March 1, 2021 RE: PHILIPS TESTIMONY for SF 1160 for SENATE COMMERCE and CONSUMER PROTECTION FINANCE and POLICY COMMITTEE HEARING

March 1, 2021

RE: PHILIPS TESTIMONY FOR SF 1160 FOR SENATE COMMERCE AND CONSUMER PROTECTION FINANCE AND POLICY COMMITTEE HEARING

Dear Chair Dahms, Vice Chair Utke and Members of the Senate Commerce and Consumer Protection Finance and Policy Committee

On behalf of Philips, I submit testimony on Minnesota SF 1160. While Philips supports this bill because it reduces barriers to telehealth in many ways, my comments today will uniquely focus on the value of telemonitoring services to enhancing Minnesotans’ healthcare. Philips believes SF 1160 is a great start, but the current language limits the use of telemonitoring to certain patients within narrowly defined parameters. This testimony highlights the following topics:

 Telemonitoring is an important patient care solution  Telemonitoring leads to cost savings  Clinicians want the use of telemonitoring  Other states are mandating coverage and reimbursement for telemonitoring  The medical assistance rules would prevent many patients from accessing telemonitoring  Philips suggested changes to SF 1160 Background on Philips: Philips is a health technology company focused on improving people’s health and enabling better outcomes. In Minnesota, Philips employs over 400 workers with facilities in Plymouth and Maple Grove. The company has been an industry leader in transforming telehealth over the last fifteen years, providing telemonitoring solutions across a patient’s care journey, from the ICU, to the emergency room, to the patient’s home.1 We applaud any legislative effort to expand telemonitoring.

Telemonitoring is an important patient care solution: Telemonitoring allows providers to continually monitor, collect and analyze a patient’s physiological data to create and manage a patient’s treatment plan. This technology helps monitor patients with chronic illnesses like chronic obstructive pulmonary disease, congestive heart failure, coronary artery disease, diabetes, among others. Moreover, telemonitoring helps monitor patients recovering from acute conditions when discharged to the home. This technology helps providers track their patients’ key vitals at any given moment on a real-time basis. Now, providers can more easily understand a patient’s response to treatment, track improvements or be warned sooner of deteriorations to intervene and minimize exacerbations. These solutions have reduced hospital readmissions and aid in sending patients home sooner after receiving treatment.

Telemonitoring leads to cost savings:

1 Philips’ telemonitoring solutions help patients including pregnant, high-risk mothers or patients who need chronic or acute care management plans. Philips also specializes in telemonitoring in the hospital. For instance, Philips “eICU” program remotely monitors 1 in 8 adult ICU beds in the United States. In Minnesota, both the Mayo Clinic and VISN-23 use eICU to monitor patients. eICU allows offsite clinicians to monitor and help treat ICU patients 24 hours a day through audio, video, patient monitoring and predictive analytics tools. These are just several of Philips telemonitoring solutions.

By expanding coverage of telemonitoring, Minnesota will realize costs savings elsewhere across the healthcare system. For example, telemonitoring reduces patients’ hospital readmission rates and emergency department visits. In addition, other patients could be discharged sooner from hospitals because physicians would have the tools to monitor patients at home.2

Clinicians want to use telemonitoring: A recent telehealth utilization survey of over 1,500 physicians highlighted that while only 10 to 13% currently use telemonitoring for patients in the home, 75% want to use telehealth for chronic disease management.3 Another survey of hospital executives shows that around 37% already use telemonitoring to provide care for chronically-ill patients and another 33% plan to explore or launch a telemonitoring plan in the next year.4 In addition, the American Medical Association’s updated policy guidance highlights remote patient monitoring as a key telehealth tool to ensuring uninterrupted care for 100 million Americans with chronic conditions.5

Other states are mandating coverage and reimbursement for telemonitoring: By enacting SF 1160, Minnesota will join a chorus of other states in expanding telemonitoring to their citizens. According to the Center for Connected Health Policy’s Fall 2020 Report, 21 states’ Medicaid programs provide reimbursement for telemonitoring.6 In addition, at least 15 states require commercial payers to cover telemonitoring.7 For example, Massachusetts enacted comprehensive telehealth legislation (S.2984) into law last month that requires commercial insurers and Medicaid to cover telemonitoring. As well, several states expanded coverage of telemonitoring by passing laws last year, including Colorado (SB 212), Louisiana (HB 530), Michigan (HB 5415), and Utah (HB 313).

