Congressman Dar…: There’s going to be definitely a push to continue that waiver, examine what should be permanent, and then from there, look to whether there’s other areas that should be expansion.
Speaker 2: Welcome to the Growing a Successful Orthopedic Practice podcast. Join us every episode to hear from fellow medical practice administrators, staff, and physicians, as we break down current issues affecting the industry and share real stories from guests on their way to growing a successful orthopedic practice. Let’s get started.
Keith Landry: Hello everyone, and welcome to the Building a Successful Orthopedic Practice podcast. A new episode in the works for you here today. I’m your host, Keith Landry, and I’ll quickly mention this episode is sponsored by OrthoLive. Today, we are talking about the future of telehealth visits and telemedicine, still amid the pandemic, with the new Biden administration and Democratically controlled Congress. And joining us today is United States representative Darren Soto of Florida’s ninth congressional district, representing parts of Osceola, or rather all of Osceola County, and parts of Orange and Polk counties. Congressman Soto, thank you so much for being on the podcast with us today.
Congressman Dar…: It’s my pleasure, Keith. Thanks for the opportunity.
Keith Landry: You bet. I’m going to give folks a little bit of background, because we do have a national audience of orthopedic physicians and practice managers. Congressman Soto is from central Florida, where he was a state lawmaker here in central Florida, graduated from Rutgers University and the George Washington University School of Law. Practiced family law, civil litigation, and real estate law. Currently serving in his third term in the United States Congress. In 2016, Congressman Soto went to Congress, passed the most laws of any freshmen member in the House. Not bad, not a bad little thing to have on the resume. And is the first Floridian of Puerto Rican descent to serve in Congress, which is particularly relevant in the district you serve, because we have so many American citizens from Puerto Rico who are in your district. So that is fantastic.
And I always like to throw in a little fun tidbit about my guests. You enjoy spending some time with your wife and your two puppies, Star and Xena. Tell us about those names, Star and Xena.
Congressman Dar…: So Xena, my wife adopted as a rescue a little before we started dating, and she’s a shepherd’s mix. And because of her fiery nature, she’s named after Xena, Princess Warrior, which I think people saw coming, because Xena’s not actually a real character of mythology. And then Star is a Husky, just turned two years old and just a beautiful dog with a lot of energy, and she brightens up the room. So they’re very near and dear to us, as we live just on a lake here, Lake Toho in Kissimmee, and have a great yard for them to run around in.
Keith Landry: Aww, that’s fantastic. That’s fantastic. So let’s talk a little bit about the future of telehealth, virtual visits, folks refer to them in different ways. But the point is, since about a year ago, during this pandemic, the acceptance of telemedicine by both physicians and by patients has exploded. The statistics are just amazing, and telehealth has become mainstream because of the safety aspect and the convenience aspect of not having to drive to the doctor’s office, sit in the patients’ waiting room, and then maybe pay for parking in the larger cities. So we’re talking about the future of telehealth visits under the Biden administration and the Democratically controlled Congress.
And I want our listeners to know that Congressman Soto serves on the Energy and Commerce Committee, which has jurisdiction over Medicare and interstate issues. And what we’re talking about today is some of these telehealth visits that are happening across state lines for folks in rural areas and Medicare patients. So we’ve got a lot of stuff to dig into here, but let’s just start at the high level. What are you hearing out of the Biden administration and from Speaker Pelosi about the agenda for the future of telehealth visits and reimbursements for orthopedic physicians and other physicians that practice telemedicine for Medicare patients and get reimbursed for it? And we’ll get into the intricacies of the details of what happened during the pandemic in a moment, but what are you hearing? What’s the latest?
Congressman Dar…: Under President Biden’s leadership, we’ll see a continuation and eventually an expansion of telehealth. As many of your listeners may know, about a year ago when we were passing our first COVID response packages, just under a year ago, we allowed for a waiver for telehealth for Medicare, and that ended up being a huge leap forward, because for years there were lot of different factions and interests fighting over it, and people would argue about the details. We started talking about telehealth when I was still in the state legislature, but it was a big food fight. But finally, COVID-19 forced our hand to make sure that we could have people be able to have a myriad of different healthcare services provided while they could stay at home, so that they’d have less of a chance to get COVID-19.
Then of course, to no surprise, it is really popular among my constituents and among patients. Medicare recipients across the nation are seniors. Really popular for providers, and it works in some areas and other areas, just by the nature of the healthcare services provided, it doesn’t work. But when we’re talking about things like mental health or dermatology, or in the case of orthopedics, just going over how the patient’s doing and how their movement is progressing and with the rehabilitation, there’s a lot of things that can be done via telehealth. And we’ll continue to expand. I expect the waiver to continue to be approved for the foreseeable future, because it’s so popular.
