landsman for his five minutes.
Greg Landsman
Thank you, Mr. Chairman, and thank you to you and the ranking member for this hearing today. I wanted to say how much I appreciated the testimony for each of our witnesses. Very supportive of the Patients First Act, want to thank my colleagues for leading this, and all of the additional suggestions around physician pay, I think are really important. I'm going to get into those a little bit more. The National Plan for Epilepsy Act, I just want to say how important that is, and Gabby, I really appreciated your testimony and your family being here today.
I know this isn't easy, and I found it to be so incredibly compelling, and obviously this is something we need to act on. The Rural Obstetrics Readiness Act, so incredibly important. The piece I want to get into today is around pay and what's at the core of this healthcare crisis, the fact that costs are skyrocketing, care is diminishing. The ability to see a doctor is becoming more and more problematic, and there are three things that Congress has not done. One is obviously kept up with physician pay.
Congress has decided not to pay physicians what they need to be paid, and that combined with the fact that Congress has decided that physicians will get paid less if they do it on their own as opposed to if they do it with a hospital. So Congress has said we're going to pay hospitals more for the exact same procedure if the procedure is done with the hospital as opposed to if it's an independent physician-owned practice. And then third, Congress has refused to rein in private equity, Wall Street, and the consolidation that's happening throughout the entire economy, but certainly healthcare. And all of this has conspired to, you know, to increase costs, huge cost increases for patients. The Kettering Foundation tells this story, and it's emblematic of stories I hear all the time, of a patient in Ohio who had a procedure, and if that procedure had been done with the physician that she found in the physician's office, it would cost $3,000.
But because of who owned the surgery center and where the insurer wanted this procedure be taken place, it was taken place at a hospital for $6,000.
So she ended up paying $3,000 more because of this. And I hear this from physicians all the time, which is, when I was on my own, I charged $800. But now that I got bought up and I work now for the hospital or this insurance company or a private equity firm, it costs patients $2,300, $2,600, two to three to four times more. This is at the heart of this healthcare crisis. The, you know, how we got here, I think is really important.
Congress has not updated the Medicare physician fee schedule since 2015. The American Medical Association estimates that between 2001 and 2025, physician pay for Medicare increased by 7% while medical practice costs rose by 59%. Physician payments have dropped by 33% since 2001, as we've heard. As of January this year, 64% of all physician practices were owned by hospitals or corporate entities. 82% of all doctors now work for the hospital, a corporation, the insurer, or private equity.
82% of all doctors. Investors are coming in and buying up our local clinics, hospitals, and doctor's offices. This has obviously led to skyrocketing costs. Dr. Alam, dermatology is obviously a place this has been hit. If Congress does not improve reimbursement rates, rein in private equity, change the way we reimburse doctors or hospitals, what will be the impact on patient care?
Murad Alam
The impact on patient care will be fewer places to find a doctor, much longer waits, dramatically worsened disease processes, advanced cancers, deaths that are avoidable, all the things that you already mentioned. We don't really know what we're going to do, how we're going to deliver the services that our patients need when costs keep going up every year and we are paid less every year. We support practices, we support staff, we need space, all of that costs money.
Greg Landsman
Thank you, Mr. Chair. Congress needs to increase reimbursement rates for physicians. Congress needs to rein in Wall Street and private equity and stop the consolidation, break this stuff up, and Congress needs to stop paying hospitals more money for the exact same procedure if it's done at a hospital versus a privately owned, doctor-owned physician clinic. Thank you, I yield back.
H. Griffith
Gentleman yields back. Now recognize the chairman of the full committee, Mr. Guthrie, for his questions.
Brett Guthrie
Thank you. Thank you very much. And I know we have a couple hearings going on, so I've been in and out. So I may ask some stuff that you've kind of touched on earlier, but it'd be good to kind of frame it or frame the question and get a more elaborate answer or elaboration. So, Dr. Alam and Andrews, MACRA was signed into law over a decade ago with the goal of moving past the need to enact annual doc fixes and transitioning the Medicare program to value-based care.
Yet many of these issues still persist. We're looking at annual doc fix coming up. Could you speak to how many of the reforms being discussed would address these challenges and what do the reforms ultimately mean for citizens' access to care?
Murad Alam
I think many of the reforms in the Patient First Act would address some of these challenges. One big problem that's been highlighted is there's really not been an inflation adjustment since about 2001. So 25 years of inflation rising but costs remaining the same, reimbursements remaining the same is a big problem.
Another big problem is budget neutrality. Budget neutrality means the pie is of a fixed size. If some part of the medical system is paid a little more, some practitioners paid a little more, someone else has to take a pay cut. When the overall pie is shrinking based on inflation anyway, that sort of double hit makes it even harder for practitioners. And then finally, as we've heard, there are many administrative rules that are burdening patients, making it harder for them to spend their limited time seeing patients, and are in fact forcing consolidation because independent practices just cannot meet these administrative burdens.
So we are hopeful that your committee and Congress will consider the Patient First Act since while it doesn't solve every problem, we think it's a very important step to mitigating this decades-long erosion of our capacity to take care of patients.
Okay, Dr. Andrews.
