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115th Congress   }                                     {        Report
                        HOUSE OF REPRESENTATIVES
 1st Session     }                                     {       115-151

======================================================================



 
           VETERANS AFFAIRS MEDICAL SCRIBE PILOT ACT OF 2017

                                _______
                                

  May 23, 2017.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

    Mr. Roe of Tennessee, from the Committee on Veterans' Affairs, 
                        submitted the following

                              R E P O R T

                        [To accompany H.R. 1848]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Veterans' Affairs, to whom was referred 
the bill (H.R. 1848) to direct the Secretary of Veterans 
Affairs to carry out a pilot program on the use of medical 
scribes in Department of Veterans Affairs medical centers, 
having considered the same, report favorably thereon without 
amendment and recommend that the bill do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     2
Background and Need for Legislation..............................     2
Hearings.........................................................     2
Subcommittee Consideration.......................................     3
Committee Consideration..........................................     3
Committee Votes..................................................     3
Committee Oversight Findings.....................................     3
Statement of General Performance Goals and Objectives............     3
New Budget Authority, Entitlement Authority, and Tax Expenditures     4
Earmarks and Tax and Tariff Benefits.............................     4
Committee Cost Estimate..........................................     4
Congressional Budget Office Estimate.............................     4
Federal Mandates Statement.......................................     5
Advisory Committee Statement.....................................     5
Constitutional Authority Statement...............................     5
Applicability to Legislative Branch..............................     5
Statement on Duplication of Federal Programs.....................     5
Disclosure of Directed Rulemaking................................     6
Section-by-Section Analysis of the Legislation...................     6
Changes in Existing Law Made by the Bill as Reported.............     7

                          PURPOSE AND SUMMARY

    Representative Phil Roe of Tennessee introduced H.R. 1848, 
the ``Veterans Affairs Medical Scribe Pilot Act of 2017,'' on 
April 3\+\, 2017. H.R. 1848 would require the Department of 
Veterans Affairs (VA) to carry out a two-year pilot program at 
ten VA medical facilities to employ medical scribes in 
emergency department and specialty care settings.

                  BACKGROUND AND NEED FOR LEGISLATION

Section 2. Department of Veterans Affairs Medical Scribe Pilot Program

    The use of electronic health records (EHRs) has become 
standard practice for the vast majority of healthcare delivery 
systems in United States. While evidence shows that EHRs do 
improve patient safety and outcomes, many clinicians find using 
EHRs to be burdensome and feel that taking time to enter data 
into a computer detracts from the quality of their interaction 
with patients and also limits the amount of patients they are 
able to see daily. To address this disconnect between 
providers, patients, and productivity, private practices have 
begun employing non-clinical staff whose sole purpose is 
entering dictations from the physician into a patient's EHR and 
helping the physician navigate the patient's existing record.
    In particular, medical scribes have proven to be 
particularly useful for increasing physician productivity and 
satisfaction in fast-paced clinical environments such as the 
emergency department (ED) and specialty care settings.\1\ 
Medical scribes are trained on privacy considerations and how 
to swiftly and accurately navigate and enter data into a 
patient's health records before being assigned to a physician. 
Once appropriately trained, the scribe then follows the 
physician during his patient interactions, carefully 
documenting each encounter.
---------------------------------------------------------------------------
    \1\Rajiv Arya MD, Danielle M. Salovich, Pamela Ohman-Strickland 
PhD, Mark A. Merlin DO. ``Impact of Scribes on Performance Indicators 
in the Emergency Department'' Academic Emergency Medicine: Official 
Journal of the Society for Academic Emergency Medicine. April 23, 2010. 
http://onlinelibrary.wiley.com/doi/10.1111/j.1553-2712.2010.00718.x/
full
---------------------------------------------------------------------------
    The Veterans Affairs Medical Scribe Pilot Act of 2017 would 
create a two-year pilot program under which VA will increase 
the use of medical scribes in emergency department and 
specialty care settings at 10 VA medical centers. To provide 
transparency on staffing methodology for medical scribes at the 
Department, this pilot would have half of the participating 
scribes be employed by the Department, with half employed under 
contract with a private-sector provider of medical scribes. 
Under this legislation, VA would be required to report to 
Congress every 180 days regarding the effects the pilot program 
has had on provider efficiency, patient satisfaction, average 
wait time, the number of patients seen per day and the amount 
of time required to train an employee to perform medical scribe 
functions under the pilot program. A report from the 
Comptroller General is also required not more than 90 days 
after the conclusion of the pilot.

                                HEARINGS

    There were no full Committee hearings held on H.R. 1848.
    On March 29, 2017, the Subcommittee on Health conducted a 
legislative hearing on a number of bills including a draft of 
H.R. 1848.
    The following witnesses testified:
          The Honorable David. P. Roe M.D. of Tennessee; The 
        Honorable Jackie Walorski of Indiana; The Honorable 
        Doug Collins of Georgia; The Honorable Mike Coffman of 
        Colorado; The Honorable Stephen Knight of California; 
        The Honorable Ann M. Kuster of New Hampshire; Jennifer 
        S. Lee, M.D., the Deputy Under Secretary for Health for 
        Policy and Services for the Veterans Health 
        Administration of the U.S. Department of Veterans 
        Affairs who was accompanied by Susan Blauert, the Chief 
        Counsel for the Health Care Law Group of the Office of 
        the General Counsel for the U.S. Department of Veterans 
        Affairs; Kayda Keleher, Legislative Associate for the 
        National Legislative Service of the Veterans of Foreign 
        Wars of the United States; Shurhonda Y. Love, the 
        Assistant National Legislative Director for the 
        Disabled American Veterans; and, Sarah S. Dean, the 
        Associate Legislative Director for the Paralyzed 
        Veterans of America.
    Statements for the record were submitted by:
          The Honorable Lee Zeldin of New York; The American 
        Legion; the National Association of State Veteran 
        Homes; Swords to Plowshares; and, the Wounded Warrior 
        Project.

