american telemedicine association likes to give us a very early example of telemedicine and that is the medical care provided in the monitoring of the astronauts and the early-stage program that continues today. it was also used in military or remote deployments to keep the troops safe. telemedicine provides three areas of patient care focused on instrumented interconnected and intelligent solutions. these key areas or medical data in transmission access for radiology imaging and this gives us the inside and provides insights that are needed to provide the information for the details of the data. also remote monitoring of the chronic care or special circumstances so for example congested heart earlier for example one needs to get the regular vitals of the hydration and the vitals of the patient. clinical consultation is the third in lieu of face-to-face interaction for convenience and to allow for it to happen more often on a regular basis. the use of electronic information and telecommunication technologies to support is now common and it's coming to provide long-distance critical care

i've had various health centers we have to telemedicine capabilities. we have tele-mental health facilities available. part of the problem with telemedicine is that in rural areas there is not a significant infrastructure for high-speed internet so we can't do home monitoring because there is not a self service cellphone signal in many places. we have patients coming to our sites, and work with the patient whether it is through direct hands-on care or telemedicine. >> we are jurisdiction over spectrum and we just had a hearing on getting access to unserved areas first with the federal support and under underserveded after that and map that and figure out those areas. thank you for the work you do. i yield back. >> chair recognizes the gentlemen from new jersey. the ranking member of the full committee. >> thank you, mr. chairman. i believe deeply in the chip program and want to see a full five-year extension of current chip poliauolicy but i believe e medicare program and i know part of the success with chip is because it builds on top of the medicare.

to be clear, telemedicine can't treat everything, but our service can treat 90% of the conditions thatto the emergency room and every year, 52% of emergency room visits are actually cases that could be treated through primary care and so, again, back to the savings opportunity, not only can we save hundreds and hundreds of millions of dollars, we can also open up access and bring a more convenient method of health care delivery to consumers at scale >> and hill, what's the appeal to the doctors, to the health care providers, if the economics are so good on the customer side >> it's a great question and our doctors are fully employed in our practice and one of the reasons they're willing to leave their private practice or leave their current role is because we take all of the administrative overhead off their plate and let them practice medicine in its purest form so they get to work from home, number one so they get massive amounts of lifestyle flexibility. they also don't have to deal directly with insurance companies or with any of the administrative overhead associated with renting

with telemedicine. the originating facility is not usually a part of the reimbursement methodology so you have to build the infrastructure without having payment for that infrastructure. you have to maintain it. you have to have enough ban division to have interactive -- bandwidth to have interactive television. >> let me spring board. the stark act, if i understand contributely, prevents us from using some facilities in conjunction with a hospital that might be willing to pay for infrastructure because at one time they were worried about collusion and raise thing bills. today i've got underserved areas, i could use in space in a nursing home long-term care facility and put in some telehealth stuff even itself it was in conjunction with the hospital because in all fairness, only have one hospital in competition if you're talking about somebody having a heart day attack but my folks have to travel 202 minutes to get there. can we relax that win we can get into underserved areas. >> antitrust issues are c

can you talk about telemedicine. also, i had an amendment before it became law and then it expired on bonus payment for home healthcare because it's more expensive to go out back 90 miles each way to take care of somebody in a remote area. perhaps you could address those things. >> we have a common electronic medical record platform across all of our sites. we have some clinics that are mid-level provider sites only engine only, staffed by nurse practitioners or physician assistants. if they have issues or questions about care of a patient they can route that chart to one of our physicians and one of our other sites for assistance and care delivery. we have some telemedicine capabilities, we have mental health services with the university of minnesota duluth where we can have patients access some psychiatric and some psychology care, and we do have some telegram setups. part of the problem we have with telemedicine is that in the rule areas, there's not a significant infrastructure for high-speed internet so we can't

it comes at a time when the state just expanded its telemedicine laws, which opens the door for patientsa doctor on their computer, smart phone or tablet without an initial face-to-face visit. knox says because a woman -- who's 18 and older -- can talk with a medical professional from the comfort and convenience of home -- patients are more likely to open up to doctors and use the app. knox: "we have had patients tell us that i feel way more comfortable talking to you and asking you sensitive questions. you've provided me way more information because i've been able to ask questions that i felt asking face-to-face with my own doctor." but, opponents of patients ordering prescription drugs through an app without personally seeing a doctor first fear a spike in misdiagnoses. knox says birth control is a safe medicine line, plus with the click of a button patients can get back in contact with doctors for follow-up questions. knox: "a lot of doctors aren't comfortable with changing the model so dramatcially. but, the model needs to change because it patients for a really long time." right now