Rebecca Andrews
I concur 100%, especially with the fact that this is one of the first acts which allows all physicians of all specialties to work together instead of pitting one loss versus one gain. A couple of the other things that the Patient First Act does that is really important is this five-year hybrid payment that will allow for primary care to not only have fee-for-service, but also a separate payment that will help us do the things that we know actually matter. If my pharmacist from my office calls patients and makes sure they are taking their medications, that helps them stay out of the hospital, but I need a way to be able to pay for that. And so that allows for innovation that truly improves quality. And then I think we're all in agreement today that having clinicians and physician organizations able to influence the quality measures that we are looking at is really important.
Let's measure what matters, what produces longer lives and healthier patients.
Brett Guthrie
Okay, thanks. And so you talked to a pharmacist as well, so I'm going to switch to Dr. Pudlo. As this committee considers policies to modernize the Medicare payment policies, what role can pharmacists play in enhancing seniors' ability to get care they need, especially like I have rural areas?
Anthony Pudlo
Yeah, thank you for your question, Chairman. I'll kind of piggyback a little bit off of Dr. Andrews' as well because there's a lot of different ways that pharmacists can provide services in the system. But I know specifically I'm here, I want to really emphasize again the valuable role of HR 3164. That alone, that type of service that is already happening for a lot of patients in your state, but where there's compensation from Medicaid and commercial plans but not Medicare, that's a problem. And 3164 is really ultimately a cost solution for Medicare.
It's letting, if a senior's not getting this service paid for, they're going to an emergency room that's much more costly, they're facing the bill. We need to have coverage at the state level for such services that pharmacists are allowed to provide.
Brett Guthrie
Thank you. Yeah, I agree. There's pharmacists could be miles, hours away from a local medical health medical provider or healthcare facility, and they're in all communities, so it's important to do. So Mr. Garcia, before we go, so we talked about regulatory burdens and paperwork burdens and all the other. So Healthcare Cybersecurity and Resiliency Act before us today includes several more policies to coordinate planning HHS for cybersecurity.
Are there any additional policies you believe would further enhance HHS's ability to address healthcare cybersecurity without risking duplication or excess burdens on the providers?
Greg Garcia
No, I don't think there's more regulation needed on the healthcare sector. One of the areas that's most essential to us is the fact that so many of these healthcare providers and large hospitals are depending on third-party technology and services that are not regulated, that are not held to higher cybersecurity standards, particularly for critical infrastructure industries like healthcare. And the end result of that is my colleagues here on the panel and other hospitals are left holding the bag when the technology goes dark. And so I think we need, and it's not just HHS's responsibility or CISA, but we need to think holistically about how we can have...
I asked you a long question and didn't give you much time to respond. I absolutely hate doing that, I hate when people do that when I'm sitting in the chair, so I apologize and I'll yield back.
H. Griffith
Gentleman yields back and... You want me to go to Ms. Houchin first? No, I don't mind a bit. Recognize the gentlelady from Indiana, Ms. Houchin, for her five minutes of questions.
Erin Houchin
Thank you, Mr. Chairman, and thank you to the witnesses for being here today. Our nation's hospitals are facing increasingly serious cybersecurity threats. Ensuring that the healthcare system has the tools and safeguards necessary to protect against these malicious actions are critical. Every cyberattack has the potential to impact hundreds, thousands, or even millions of individuals, and in healthcare, the consequences go much farther than a simple stolen password or a compromised computer system. Recent cyberattacks, including those in my district, have resulted in cancelled surgeries and appointments, payment system outages, and even an inability to provide emergency care.
The Department of Health and Human Services has reported a staggering 329 reported breaches this year involving hacking or information technology incidents at healthcare providers and health plans. These threats pose even greater risks to rural hospitals, which may serve as the only source of care for miles and often have fewer financial and personnel resources to prevent and respond to cyberattacks. And the reported breaches are only those of a greater than 500 patient impact. That's why I'm pleased to see H.R. 9908, the Rural Hospital Cybersecurity Enhancement Act, included in today's hearing, and I want to thank my colleague, Congresswoman Schrier, for her partnership on this bipartisan bill. Our bill takes a targeted approach by directing HHS to develop a comprehensive rural hospital cybersecurity workforce strategy, expand cybersecurity training resources, and improve preparedness against these growing threats.
Mr. Garcia, in your testimony, you emphasized the importance of structured coordination between HHS and CISA and the healthcare sector. How could this bill improve that coordination between the entities, and what gaps are there in the current federal response that this legislation could address?
Greg Garcia
Well, I can tell you that HHS and the Sector Council are very well focused on the rural healthcare issue and the resource-constrained, not just rural, those that just don't have the resources. I think there is a lot that the government can do to help, but there's also work being done on the private sector side in the form of mutual assistance and partnership. And I'll highlight one issue for the Congresswoman from Texas, that there is an initiative going on right now called Secure Texas, in which they are looking to improve the interoperability and security of healthcare data. And they're using an accreditation system to train people, young students in college, to learn good healthcare cybersecurity using the tools that my council has produced, accrediting them, and then placing them in healthcare organizations, particularly rural and resource-constrained providers. So that's a good example of where government and industry, in this case state government, are working together to help rural providers.