And the other thing we’ll be looking at is patient safety. Have we seen a larger than average number of adverse cases because of telehealth? We’re not hearing that evidence much yet, that it’s had these adverse reactions that a lot of folks who opposed it were worried about. And of course, the providers’ perspectives on it, very helpful as well. They can be more efficient going from Zoom call to Zoom call with their patients throughout the day and that means that they could take care of more patients, expand access to care, and do it in a way where they could save money for both their practice and for Medicare. So there’s going to be definitely a push to continue that waiver, examine what should be permanent, and then from there, look to whether there’s other areas that should be expansion.
Keith Landry: Yeah, great points there. So a majority of our listeners are orthopedic physicians and their practice managers, and they know well that over the last year that CMS, the administrator of Medicare, has had that waiver in effect, so they could get reimbursed for doing Medicare telehealth visits often in rural areas. And they do want to know, are they going to continue to get reimbursed for doing these visits, or are they just providing a great service and not getting paid? So basically what you’re seeing over the horizon is most likely the waiver continues and they continue to get reimbursed for the visits. That’s what you’re hearing, yeah?
Congressman Dar…: Sure. I support the waiver, and I know our committee on both sides of the aisle support a continuation of the waiver. It passed unanimously out of the committee, a lot of these different issues related to the waiver. And certainly I don’t see anything other than making sure that we’ve continued [inaudible] patient safety, which all evidence so far points to works. We’re getting the same high quality service. So it is highly likely. I expect it to continue in the future.
And the real work at hand is what to make permanent. And I could see several different aspects of providing care by orthopedic surgeons that could be there, like followups, initial diagnoses could potentially be done that way. Obviously, the surgery is very much a hands-on activity, so that would still be in-person, but I could see definitely a lot of different ways, and I’m hopeful that your physicians also feel like they’re being more efficient and more effective in their practice.
Keith Landry: There’s been a lot of lobbying of Congress over the last few months to make sure that Congress takes action, because when the national emergency order from this pandemic expires, the waiver in theory would expire, as well. So are you hearing and seeing buzz and activity on Capitol Hill?
Congressman Dar…: Without question, we’ll see a movement to continue that waiver. And again, it’s what we make permanent. Another issue that’s come up, though, is we face a potential cut in Medicare rates because of readjustment they did to raise primary care rates. And for a lot of us, including myself, that’s madness. We’re dealing with a pandemic right now. Our frontline doctors are part of the solution. Not only that, but you have a lot of electives and then surgery that becomes necessary, it can’t even wait anymore, that it’s really important to keep this flow going. So we need to keep incentivizing doctors to be able to perform these specialties.
So there hasn’t been cut yet in those rates, and there’s a big fight to make sure that we continue on with keeping those rates as is, particularly throughout the pandemic. So again, we need to, whether it’s making it easier for orthopedic surgeons to be able to perform their health services through telehealth where appropriate, and also keeping those reimbursement rates at a level to incentivize them working at what is a tough time. There may be some orthopedic surgeons who are older and potentially at the end of their career. We want to keep them on. We need them for the future right now. So we want to make it easy for folks to continue performing at peak performance in treating our patients across the nation.
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Keith Landry: And when you talk to people who are in the field of telehealth, even hospital administrators, they all say, you know, we were moving at the beginning of 2020 to improve our telehealth services. We were planning to get that up and running by 2021. But the pandemic clearly just spring-boarded the telehealth effort in America. It’s just forced everybody to speed it up. So I think there’s a general consensus that clearly you can’t turn the clock back on telehealth medicine. The genie’s out of the bottle. It’s convenient, it’s safe. It has purposes that are great for post-op analysis, even screening someone before they go to an emergency care room to look at the bruise or the wound or possible break and say, “Yeah, you’ve got to go to the emergency room immediately.” Or, “No, that might be a sprain type thing.”
What are the hurdles you see as Congress and the Biden administration try to please everybody and all the players to get something through that actually passes at the federal levels, that will serve all the different constituencies and jockeying positions out there? What are the hurdles that you’re watching?
Congressman Dar…: I wouldn’t call them hurdles, as much as work we have to do. We have to do an analysis of each of these areas that have been able to utilize telehealth, and make sure one, we’re maintaining quality and patient safety. Two, we’re increasing, or at least keeping the same amount of access. Is it saving money for our medical providers so that they can continue to give a good deal to Medicare as we pay into this system and we safeguard Medicaid payers throughout their career, who paid into the system, that that money is being used wisely in each different area, whether it’s orthopedic surgery, post-op and initial consultations, whether it’s dermatology, whether it’s mental health, whether it’s primary care.
A lot of those areas, we’ll do independent reviews of each of them, not only in the Energy and Commerce Committee, where a lot of these decisions will be made, along with our partners in Ways and Means, but also by engaging folks in HHS and CMS, and they are already looking at outcomes and starting to weigh these things. I anticipate you’ll see several waivers before we get to the final decision point about what to make permanent or not. It could be months. It could even be years. But I think you’ll see in the meantime those waivers continue on, unless you get some areas where we’ve seen a real spike in bad outcomes in patient safety. We haven’t seen those stories yet.