it comes at a time when the state just expanded its telemedicine laws, which opens the door for patientsith a doctor on their computer, smart phone or tablet without an initial face-to-face visit. knox says because a woman -- who's 18 and older -- can talk with a medical professional from the comfort and convenience of home -- patients armore likely to open up to doctors and use the app. knox: "we have had patients tell us that i feel way more comfortable talking to you and asking you sensitive questions. you've provided me way more information because i've been able to ask questions that i felt asking face-to-face with my own doctor." but, opponents of patients ordering prescription drugs through an app without personally seeing a doctor first fear a spike in misdiagnoses. knox says birth control is a safe medicine line, plus with the click of a button patients can get back in contact with doctors for follow-up questions. knox: "a lot of doctors aren't comfortable with model so dramatcially. but, the model needs to change because it hasn't been working for really long time." right now t

that marketplace makes it harder but there are examples and actually i would argue telemedicine is one, but what i would like to see is a closer linkage of the payers and patients and medical centers around figure out when an innovation is reducing cost over all, how to recapture that value appropriate and who gets rewarded. he goes right now it's very hard. >> i would just observe people make the observation about technology and other businesses. urgently talk about the substitution effect and the ability for technology, the result into people be necessary. we saw in the last election some of the consequences of those advances in terms of how people feel about and what's occurring in, with regard to the adoption of technology that can eliminate jobs. healthcare is still, healthcare is a service business. it's like the hotel business in that regard you. at least the hospital sector it's a service business that involves people. the kind of thing you're describing if it were applied to health. would involve things that would allow the technology to replace people. i think that beyond tha

in good care but one example that is minor but so much has been replaced with technology like telemedicine just give everybody and ipad and it will be better for electronic medical records that you were a part of is a useful tool but often they have been used as a substitute for the face-to-face interaction which is so crucial there was a program to give patients in hospice in my pad. -- the ipad that is great if used for certain kinds of things but if that is instead of a nurse to come by to hold their hand and talk to them which a lot of people need with home hospice that news is what is precious to me about health care and that is what patients and physicians want so health care could have done a lot more efficient and 30 years ago but it should not be the primary goal of health care. >> as we're speaking the house is deeply engaged in the future of the affordable care act with a government san policy at the national level and underline that discussion is whether health care is a market good that should be ruled by market forces or another mechanism for:the read your book sometimes i fe

great place to do it and we could get ideas from republicans ap democrats that get behind the telemedicinecost of care and increase the quality of care without making massive changes to way that medicare or medicaid works. >> take is inside what you're hearing from members of the republican party, of the republicans that want to see progress on health care. what happens if members of congress, if senators go back to their home districts without getting anything significant done? i mean how much urgency is there to make sure they can show some progress, can tell votes hey, we're trying to carry out the promises that we made to you. >> well what we're seeing here from the people i have spoken to on the senate side, they know they'll end up passing some sort of a bill that's different from the house version of the bill. >> by july 4th, you think? are they saying by july 4th? >> i would say closer to bastille day. they want to be able to say listen, we as the senate did our job. we passed a bill. they know in reconciliation the gulf is so wide that it will be impossible to bridge and that this

community, if you have people who are able to communicate with their health care professionals in telemedicine paradigm, if we can get that through life line, through satellite, go stations or whatever it is called in terms of satellite orbit. if we could do all of those in terms of the infrastructure as well as through programs that are means tested like life line is the target. we can solve many of our critical problems and the answer is yes no matter what the discipline if it is health, education or live. connectivity is key and we have to use the tools in our arsenal to encourage opportunities. >> thank you. madam chairman, look forward to working with you and members of the committee and commissioners on some of the suggestions that were made on this vital issue. thank you. >> senator moran. >> chairman, thank you very much and congratulations on becoming the chair person of this subcommittee. i know your continual efforts in regard to broadband deployment in west virginia and obviously we care about kansas and arizona and connecticut and i look forward to working with you and senator coo