Erin Houchin
This will provide much-needed stability and predictability into the Medicare physician fee schedule while also improving incentives for value-based care. I'm proud to co-sponsor this legislation and I'm grateful to Dr. Joyce for his leadership on this important issue. Dr. Andrews, in your testimony, you highlight how essential a healthy primary care physician workforce is to improving patient outcomes. What would the reforms proposed in this bill mean for primary and independent providers, especially in rural areas? And in what other line of work do we pay people less if they are more efficient in doing their jobs?
Great, thank you. And I want to turn to the Patients First Act, H.R. 9693.
Rebecca Andrews
That's a great question. I guess the same kind of industry where you can bill and then have it automatically downcoded and sent back to you for less reimbursement. You know, the Patients First Act, I have to say again, is the first bit of hope I've had in a long time for primary care, especially the independent practices that produce just absurdly great outcomes for their patients. Being able to have this stable payment, both from the physician fee schedule, but also correcting the, you know, three decades of inflationary losses, will really allow a stable business model for people to open their own practices and those who are in practice to continue. And then I love the part about, you know, paying them for innovation.
Erin Houchin
Efficiency. Thank you. In the remaining time I have, I just want to note that in the Working Families Tax Cuts Act, we did include a fix for the physician fee schedule, which was subsequently supplanted by the efficiency adjustments, which I hope that we will soon correct, and I'm proud to see this legislation as a subject of this hearing today. Thank you. I yield back.
H. Griffith
And gentlelady yields back. Now recognize gentleman from Georgia, Mr. Carter.
Earl Carter
Thank you, Mr. Chairman. Mr. Chairman, before I begin, I would like to ask that on unanimous consent to enter into the record supportive statements from the National Consumers League, the Patients Rising, and nearly a dozen other national patient consumer and provider advocacy organizations.
Without objection, so ordered.
Earl Carter
Thank you. Thank you. First of all, I want to express my thanks to my colleagues, particularly on both sides of the aisle, particularly to the gentlelady from New York, Congresswoman Clarke, who has for nearly a decade worked with me on needed vision benefit manager reforms. And I am saying VPM, and V is in vision. Many of you know me as Mr. PBM, and I'm not talking about PBMs in this case, I'm talking about VPMs.
National surveys showed that healthcare affordability and control of important health decisions remain one of the top topics that people are concerned about. And the growing insurer consolidation that I pointed out in pharmacy is also spreading in other parts of healthcare as well, including in vision management. It's making our healthcare too expensive and too restrictive. Dr. Alum and Dr. Andrews, both of you have testified that payment pressure and administrative burdens are pushing independent practices towards consolidation. Dr. Alum, when independent practices disappear, what changes for patients in term of access, choice, and cost does this create?
Murad Alam
When independent practices disappear, people first have to travel very often further because some of the first independent practices to mow away are those in rural areas, and also when there's consolidation, there's less incentive for those large practices to even develop areas in rural areas which are often less profitable. In addition, because there're fewer places overall, people have to wait in line to get an opportunity to go there, which means they're often going to have more advanced disease, have suffering, and often have irreversible harm that could have been prevented had they seen someone sooner.
And then finally, of course, the costs go up because the consolidated entities are very good at negotiating higher rates with commercial insurers and creating other barriers to care.
Earl Carter
In other words, what we need is more competition. Dr. Andrews, you want to comment on this?
Rebecca Andrews
I do. I would agree that when we close practices and patients have to drive farther and they have to give up workdays and their own income, that means that they're going to present less frequently for control of their diseases, which means they're going to cost the whole system, but more importantly, their quality of life is not going to be what it could be. So supporting independent practices, being able to stabilize the physician fee schedule would go a long way to enhancing, especially in those areas where staff cost more, such as those rural environments.
Earl Carter
And you know, I've often said that at the end of the day, whether you're Republican, a Democrat, or an independent, we all want the same thing when it comes to healthcare. We want affordable, accessible, quality healthcare. And accessibility is being impacted by consolidation, particularly in the rural areas as you point out. And I've seen it in pharmacy. Pharmacists are the most accessible healthcare professionals in America.
Almost 88% of all Americans live within five miles of a pharmacy. As pharmacies begin to close as a result of the PBM pressures that are put on them, then we impact accessibility to healthcare. I would also be remiss if I did not mention the funding that we put in the Working Families Tax Cut Act to help rural hospitals. That helps accessibility, so that's very important. I want to talk mainly today about vision benefit managers as I said, because this is something that's happened that is through the consolidation and it's highly concentrated.
There are only, there are two dominant vision benefit managers that cover roughly 85% of the 220 Americans with vision benefits. Now we all know vision insurance is important. We appreciate it, but at the same time, when you've got this kind of concentration, it does not lead to competition and therefore it leads to an increase in prices, a decrease in accessibility, which is not what we want. Dr. Atwood, you testified that the current Medicare payment system has contributed to physician practice consolidation. How do unstable reimbursement and take-it-or-leave-it payer contracts affect a small practice's ability to remain independent?
Amie Atwood
Similar to what my other colleagues have said, you know, as the payment cuts have gone into effect over the course of time and we've seen how that has occurred over the past 25 years, it does have increasing consolidation of physician practices, which include OB-GYN physician practices who do take care of Medicare patients as well.
