Wednesday, December 12, 2012

#ONC2012 - Rep. Phil Gingrey remarks

Rep. Phil Gingrey (R-GA) addressed #ONC2012 on December 12, 2012. These are his comments and his introduction as taken from the full transcript.

Dr. Farzad Mostashari
>> Thank you so much. We have another special guest with us today, and unfortunately our guest Congressman Phil Gingrey Georgia 11th district does have a vote to run to, so left us without too much of an overlong instruction, if everyone could take your seats and get started Congressman Gingrey is a member of the energy commerce meet, over activities we have here at ONC and also as a physician, OB-GYN who trained at memorial hospital, did residency at medical college of Georgia, he also has been a major driver and chair of the GOP doctors caucus, and provides that clinical perspective to the health policy discussions and activities that have been going on.

And I want to thank Congressman Gingrey for being with us today, and turn it over to the Congressman. Thank you. (Applause.)

Rep. Phil Gingrey (R-GA)
>> Well, thank you. Thank you very much for that. It's certainly an honor to be asked to speak, to say a few words and to be introduced by the national coordinator of ONCHIT. I'm always a little hesitant to use that acronym because with the least bit of speech impediment God knows how that comes out.

But we had a little side bar conversation as I was coming in. I have been a supporter of electronic medical records for a long time. I spent 26 years in the private practice of medicine, the specialty of obstetrics and gynecology in my congressional district, the 11th of Georgia, northwest Georgia, the County could beb the town Marietta and I know all about shuffling papers, and charts of patients, looking for a report, not being able to find it, when the patient had their last PAP smear.

So clearly I do understand and support. In the interest of full disclosure, although you probably already know, as a Republican member I was not very supportive of patient protection and affordable care act, and I was not very supportive, you could either support it or not support, so yea or nay on the stimulus bill.

But definitely, this aspect of ARRA, American recovery reinvestment act of was it what, February of 2009, I believe, it just struck my eye immediately as something that I thought had the potential and has the potential to get this effort toward a fully integrated electronic medical record system adopted nationwide to every single office of every physician in this country all, what, 850 to 900,000 physicians in the United States.

It is just hugely important, and bottom line of course is that we're talking about not just saving money, and I feel like that if this had been the only thing that we did and accomplished to its full conclusion, and not 1.7 trillion dollars on other things, it would have gone a long way -- and it will go a long way, toward bringing down the cost of health care.

But as I say more important, the ability to save lives, and not make mistakes, and errors.

And I think ultimately, too, I think it will result in in poybl better physician provider reimbursement. In fact the numbers to date so far bear that out.

The part of the American recovery and reinvestment act, the stimulus act, of course that I'm talking about, is the HITECH provision. And this idea of trying to incentivize providers, whether it's a hospital or as a designee the professional provider, the doctors, to do that through this incentivize them for meaningful use of electronic medical records.

It really doesn't do a whole lot of good, does it, as all of you know, those of you, many of you I'm sure are vendors, for physician practices to purchase hardware and software and long-term contracts for maintenance and upgrades, and to be able to maybe get rid of the charts in their own offices and have that electronic, but not have the ability to communicate once that patient leaves the office. And maybe even goes to a provider, another provider, another specialist in the same town. But how about if they go across the country or across the pond? That's why ultimately this is so important, and why I continue to be a very, very strong supporter.

Now, saying that, obviously we've got a lot of work to do. And when I'm home in my district and meeting with physicians that are maybe not just constituents who support me with their vote, but constituents who support me financially, and yes indeed there are some doctors that do that, although they're not the easiest nuts to crack from that perspective, you all know that too.

But the last time I was meeting with a group, and I thought it was going to be a kind of a social meet and grate and kind of have a good time enjoy a drink, holiday season -- boy, I got blasted, I really got blasted. And these were maybe 15, 20 of my best friends.

A lot of the doctors that I had actually practiced with, although it's been 10 years now since I was in clinical practice. And they -- there were even some comments to the effect that we don't even want this. We wish it would go away, you know, it's more trouble to us than it's worth.

And clearly, they just need to be more patient. They need to understand that the bottom line of course we all understand, that you maybe take two steps backwards and then hopefully eventually four forward. But the initial investment, the cost of, I don't know, 35, 40, $50,000 per provider, that might not be so difficult if you're talking about a big hospital system that can absorb that kind of investment, but for a small single specialty group practice of two or three in rural America, it's very, very difficult. And then to have a learning curve of six months or so, where your productivity is decreased because you're looking at that computer screen and you're trying to figure out what the right inputs are, and you ultimately hope that you have some time to turn around and look at the patient and examining the patient.

These are some of the concerns that I hear as a former doctor, and now of course as a member of Congress.

My position currently in the Congress, on the House side, is on the energy and commerce committee, one of what's considered exclusive House committees, there are four or five of those, and we're only permitted to be on the one committee because the workload is so heavy.