For these reasons and others, the Centers for Medicaid and Medicare Services reimburse for telemonitoring, giving access to this care for Medicare beneficiaries.8

The medical assistance rules would prevent many patients from accessing telemonitoring:

The bill would limit the use of telemonitoring for patients covered by Medical Assistance if they meet all five of these criteria:

2 Several healthcare studies have looked at how telemonitoring reduce costs: - A 2014 study by Brockton Hospital in Massachusetts began using a remote care program to follow congestive heart failure (CHF) patients. Hospital readmission rate within 30 days of discharge is typically 25% for CHF patients, but of the 30 CHF patients enrolled in the study, not one was readmitted to the hospital within 30 days. Brockton achieved a savings of $216,000. - A 2017 pilot study looked at how continuous data collection, among other strategies, would help influence hospital readmission rates for approximately 890 patients with chronic obstructive pulmonary disease. The study resulted in an 80% reduction in acute 30-day readmissions and a greater than 70% reduction in total all-cause acute care events driving a savings to the hospital of $1.3 million and $4.4 million, respectively. - A 2005 study looked at how tele-monitoring would help approximately 445 veterans with diabetes who had two or more hospitalizations or emergency room visits. The proportion of patients who were hospitalized reduced by 50%, who went to the emergency room were reduced by 11%, and the average number of bed days were reduced by three days. 3 See Telehealth Impact: Physician Survey Analysis, 11/16/20 4 See Hospital Executives Weigh in on Telehealth Utilization, 9/18/20 5 See AMA Telehealth quick guide, Updated 9/24/20 6 See CCHP Fall 2020 Report 7 See 50-State Survey of Telehealth Commercial Insurance Laws, Foley, February 2021 8 See CMS Clarifies 2021 PFS Reimbursements for Remote Patient Monitoring, mHealth Intelligence, 1/21/21

1. Has been diagnosed and is receiving services for at least one of the following chronic conditions: hypertension, cancer, congestive heart failure, chronic obstructive pulmonary disease, asthma, or diabetes; 2. Requires at least five times per week monitoring to manage the chronic condition, as ordered by the recipient's health care provider; 3. Has had two or more emergency room or inpatient hospitalization stays within the last 12 months due to the chronic condition or the recipient's health care provider has identified that telemonitoring services would likely prevent the recipient's admission or readmission to a hospital, emergency room, or nursing facility 4. Is cognitively and physically capable of operating the monitoring device or equipment, or the recipient has a caregiver who is willing and able to assist with the monitoring device or equipment; and 5. Resides in a setting that is suitable for telemonitoring and not in a setting that has health care staff on site

The first criteria limits telemonitoring to patients who one of six listed chronic conditions. However, there are many other use-cases for telemonitoring. For example:

 A high risk pregnant mother who may require a fetal monitor to help monitor her health and her fetus’ health.  A patient with chronic kidney disease may need a blood pressure cuff and a weight scale.  A cardiac rehab may need a blood pressure cuff, an EKG, and a pulse oximeter.  A patient undergoing physical therapy whose blood pressure or oxygen levels are monitored.  A patient with cardiac complications who wears a heart monitor to measure palpitations;  A patient who needs monitoring following surgery. This could include a patient prescribed a narcotic for pain whose breathing could be monitored from home or a patient who could be monitored for reinfection risks from their home instead of in the hospital. The second criteria further limits telemonitoring coverage only if the patient is monitored at least five times per week. This would deny patient access to telemonitoring who don’t need telemonitoring five times a week. For example:

 A diabetic patient who needs to have their weight monitored, but it is not clinically appropriate to have the patient step on a scale five times a week.  A patient with hypertension who needs only weekly monitoring for long-term management of their condition.

Philips suggested changes to SF 1160:

Philips would urge senators to amend this bill to create more flexibility among potential use- cases. State policies should not dictate what patient conditions have access to this care verses others. By listing specific conditions, Minnesota would be limiting the law’s application to all other patients who fall outside these few buckets. Rather, telemonitoring should be used by the provider so long as the appropriate standard of care is being met and there is medical necessity

for the service. For example, Nebraska’s model allows the provider to determine whether telemonitoring is medically necessary.9

Thank you for the opportunity to submit testimony on this important issue. Please let me know if you have any questions or need more information.

Sincerely,

Evan Hoffman Director of State and Local Government Relations Philips

9 See the Nebraska Medicaid RPM model here: https://www.cchpca.org/telehealth-policy/current-state-laws-and- reimbursement-policies/nebraska-medicaid-remote-patient-monitoring-policy