Earl Carter
Absolutely. I want to end on one note. I had the opportunity during a hearing, not a hearing, but a meeting of this committee, of the, not the health subcommittee, but the full Energy and Commerce Committee and the CBO, the Congressional Budget Office. We had the director and we had 20 of their staff members there. I asked them directly, give me one example of where consolidation in healthcare has decreased cost.
They could not give me one example. Folks, we've got to do something about this, particularly in vision management, particularly in pharmacy management. Otherwise, healthcare costs are never going to come down and accessibility is going to be impacted as well. Thank you, Mr. Chairman, and I yield back.
H. Griffith
Chairman yields back, now recognize the gentlelady from California, Ms. Barragán.
Nanette Barragán
Thank you, Mr. Chairman. Today, if a senior with Medicare sees a nurse practitioner or a physician's assistant for their diabetes care, they must go through a complicated process to get therapeutic shoes that help prevent diabetic foot ulcers. This means delays that leave patients at a higher risk of more serious health complications and more expensive care. That's one of the reasons I'm proud to cosponsor, that's one of the reasons I'm glad the Promoting Access to Diabetic Shoes Act is included today, which I introduced with Representative LaHood to remove administrative barriers so that seniors can more easily access diabetic shoes that they need. So with that, I would like to submit for the record a letter of support from 25 organizations.
Without objection.
Nanette Barragán
Thank you. So ordered. Thank you. I look forward to working with the committee to advance that bill. Dr. Pudlo, you mentioned in your testimony that pharmacists are among the most accessible healthcare professionals in America.
And for seniors, pharmacists are often the healthcare professional they see most frequently, the medication experts they trust most, and a critical member of their care team. I know personally, my father had Parkinson's when I was growing up, and we always went to this local pharmacist. We could just walk right in, we saw him, he knew our name. If there was ever a problem, we were short one pill, he could advance it. And it was really great service.
It was something that 50 years later, I can walk into that same pharmacist and get that type of service. So as flu season starts, we know that Black and Latino older Americans on Medicare are less likely to get vaccinated than their white counterparts. How can community pharmacists help address these disparities in vaccinations?
Anthony Pudlo
Thank you, Congressman, for your question. I think I'll draw some comparisons to some of the conversation we've had with 3164. And, you know, while that bill isn't directly discussing vaccinations, I think you can look at how we are trying to give seniors access to testing services and treating services by pharmacists. You know, I think access alone, it's not going to reduce any kind of disparities. It comes from trust.
And as you highlighted, pharmacists build that trust over decades, like your father. And, you know, that kind of relationship creates those opportunities for open dialogue between a pharmacist and a patient, education, and those types of preventive services like vaccines.
Nanette Barragán
Well, thank you. This recently happened where my mother, who's now 85 with Alzheimer's, although she's now bedbound, several months ago when she still could walk, walked right into the pharmacist to pick something up and they just happened to remind her of a vaccine she needed and she was able to get it on the spot and didn't hesitate. So this is one of the reasons that I co-sponsor the Ensuring Community Access to Pharmacy Services Act, which would improve Medicare coverage of essential care provided by pharmacists, including tests for common respiratory illnesses such as strep, flu, and COVID-19. Trying to get her to a doctor's office is a little more challenging. Dr. Andrews, my next question is for you.
As you highlighted in your testimony, a primary care physician is your health guide over the course of your life and that this relationship builds the trust that produces better outcomes. Yet nearly a third of Americans lack access to a regular primary care provider, and less than 5% of all healthcare spending goes to primary care. What is consolidation in the healthcare system and what could more consolidation mean for patients' ability to access and afford primary care?
Rebecca Andrews
Unfortunately, consolidation has been shown to increase costs versus the lower-cost, high-quality care we see in independent practices. I think one of the other things that consolidation does is when you're putting profits first and patients second, then there's a push for volume over quality. So tagging it back to what you mentioned earlier in the Patient First Act with that upfront per-member fee hybrid model, maybe I'm sitting in the office talking to my Black or Latino patients and saying, "Let's get a vaccine," and that's the most important thing I might do that day. And that's something you don't see or have the time for or the liberty to do with consolidation.
Nanette Barragán
And how does the current Medicare payment system impact doctors' ability to stay independent?
Rebecca Andrews
Unfortunately, you know, going three decades without an inflation increase in payment, staff costs have increased, and then the burdens of MIPS, even as well-intentioned as it was, what has happened is people have to make decisions. I still want to practice medicine, I might have to shutter my doors, and then they become employed, and it reduces access. Rural offices are more costly with staff and less access when they close as well, and it all actually impacts the quality of patient care and the health of our nation.
Redner 46
Well, thank you for that. It's why I cosponsor the Patients First Act. With that, I yield back.
Rebecca Andrews
Gentlelady yields back. Can I ask the gentlelady who her favorite pharmacist is?
We already all know the answer.
Gus Bilirakis
Hey buddy, I like you, but I've got several pharmacists in my family, so I can't, I can't say that, but you're my favorite pharmacist here at this particular hearing at this particular time. Thank you very much. I appreciate it, Mr. Chairman. I appreciate the committee considering my bill, H.R. 7863, the Promoting Fairness for Medicare Providers Act, in today's hearing. I'm proud to lead the bipartisan effort with my friend Representative Ruiz and of course Dr. Murphy and Davis.