On energy and commerce, one of my assignments is to the health subcommittee, and along with the ways and means committee. That's where the authorization, we have health information technology is one of the many things that we oversee, on energy and commerce, of course, it's the Medicare part B, all of Medicaid, the SCHIP program.

And there is, you know, a little bit of concern. And I think you all are aware that recently there was a letter sent to secretary Sebelius from both energy and commerce committee and ways and means signed by the chairman of the two committees as well as the chair persons of the two health subcommittees, saying look, you're not -- you're not really progressing rapidly enough through the stages of meaningful use, and maybe you should just suspend the program. Even though I think some seven or $8 billion has already been spent in regard to incentivizing doctors and hospitals to adopt meaningful use.

I have some statistics here somewhere, if I can pull those up. Well, let's see. Between the start of the payments in the spring of 2011 and September of 2012, just over a year, over $7 billion have been paid to providers. In 2012, 72 percent of office-based physicians used electronic health records, which is up from only 48 percent in 2009.

That doesn't mean that they have even reached stage 1, however, of meaningful use.

More than 120,000 eligible health care professionals and more than 3,300 hospitals have qualified to participate in the program.

But as I say, there is this concern, and when you get a letter from the chairman of ways and means and chairman of energy and commerce, saying maybe you should suspend the program for awhile until you get it right, that is a little scary. I mean, it's pretty serious, and it scares me, and I did take the opportunity to read that letter, although I was not part of the discussions and the decision to send such a letter, but it was based on -- and I have these reports with me, obviously not time to go into them in any depth, but I was reading these at 5:30 this morning, I want you to know.

But one from the office of inspector general of the Department of Health and Human Services, and it's titled early assessment finds that CMS faces obstacles in overseeing the Medicare electronic health record incentive program. This is one report that I think the letter was based on.

The other is a government accountability, GAO report, even thicker, titled electronic health records, first year of CMS's incentive programs shows opportunities to improve processes, to verify providers met requirements.

This is all about -- well, was the $7 billion that was spent, has been spent, in the first 14 months of the program, was it taxpayer money well spent. Were these providers eligible, and were they supplying the data that they were required to supply, to the department and to CMS, that would justify giving them the incentive under phase 1 or phase 2. I don't guess the final rule on phase 3 is here yet, but, you know, it brings up some real serious questions. That there is more work to be done, and there are challenges. And, you know, the political landscape, you have to deal with opposition from, say, folks like me to what -- and I don't say this pejoratively, because he has embraced the term, Obamacare or back in 2009 the opposition from the minority, of which I was a part, to spending $850 billion to stimulate the economy and the concerns that, you know, that that wasn't successful.

But I don't want to see any of that opposition destroy something as important as electronic medical records and the universal adoption of that and the interoperability of it, and the security of it. I'm still, as I stand here today -- and again, I thank you for giving the opportunity, I know you've heard from senator Warren on a lot of other great experts in the field, in the space.

And my knowledge is just, you know, maybe a mile wide and an inch deep, that's one of the reasons why I'm not taking any questions. Thank God I've got votes to get me off the hook.

But you know, I think about stage 3, where patients have the ability, maybe, to share with their providers information in their records, or maybe they have the opportunity to directly access those records, and to know what's in their medical records.

I think that's a good thing. It certainly reminds me, though, of the Seinfeld episode when Elaine went to the dermatologist with a rash, and she looked over the receptionist's shoulder at her chart and found out that she was a, difficult patient. You all remember that episode? I am an absolute fanatic over Seinfeld, I think I've seen every episode at least five times.

But and then finally in that episode, you know, she actually grabbed her medical records and went running out of the office with them tucked under her arm, and they caught her at the elevator.

Well, I guess once we get to phase 3 that will no longer be necessary, that people will have access to their medical records. And again, I think bottom line is it's all about saving lives and saving money. And right now we're still struggling with saving money. We have, I think, the greatest health care system in the world, I'm extremely proud of having chosen medicine as my profession and having been 31 years since medical school and practicing all those years and delivering lots of babies, and I miss it very, very much.

And I do empathize with the providers now who are facing all of these burdens and rules and regulations and, you know, whether we're talking about the meeting these requirements and hoping to get a little plus up in their reimbursement on either the Medicare or Medicaid program. You can understand. I think you do understand. And maybe more attention needs to be directed. You're so busy developing hardware and software and making things better and quicker and smaller, and all of the wonderful things that the people in this room do from the industry perspective, but, you know, if you don't have someone to purchase and you're not going to be successful if it's just a few huge hospital systems across the country, you need to sell it to every nook and cranny, every practice across this country.

So that's what it's all about, and I think that gives me a little bit different perspective, and I wanted to come today and share that with you.

Thank you very much for the opportunity, I appreciate it.


Dr. Farzad Mostashari
>> Thank you so much.

Rep. Phil Gingrey (R-GA)
>> Great to be with you.

Dr. Farzad Mostashari
>> Appreciate the need to go for your vote.

Rep. Phil Gingrey (R-GA)
>> Absolutely.

Dr. Farzad Mostashari
>> Thank you.

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