WASHINGTON – Today, Congressman Vern Buchanan, Vice Chairman of the House Ways and Means Committee and Chairman of the Health Subcommittee, led a letter concerning MedPAC’s guidance on AI and urging them to take several considerations into account as technology’s already unambiguous role in health care expands. Congressman Schweikert (R-AZ) and Congresswoman Steel (R-CA) joined in sending the letter.
The Medicare Payment Advisory Commission (MedPAC) is a congressional agency established by the Balanced Budget Act of 1997 to advise Congress on issues affecting the Medicare program.
Earlier this year, House Ways and Means Committee Republicans held a roundtable on the use of artificial intelligence (AI) in health care. After hearing from Republican members on the committee and the roundtable’s participants, Buchanan was encouraged by the ways health professionals can utilize AI technologies in health care, especially in preventative care measures. To date, MedPAC has not significantly addressed the role and potential benefits of utilizing AI and digital health tools, which have exploded in recent years.
MedPAC’s current approach to AI would effectively punish providers and innovators by not accurately reimbursing them through Medicare. This would also disincentivize the development of breakthrough new digital health tools and technologies that aim to improve health outcomes and control costs.
“I am deeply concerned about MedPAC’s negative and impractical guidance and recent work on digital health (AI) tools,” said Congressman Buchanan. “It is my fear MedPAC is taking marching orders from the Biden administration on AI and providing unhelpful feedback to Congress on how these new products could help lower prices in the Medicare space.”
By law, MedPAC is required to report to Congress each March on the Medicare fee-for-service (FFS) payment systems, the Medicare Advantage (MA) program, and the Medicare prescription drug program (Medicare Part D).
“Artificial intelligence is on the cusp of a revolution that will bring cures to market dramatically cheaper and faster,” said Congressman Schweikert. “Leveraging this emerging technology will help alleviate the stress on our trust funds and help to make Americans much healthier. I urge MedPAC to embrace these innovative solutions that will significantly disrupt the cost of health care and improve patient outcomes for our brothers and sisters who have suffered for far too long.”
“For Medicare to meaningfully transition to value-based care, payment policies need to maximize efficiencies in care delivery and enhance patient safety using digital health tools,” the lawmakers wrote in the letter. “Yet MedPAC’s recommended approach would effectively punish providers for using—and innovators for developing—digital health tools that improve health outcomes and control costs.”
“As a member of the Ways and Means Committee and the bipartisan Congressional AI Task Force, I’m committed to advancing policies that protect American data privacy and intellectual property without stifling innovation and economic development,” said Congresswoman Steel. “MedPAC is following a misguided path of burdensome regulation that will harm American patients and prevent the development of potentially life-saving technologies. They must reevaluate their guidance on digital health tools.”
In addition to being the Vice Chairman and most senior Republican on the powerful U.S. House Ways and Means Committee, Buchanan is also the Chairman of the Health Subcommittee, which has broad jurisdiction over traditional Medicare, the Medicare prescription drug benefit program, and Medicare Advantage.
You can read the full letter HERE or below:
April 18, 2024
Dr. Michael Chernew
Chair
Medicare Payment Advisory Commission
425 I Street NW, Suite 701
Washington, DC 20001
Dear Dr. Chernew,
The Medicare Payment Advisory Commission's (MedPAC’s) history as an independent advisor to Congress on issues affecting the Medicare program has been crucial to our successes. Since its establishment as part of the Balanced Budget Act of 1997, MedPAC has helped Congress ensure the long-term sustainability of Medicare and avoid policies that could negatively impact patient outcomes and the cost-effectiveness of care. Accordingly, we urge MedPAC to take several considerations into account as technology’s already ubiquitous role in health care expands.
MedPAC’s consideration of digital health’s role in health care for elderly Americans must run both broader and deeper. The United States is staring down a persistent physician shortage, which continues to exacerbate health care resources.[1] Now, over 80 percent of Americans have at least one chronic condition, and most have at least two, with increasing disease combinatorial complexity.[2] Given these trends, Medicare’s viability hinges in no small part on whether federal policy allows and prioritizes the use of digital health to execute health care delivery; preventive care strategies; better care coordination; and to minimize data entry by caregivers.