Today, many procedures that once required a hospital visit can be performed safely and conveniently in a physician's office. I've seen it with my own eyes. But Medicare's payment system has not kept up. For procedures that require expensive medical supplies, Medicare may not reimburse physician offices enough to cover the costs of those supplies, unfortunately. That leaves doctors with a difficult choice: absorb the loss or send the patient to a hospital or surgical center where the same care will cost more.
For seniors, that means more travel and longer waits, particularly in the rural areas. For taxpayers, it means paying more than necessary. And for independent practices, it's one more financial strain at a time when many are already struggling to stay open. We see that too every day. My bill provides a straightforward, targeted solution.
For a narrow group of procedures involving high-cost supplies, Medicare would reimburse qualified physician offices at 90% of what it would pay an ambulatory surgical center. That gives physicians a fair opportunity to cover the costs of providing the care while still preserving savings for Medicare. This is a common-sense way to bring Medicare's payment system in line with how care is delivered today, all while providing more choice and lower costs to patients. But addressing this specific problem is only one part of the broader work we need to do to strengthen Medicare physician payment. I am also proud to be an original cosponsor of H.R. 9693, the Patients First Act, and I want to thank Representatives Dr. Joyce and Dr. Schrier for their leadership on this effort.
It's a bipartisan effort, and I understand both Doctors Caucuses endorse this bill.
Redner 41
The bill would provide physicians with greater stability and predictability, reduce unnecessary administrative burdens, and help protect the care that millions of seniors rely on. So Dr. Alam, I hope I pronounced that right, you testified that declining payments and growing administrative burdens are placing significant pressure on independent practices. Question number one for you, sir: in your view, how does that ultimately affect patients' access to care and their ability to choose their physician? You also described the concerns your students have about reimbursement uncertainty as well. But if you could answer that question for me, elaborate please, doctor.
Murad Alam
Yes, I think the main way that these effects are seen is by both delay and availability. So people can't get the care they need when they need it and they have to travel much further to get it. I can give you an example that I saw recently: a gentleman, a farmer with a growing cancer around his eye. He had a little bit of denial, kind of really worried, maybe thought he might lose his eye. Finally his daughter took a day off and drove literally a hundred miles from Southern Illinois to see me and I was able to reassure him that it wasn't fatal, that we could save his eye, and we could do the whole procedure that day.
And he was much happier, he went from being shaking and panicky to being relaxed and was able to go back. But it would have been great for him if that care hadn't come so late and if it had come closer to home. So I think that's the fear we have, that this is a gradual erosion and care is going to get harder to find and you'll have to wait longer and longer.
Gus Bilirakis
Yeah, we don't want that, that's for sure. It's not good for our constituents or families. What decisions are they making differently because of that uncertainty as far as the students are concerned, the reimbursement uncertainty, and how could the Patients First Act change those calculations?
Murad Alam
At present, most of the people who finish residency training in dermatology are going to work for large groups, hospital groups, private equity groups, because they get this guarantee of some salary for a year or two. And even though it's a difficult environment and they know they're not providing the best care for their patients and their hands are tied by all kinds of bureaucratic constraints, they have to survive. So we have to give them a fighting chance to have an independent practice.
Thank you very much. I yield back, Mr. Chairman.
H. Griffith
Gentleman yields back, now recognize the gentlelady from Iowa, Dr. Miller-Meeks.
Mariannette Miller-Meeks
Thank you, Mr. Chairman, and thank you to our witnesses for being here today. As a physician who has spent more than two decades caring for patients, maybe three decades, I've seen firsthand how important it is to have a Medicare payment system that allows doctors to focus on what matters most: providing high-quality care to patients. I've also seen how difficult it is for physicians, particularly those practicing independently as I have and in rural communities as I have, to navigate a payment system that is increasingly complex, unpredictable, and disconnected from the realities of practicing medicine. Our goal should be straightforward: make sure Medicare supports access to high-quality care, reward physicians for delivering better outcomes, and provide patients with the choices they deserve. Unfortunately, the current system does not always accomplish these goals.
Physicians are facing rising practice costs, workforce shortages, administrative burdens, increasing pressure to consolidate into larger health systems simply to remain financially viable, while they're combating the very insurance companies and providers who deny their claims even though they ultimately will be accepted. And this is particularly concerning in rural America. In Iowa, we know that when an independent practice closes or a rural hospital is forced to reduce services, patients can't simply find another provider down the street.
They may have to drive an hour or much further to receive care. That's why I believe we need to move toward a Medicare payment system that is predictable, transparent, and focused on outcomes. That is the goal behind the Medicare Physician Data-Driven Performance Payment System Act, which I introduced with Congressman Conway. H.R. 8622 would give us an opportunity to rethink how Medicare rewards physicians for delivering high-value care and achieving meaningful outcomes. We should be looking for ways to move beyond a simple payment for volume of services provided and instead recognize the quality and value of care physicians deliver.