is rural broadband, high-speed internet for communities to access education, rural health care, telemedicine, as well as addressing issues like resources to curb the opioid epidemic. last year the f.c.c. found that 39% of rural americans -- that's roughly 23 million people -- lack access to high-speed internet service, and this is astounding to me when we look at this as a challenge that we have in 2017. president trump's budget also targets the farm bill directly for $231 billion in cuts. we worked together on a strategy for a five-year economic development plan. we do it on a bipartisan basis. it's time to bring that up again next year. that five-year process gives certainty for our farmers and communities and those interested and committed to conservation, bioenergy, all the other provisions in the farm bill, and to see outside of this five-year period in our bipartisan process the trump administration come in and target these funds for a cut of $231 billion, again, is shocking to me. if that were to pass, it would be impossible for us to write the next farm bill next year. cutting crop i

connected community, if you people who are able to communicate with her healthcare professionals in a telemedicine or telehealth, in that paradigm, if we can get that affordably through lifeline through satellite, through ngs, a geostationary, whatever it is called, in terms of satellite, if we could all of those in terms of infrastructure as well as through programs that are means tested, lifeline, targeted, then we can resolve many of our critical problems. so the answer is yes, no matter what the discipline, the matter what, if it's health, education, connectivity is key and we had to really use all of the tools in her arsenal, our regular arsenal to encourage innovation and investment and opportunities. >> thank you. look, madam chairwoman, of the four to working with you and members of the committee and commissioners on some of the suggestions that were made on this issue. thank you. >> senator moran. >> thank you very much. congratulations on becoming the chairperson of this subcommittee. i know your efforts in regard to broadband appointment in west virginia, obviously we care about kansas

not have the do workforce, the availability, the telemedicine. let us build that out. >> what does that look like? there is an epidemic. there are some encouraging things that are bipartisan. you are talking with newt gingrich. and you are with chris christie. and donald trump's brother had problems with this. >> this does not know any partisan boundaries. -- someone this morning billion -- >> within the aca. the republican plan to substitute that with the $45 billion pass. at a time when this epidemic is getting worse. going back to the bipartisan aspect of this. speaker gingrich and i are pushing for a $10 billion brain byd which can be paid for slowly reducing the costs that are incurred from brain illnesses because of the increase in research and therapies. if we were to put the real price epidemic, we would be including the increase in child welfare cost, the increase in police time, adjudication time, correction time, prison time, parole time. crisis asty of this it relates to a number of different budgets. we have not quantified across man

we don't have telemedicine out there. let's build that out. >> what does that look like? there is an epidemic and everyone knows it. there's encouraging things bipartisanship in a town and country they can't on anything. you are talking with newt gingrich on one of the panels here. and you are with chris chris d. and donald trump's brother. >> this does not know any partisan boundaries. >> people are talking. if it is money that we have to watch, some of these programs are added. someone this morning said $91 billion. >> $91 billion for opiates within the aca. the republican plan is to substitute it with the $45, half of what the aca provides two opioid treatment. at the dollar is a time when the epidemic is getting worse, not better. going back to the bipartisan excerpt of this. speaker gingrich and i are pushing for a $10 billion brain bond, which can be paid for by fully reducing the cost incurred from brain illnesses because of decrease in understanding and research of newer therapies. that is the kind of marrying both conservative and liberal points of view because a

don't have the workforce out there, we don't have the availability out there, we don't have the telemedicine out there, let's build that out. >> what does that look like? what does the -- there is an epidemic and everyone knows it. there's some encouraging things that there's bipartisanship in a town in a country that can't agree on anything, you are talking with newt gingrich on one of the panels you're on, right? >> yes. >> and you are with chris christie and donald trump's brother had problems with this. >> this doesn't know any partisan boundaries. >> okay. and people are talking. so what is the -- it's money that we have to watch where if some of these programs are gutted there was someone this morning said $91 billion could be -- >> $91 billion for opiate within the aca. if the republican plan plans to substitute it with the $45 billion half of really basically what the aca provides to opiate treatment over ten years, half the dollars. at a time when this epidemic is getting worse, not better. but going back to the bipartisan aspect of this, speaker gingrich and i are pushing for a $10