Research shows that digitally enabled preventive care strategies and remote patient monitoring can minimize costs and improve patient outcomes while controlling health care costs.[3] Unfortunately, Medicare rules have acted as barriers to their adoption and proliferation, evidenced by the fact that just 3 percent of Medicare expenditures go toward prevention. The only Medicare program that explicitly pays for preventive care is the Medicare Diabetes Prevention Program (MDPP), which is only inclusive of some virtual delivery capabilities. That MDPP does not permanently support fully virtual diabetes prevention services when all but a few Medicare beneficiaries live too far away from MDPP suppliers’ physical locations to make use of them in person is unfeasible. This is only one example of how far behind Medicare is when it comes to digital health. MedPAC is well positioned to advise Congress on how to appropriately bring Medicare rules more in line with beneficiary and caregiver expectations as they seek to access digital health tools to enhance caregiver efficiency and efficacy, improve healthcare outcomes, and better control costs.
To date, MedPAC has addressed digital health tools only to a limited extent, and with a narrow focus. For example, during its November 2023 public meeting, MedPAC staff gave a presentation on software as a service (SaaS) and prescription digital therapeutics (PDTs) and suggested that Medicare could “require that a manufacturer of a SaaS/PDT provide evidence that its product results in a clinically meaningful improvement for Medicare beneficiaries compared with the standard of care.”[4] This suggestion does not veer from established Medicare guidelines of reasonable and necessary and ignores the potential of SaaS and PDTs role in preventative medicine.
For Medicare to meaningfully transition to value-based care, payment policies need to maximize efficiencies in care delivery and enhance patient safety using digital health tools. Yet MedPAC’s recommended approach would effectively punish providers for using—and innovators for developing—digital health tools that improve health outcomes and control costs. MedPAC has focused on prescribed therapeutics anchoring care through physicians and has ignored the importance of beneficiary driven service assisted by autonomous care. MedPAC needs to better evaluate the flourishing health care technological landscape, which is showing great potential. Specifically, “the early detection of disease through efficient and cost-effective patient data screening tools that benefit from the predictive capabilities of AI” will be crucial to the future of preventative care in the U.S.[5]
MedPAC’s most recent assessment of digital health tools misses some key aspects of their most recent capability and future applicability. First, the standard of care is now often inclusive of digital health tools. Accordingly, a digital health tool that meets the standard of care would be unlikely to show meaningful improvement “compared with” the existing standard of care. Second, patients and caregivers are in the best position to evaluate the relative efficacy of digital health tools against alternatives and may lower costs. As heart failure and diabetes cases continue to skyrocket across the country, it’s critical that patients have access to new and affordable technologies, such as digital health apps, that can help with monitoring their health and keep them out of more expensive settings, like the hospital. Embedding those rigid determinations in payment policy inappropriately limits beneficiaries’ and caregivers’ options, stunting dynamic market mechanisms that would otherwise advance the best options. Third, as the world continues to adopt digital health platforms and apps, MedPAC has not incorporated their ubiquitous use and the critical role they now play for patients, caregivers, and others into their assessment of the health care ecosystem. MedPAC must explore digital health’s role in improving outcomes and lowering costs in the face of an overwhelming evidence base demonstrating these tools’ ability to deliver value to Medicare beneficiaries and providers.
We strongly encourage MedPAC to incorporate digital health tools into future evaluations of Medicare policy recommendations and, in partnership with all stakeholders impacted by Medicare policy, ensure that its evaluations and recommendations related to digital health are inclusive of each of the Quadruple Aims. We want to make sure that as MedPAC stands at the center of healthcare’s evolution, and does not inadvertently stand in the way.
I look forward to your response and thank you for taking these considerations into account.
Sincerely,