But as we consider payment reform, we also need to make sure that our policies do not unintentionally disadvantage smaller practices, independent physicians, or providers serving in rural and underserved communities, as was done in the Affordable Care Act in driving consolidation. A payment model that works for a large health system in an urban area may not work for a two- or three-physician practice in rural Iowa. We need flexibility, reliable data, and a recognition of the very different circumstances in which physicians practice. And let me give you an example. I had recruited two ophthalmologists to Burlington, Iowa, a town of about 26,000 to 36,000 individuals, and there was already an existing ophthalmologist.
There are now no ophthalmologists practicing in Burlington, Iowa, a travesty. And just as we need to make sure our healthcare system is financially sustainable, we also need to make sure it is secure. Cyberattacks are no longer simply an information technology problem, they are a patient care problem. When a hospital's systems go down, physicians may lose access to medical records, pharmacies may be unable to process prescriptions, and patients may see procedures delayed or canceled. These disruptions can be particularly devastating for rural hospitals and smaller providers that lack the financial resources of a larger health system.
Government has a role to play, health systems and technology companies have a role to play, and providers have a role to play. Our policies should encourage all of these stakeholders to take reasonable steps to protect sensitive patient information and ensure that healthcare can continue when a cyberattack occurs. Ultimately, these two issues, Medicare payment reform and cybersecurity, are about the same thing: ensuring that patients can continue to access high-quality care. Whether it's a senior in Ottumwa seeing her physician, a farmer in rural Iowa receiving care close to home, or a patient undergoing a complex procedure at a major medical center, our healthcare system has to be there when patients need it. We should pursue reforms that strengthen independent practices, I see that you're nodding heads, so thank you for that, preserve access in rural communities, reward quality and value, and protect the healthcare infrastructure Americans depend on.
I look forward to working with my colleagues and our presenting witnesses, our physicians here who are practicing in rural areas, underserved areas, in independent practices, and thank you, Mr. Chairman, I look forward to the further discussion of today, and I yield back.
H. Griffith
Gentlelady yields back, now recognize Mr. Carter of Louisiana for five minutes of questioning.
Troy Carter
Thank you, Mr. Chairman. Under the failed leadership of the Trump administration, we've seen the largest cuts to Medicaid in history, and ACA premiums have skyrocketed. Patients and providers are already feeling the effect of the big ugly law as people become uninsured, waiting room times increase, providers covered uncompensated care, and facilities close. This is on top of the already severe physician shortage in the U.S. is currently experiencing and existing barriers to primary care, particularly in rural and underserved communities like those in Louisiana, where 73% of the residents, including those throughout the river parishes in my district, live in a primary care health professional shortage area.
We must take action to support providers and patients by fixing our flawed payment system and strengthening healthcare access before it's too late. Dr. Andrews, HR 9693, the Patient First Act, includes a five-year pilot program that adopts a hybrid payment structure where independent primary care providers can provide, can receive per-month payments along the regular service fee. How would this bolster the primary care workforce and lead to better health outcomes for patients?
Rebecca Andrews
Thank you for that great question. It allows us to do in primary care the things that traditional fee-for-service doesn't cover, which is me going into my patient records and figuring out who's due for a mammogram, reaching out to them or having my staff reach out to them so that instead of just ordering another mammogram, we can capture it and know that we're providing quality screening and quality care.
Redner 44
And what will happen, what will happen if Congress does not act on the fee schedule reform this year?
Rebecca Andrews
You'll see an even greater primary care shortage than you have today.
Troy Carter
Thank you. Dr. Putla, pharmacists are often one of the most accessible healthcare providers, particularly in stressed, in states like mine where access to primary care is limited. This is especially true during COVID-19 when our independent pharmacies stepped up to play a critical role in providing testing and vaccines. For a Medicaid beneficiary who could not get an appointment with a primary care provider, how can access to pharmacist-provided testing and treatment under HR 3164 help to avoid a more expensive emergency room visit?
Anthony Pudlo
Thank you for the question, Congressman. HR 3164 does exactly that. Pharmacists, based on their scope of practice at the state level, has these authorities, and we've already seen that in 28 other states right now that have that authority, and we are seeing patients come to that pharmacy for those services. However, you're not seeing Medicare cover that service. We're seeing Medicaid and commercial plans do that, but not Medicare, and that's what HR 3164 would help.
Troy Carter
And very quickly for the listeners and viewers, why should Medicare recognize and cover that service for beneficiaries?
Anthony Pudlo
To me, it's a cost solution for Medicare. Right now, that service is not being covered, so that individual is going to the ER for care.
Redner 43
Where that cost oftentimes is exponentially greater in an emergency room in a curative care versus a preventive care.
Correct. Correct.
Troy Carter
Thank you. In my remaining time, I'd like to speak in favor of HR 1521, Dental and Optometric Care, DOC Access Act. In Louisiana, we've already recognized that abuses by vision benefit managers, VBMs, need to be addressed. This year, our state legislature unanimously passed comprehensive bipartisan VBM reform to protect patients and providers from restrictive contracting practices and preserve meaningful choice. However, state action alone is not enough.
Congressional action is needed to close federal loopholes and to ensure Louisiana's protections cannot be simply sidestepped by vision plans who repeatedly avoid state provisions by asserting federal preemption, including ERISA exemptions.