Many of the initial obstacles, opposition to telehealth, was the technology up to speed, access issues, because not everybody had internet and still not everybody has internet, whether there was going to be a dive in quality because the doctor wasn’t in the room with the person, and any other number of concerns when you have a new technology, and it literally took years. But when you have great crises in this nation, we have to make big decisions quickly that otherwise take years. And so in the case of telehealth, it was a lightning speed fast-forward to where we are now, where it’s a huge part of the everyday delivery of healthcare in America, when less than a year ago, it was only a small part of that.
Keith Landry: And it’s so interesting, because the part of the story that’s gotten a lot of media coverage has been this, and the general public might not follow it as much, but really the pressing question has been are these orthopedic physicians and other doctors going to get reimbursed for doing these telehealth visits for our Medicare patients? So I’m curious to know, do you think this is going to play out with a solution to that first, and then visiting questions about practicing telehealth medicine across state lines as a separate bill next, and then other elements as separate bills? Or do you think that the Energy and Commerce Committee tries to put forth one piece of legislation that tries to encompass most of this? Based on your experience up there on Capitol Hill in three terms, how do you think they’re likely to play that out?
Congressman Dar…: Well, first in the short term, while waivers exist and Medicare has given advisory opinions to orthopedic surgeons, that they can perform certain types of their healthcare service via telehealth, absolutely get reimbursed. And if there’s any issues on it, part of that is the oversight power. We send letters that we sign on to, much like where there was a worry about a reduction in reimbursement rates that right now has been pushed off for a while, we’re hoping permanently. So part of it initially is just the oversight power of making sure that Medicare is doing the right thing.
From there, there’ll be a longer analysis into what’s permanent, but as long as there’s a waiver and as long as there’s been some guidance from Medicare, orthopedic surgeons who rely on that advice should be able to get paid. And if they don’t, that’s where Congress has to step in to put pressure on CMS and HHS to hold true to their word. But knowing folks coming into the Biden administration, Xavier Becerra, I served with, will be coming in as the head of HHS. He’s actually been to our district on the campaign trail with me. I know that he, as a long, more than 20 year member, recognizes when we do waivers, we can’t just suddenly hurt people who rely, reasonably rely, on agency and legal action. So if there’s a waiver, there should be reimbursements for as long as those services occurred during a waiver. And if there isn’t, then Congress needs to play an active role to ensure that those reimbursements are made.
Keith Landry: Congressman Soto, you’ve given us some wonderful insights, very latest information on these trends and issues that a lot of people have been wondering about. And while we’ve got you for just a couple more minutes, are there any other issues that are on your radar screen or Speaker Pelosi’s screen or the Biden administration’s screen, regarding the future of issues that orthopedic physicians or doctors in general should be aware of listening to, reading up on, things that you foresee coming down the turnpike here in a minute?
Congressman Dar…: Sure. So a couple of things. First, we know post election, America wants us to have a World War II like effort to produce vaccines, to get them out in a massive style, to use the Defense Production Act to do that, FEMA, the National Guard, and that’ll affect overall how quickly we can vaccinate America. We just made an additional purchase of over 200 million doses of vaccine, which obviously there’s two doses per individual. So we’re now at over 600 million doses, which is enough for 300 million people.
And the sooner we get back to that, the sooner we can get more orthopedic surgeries moving more quickly, because sometimes as states have to go into emergencies, I know many of our orthopedic surgeons have had to stop practicing, weren’t able to put together a surgery during this week or that week, or even over extended periods spanning months, because of the COVID-19 pandemic. So getting shots in arms, getting herd immunity through vaccination, is a key part of getting our orthopedic surgeons and the industry back to more normalcy again.
In addition, we saw just this week President Biden make an order to reopen the Affordable Care Act exchanges. A lot of people have lost their health insurance because of a job loss, and most people aren’t paying for their orthopedic surgery with cash out of pocket. They have insurance that pays for it because it’s medically necessary. And so when you have that many fewer people with insurance, that affects the number of patients who could actually go through with the surgeries. So reopening the Affordable Care Act exchange, where Florida has the largest federal exchange in the nation, means more folks who are covered again, who can not only get the care that they need for COVID-19, but also for these critical, medically necessary surgeries, like in orthopedics, where you’ll have more people with insurance being able to get these key procedures done.
Keith Landry: Wow. This is just awesome, the very latest insights from Capitol Hill. It’s just awesome that we’ve had you today with us. Thank you so much for your time. United States Representative Darren Soto, representing the ninth congressional district in Osceola, Orange, and Polk counties. Men, let me tell you, Polk County is growing quickly. That is really something, how quickly Polk County is growing. But thank you so much for being here today, and we’ll have to have you back on pretty soon, sir.
Congressman Dar…: Sounds great, Keith. Thanks for having me.
Keith Landry: You bet. It was a pleasure. My friends, that is a wrap on this episode of the Building a Successful Orthopedic Practice podcast. I’m Keith Landry. We’re going to do this again soon. Thanks for listening.
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