HR 1521 would address these concerns and ensure patient and doctors have meaningful protection regardless of how their vision plan is regulated. I'm pleased to support this bipartisan effort and ask that my colleagues move forward with this common sense step forward. We do not need to completely and continue to make healthcare more difficult for people to access, convolute plans so they don't understand what their coverages are, and play hide the ball for the American people. I urge your continued stepping up as you have. Thank you for being here and I urge my colleagues to follow suit.
Mr. Chairman, I yield.
Redner 48
Gentleman yields back. Now we'll move to our wave-ons and we're going to go to Ms. McClellan of Virginia first for her five minutes.
Jennifer McClellan
Thank you, Mr. Chairman. Since passage of HR 1, which I call the big ugly law, over 1,000 hospitals, clinics, and nursing homes have shut down, cut services, or are at risk of doing so. These facilities are now stretched thin on the staffing and funding needed to keep their doors open, and the American people are paying the price. Expecting mothers, in particular, are having to travel farther and farther for maternity care. As of July 1 of this year, over 40 maternity wards have shuttered their doors.
In Virginia, Centra Southside Community Hospital closed its labor and delivery unit in Farmville at the end of 2025, citing, quote, reductions in federal healthcare funding among the reasons for their decision. Between 2022 and 2024, that hospital was the most common delivery hospital for women in Prince Edward County, where it's located, and the surrounding counties. Now, women like Tammy James has to drive an hour away to receive care. Now Tammy shared her story with Charlottesville Now. She was pregnant with her eighth child and near full term when she woke up in the middle of the night with a sense that something was wrong.
She couldn't remember the last time she felt her baby kick, and she thought about going to the emergency room at the Farmville hospital a half hour away, but it had already closed its obstetric services just weeks earlier. So Tammy switched to Central Virginia Health Services, a nonprofit healthcare organization in Farmville whose services were limited, but it was close to home. But it wasn't open until the morning. So Tammy had to drive, she could either drive an hour to Lynchburg in the middle of the night or wait until the morning to go in her hometown. She waited because she already had an appointment scheduled for 8:00 AM in Farmville.
By morning, it was too late. The ultrasound showed no heartbeat. Now reading Tammy's story, I couldn't help but think back when my placenta ruptured nine weeks before my due date 11 years ago when I had my daughter. I most certainly would not have survived an hour-long ambulance ride to the emergency room. And for too many people, getting the care they need now means traveling farther, waiting longer, paying more, or going without it altogether.
And this is going to make an already bad maternal and infant mortality crisis even worse. Now one of the bills being considered today would confront this growing trend of maternity care deserts caused by labor and delivery unit closure. HR 1254, the Rural Obstetrics Readiness Act, led by Representatives Kelly, Kim, Schrier, and Musser, seeks to close maternal healthcare gaps in rural areas by funding emergency training, equipping non-obstetric facilities, and expanding telehealth.
I am a proud co-sponsor of this bill, which would specifically establish federal grants for equipment, specialized training for rural staff, and pilot programs for urgent teleconsultation with a focus on areas without dedicated obstetric units. Now, while H.R. 1254 doesn't solve systematic loss of labor and delivery units and hospital closures, it would provide real relief to communities, particularly rural ones, affected by these H.R. 1-driven closures. Now, Dr. Atwood, you have said in your testimony that the maternal health crisis is a multi-factorial problem and includes sustainable payment rates as part of the solution. And while the Rural Obstetric Readiness Act doesn't touch reimbursement, if a facility is trained and equipped under this bill, but Medicare physician payments keep declining, as you note they have by 33% since 2001, what is the risk to that facility's ability to sustain readiness to respond to obstetric emergencies?
Eileen Atwood
Thank you for that and thank you for lifting up both your constituent story and your story. It highlights how important the Rural Obstetrics Readiness Act truly is and how it can truly impact the health and well-being of our patients across the country. To your point, our patients are needing care in their local communities, and we do worry that if we cannot stabilize the Medicare physician fee schedule with the importance of many of the things put forward in the Patients First Act, that more hospitals are going to close. This problem is only going to be compounded. It's not just the closure and consolidation of outpatient practices, which is an important detail both for primary care, surgical care, obstetricians and gynecologists, but it will continue to close hospitals and continue to make this problem more and more difficult and ultimately more unsafe for our patients.
Thank you, I yield back.
Yvette Clarke
Gentlelady yields back, now recognizes the gentlelady from New York, Ms. Clarke.
Good afternoon and thank you, Chairman Griffith, and let me thank our panel of witnesses for joining us today. I want to take this time to highlight a bipartisan piece of legislation that I've led with my colleague, Representative Buddy Carter, which is H.R. 1521, the Dental and Optometric Care, or DOC Access Act, which is being considered today. This legislation seeks to lower prices and puts control back into the hands of patients and their doctors. For far too long, our nation's healthcare system has increasingly grown out of reach for Americans across the country. Specifically, doctors and patients have been sounding the alarm about the practices of vision benefit managers, or VBMs.
VBMs have engaged in rampant consolidation, vertical integration, which has led to rising costs, less transparency, and patients to have less control in deciding their care, the care they receive. These practices have resulted in companies having a monopoly in the vision market, so the same company that administers a patient's vision benefit can operate retail locations and be affiliated with filling prescriptions and manufacture eyewear. It is clear patients deserve lower costs, greater transparency, accountability, and the freedom to choose their care.
Which is why we've introduced bipartisan legislation, a common sense step toward addressing anti-competitive conduct and strengthening protections for patients. Additionally, I want to take this opportunity to highlight another piece of legislation that would ensure the stability in Medicare provider payments and protect the patient, the care patients receive. I am proud to lead HR 2199, the Restore Protections for Dialysis Patients Act, alongside my colleagues Rep Mike Kelly, Neal Dunn, Danny Davis, John Joyce, and Raul Ruiz, which would restore long-standing protections, preserve patient choice, and safeguard Medicare dollars. This bill is supported by most members in this committee, some of whom are here today. Kidney disease is an urgent health equity crisis in our country.
In my state of New York, tens of thousands depend on life-sustaining dialysis every week, and nationally, Black Americans are nearly four times more likely to develop kidney disease. For more than 40 years, people with kidney failure have been able to stay on their employer's health plans for 30 months. Now, third-party administrators are excluding dialysis coverage, forcing patients off their plans and disrupting access to dialysis, transplant evaluations, and other critical care. I want to urge my colleagues to join me in moving this impactful and life-saving bills forward, and I want to thank all of our experts who are here today for lending your expertise as we move forward in our quest to bring our medical infrastructure into the 21st century. With that, Mr. Chairman, I yield back.
H. Griffith
Gentlelady yields back, now recognize the gentleman from New York, Mr. Tonko.
Paul Tonko
Thank you, Chair, and I thank the Chair Griffith and Ranking Member DeGette for hosting this important hearing today examining legislative proposals to help strengthen physician payments and preserve patients' continued access to care. And thank you to all of our witnesses for being here and sharing advice and expertise. I would like to use this moment to briefly highlight a piece of legislation that I have co-authored, that is the Radiation Oncology Case Rate Value-Based Payment Program Act. This bill would set fair, bundled Medicare payments for cancer radiation therapy to improve patient care and health outcomes. And while we're not considering the ROKER Value-Based Payment Act today, I would encourage the committee to support this bipartisan bill.
It would provide payment stability and help offset the cost of future physician payment reform, including the Patients First Act, which we are discussing today. That being said, I'm thrilled to see the inclusion of my bill, the Alzheimer's Screening and Prevention Act, or ASAP, which would create a pathway for Medicare coverage of FDA-approved blood biomarker screening tests. Over the years, I've gotten to know many people in our community that are living with the disease and have seen the heavy burden it places on them and certainly their families. Take for instance my constituent Erin Vickers, who is a caregiver to her mother, who has Alzheimer's. She shared that it took months to get an appointment with a neurologist and then several more months to get a diagnosis.
To Erin, the inability to receive an early diagnosis was like a death sentence for her beloved mother. So Dr. Rebecca Andrews, as you know, more than 7 million Americans have Alzheimer's. It is the most common form of dementia and unfortunately one in three seniors dies with Alzheimer's or another dementia. As the immediate past chair of the Board of Regents for the American College of Physicians, can you speak please to some of the challenges that physicians face in diagnosing and managing Alzheimer's?
Rebecca Andrews
Yes, and thank you for your question. Um, I think we've covered how much access is limited for patients and why the Patients First Act is so important for stabilizing treatment. In addition, some of the things that it has in there including this five-year hybrid payment would allow for certain things, like a conversation between myself and your constituent trying to plan for the future for her mother, advising her what the test for Alzheimer's would look like because it's not a clear yes or no, it comes out as a probability and that takes time to discuss. And then it allows for the important planning, such as any chronic condition, what do we need to do to get your life set up, your mom's life set up so that you can appropriately care for her. And as we've said many times today, in the lower cost environments that provide a high quality of care for you.
And this is just one disease and one example, but it is a growing problem that you highlight.
Paul Tonko
Thank you so much. And with the tool like a blood-based biomarker test, um, is it going to assist you believe in earlier, more accessible diagnoses?
Rebecca Andrews
Clinically I can tell you that when people come in to the office worried about memory, their first question isn't just dementia in general, it's about Alzheimer's. And everyone is looking for a way to be able to diagnose it sooner so that they can appropriately plan, enjoy the remaining time with their memory and have time with their family. Um, I certainly do think earlier diagnoses of all conditions allows for better care and better planning and with the new treatments that are on the horizon, early diagnosis is important.
Paul Tonko
Thank you so much. Well in closing, the bipartisan ASAP Act expands access to early detection and gives individuals and their families more time to plan, to start treatment and seek support when it matters most. And my hope is that we can get this legislation across the finish line ASAP. So I thank you and yield back. Thank you, Mr. Chair.
H. Griffith
The gentleman yields back ASAP. And now we will move forward. I ask unanimous consent to insert in the record documents included in the staff hearing documents list. Without objection, so ordered. I would like to thank all of our witnesses again for being here today.
We had bonus questioners in our wave-ons, which we always appreciate. After today, members may have additional written questions for you all. I'll remind members they have 10 business days to submit questions for the record and I ask the witnesses to respond to the questions promptly. Members should submit their questions by the close of business on Tuesday, September 29th. Without objection, subcommittee is adjourned.