                       SUBCOMMITTEE CONSIDERATION

    On April 6, 2017, the Subcommittee on Health met in an open 
markup session, a quorum being present, and ordered H.R. 1848 
to be reported favorably to the Full Committee by voice vote.

                        COMMITTEE CONSIDERATION

    On May 17, 2017, the Full Committee met in open markup 
session, a quorum being present, and ordered H.R. 1848 to be 
reported favorably to the House of Representatives by voice 
vote. A motion by Representative Tim Walz of Minnesota, Ranking 
Member of the Committee on Veterans Affairs, to report H.R. 
1848 favorably to the House of Representatives was agreed to by 
voice vote.

                            COMMITTEE VOTES

    In compliance with clause 3(b) of rule XIII of the Rules of 
the House of Representatives, there were no recorded votes 
taken on amendments or in connection with ordering H.R. 1848 
reported to the House.

                      COMMITTEE OVERSIGHT FINDINGS

    In compliance with clause 3(c)(1) of rule XIII and clause 
(2)(b)(1) of rule X of the Rules of the House of 
Representatives, the Committee's oversight findings and 
recommendations are reflected in the descriptive portions of 
this report.

         STATEMENT OF GENERAL PERFORMANCE GOALS AND OBJECTIVES

    In accordance with clause 3(c)(4) of rule XIII of the Rules 
of the House of Representatives, the Committee's performance 
goals and objectives are to create a pilot program to increase 
the use of medical scribes in Department medical centers.

   NEW BUDGET AUTHORITY, ENTITLEMENT AUTHORITY, AND TAX EXPENDITURES

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee adopts as its 
own the estimate of new budget authority, entitlement 
authority, or tax expenditures or revenues contained in the 
cost estimate prepared by the Director of the Congressional 
Budget Office pursuant to section 402 of the Congressional 
Budget Act of 1974.

                  EARMARKS AND TAX AND TARIFF BENEFITS

    H.R. 1848 does not contain any Congressional earmarks, 
limited tax benefits, or limited tariff benefits as defined in 
clause 9 of rule XXI of the Rules of the House of 
Representatives.

                        COMMITTEE COST ESTIMATE

    The Committee adopts as its own the cost estimate on H.R. 
1848 prepared by the Director of the Congressional Budget 
Office pursuant to section 402 of the Congressional Budget Act 
of 1974.

               CONGRESSIONAL BUDGET OFFICE COST ESTIMATE

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate 
for H.R. 1848 provided by the Congressional Budget Office 
pursuant to section 402 of the Congressional Budget Act of 
1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                      Washington, DC, May 19, 2017.
Hon. Phil Roe, M.D.,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 1848, the Veterans 
Affairs Medical Scribe Pilot Act of 2017.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Ann E. 
Futrell.
            Sincerely,
                                                        Keith Hall.
    Enclosure.

H.R. 1848--Veterans Affairs Medical Scribe Pilot Act of 2017

    H.R. 1848 would require the Department of Veterans Affairs 
(VA) to establish a two-year pilot program to increase the 
number of medical scribes (or personal assistants to 
physicians) employed at the department. The bill also would 
require VA to report to the Congress every six months and would 
require the Government Accountability Office (GAO) to report, 
within 90 days of the program's termination, the results of the 
pilot program compared to similar programs in the private 
sector.
    Under the bill, CBO estimates that VA would need to hire 40 
medical scribes (20 term employees and 20 contractors) in 10 
medical centers. CBO expects that the pilot would run from the 
middle of fiscal year 2018 through the middle of fiscal year 
2020 and that the GAO report would be completed in 2020. On the 
basis of information from VA on the average salary for medical 
support assistants, CBO estimates that pay and benefits for a 
medical scribe would be roughly $48,000 in 2018. After 
incorporating the effects of inflation, CBO estimates that 
implementing the two-year pilot program and preparing the 
required reports would cost $5 million over the 2018-2022 
period; that spending would be subject to the availability of 
appropriated funds.
    Enacting the bill would not affect direct spending or 
revenues; therefore, pay-as-you-go procedures do not apply. CBO 
estimates that enacting H.R. 1848 would not increase net direct 
spending or on-budget deficits in any of the four consecutive 
10-year periods beginning in 2028.
    H.R. 1848 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act, and 
would not affect the budgets of state, local, or tribal 
governments.
    The CBO staff contact for this estimate is Ann E. Futrell. 
The estimate was approved by H. Samuel Papenfuss, Deputy 
Assistant Director for Budget Analysis.

                       FEDERAL MANDATES STATEMENT

    The Committee adopts as its own the estimate of Federal 
mandates regarding H.R. 1848 prepared by the Director of the 
Congressional Budget Office pursuant to section 423 of the 
Unfunded Mandates Reform Act.

                      ADVISORY COMMITTEE STATEMENT

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act would be created by H.R. 
1848.

                 STATEMENT OF CONSTITUTIONAL AUTHORITY

    Pursuant to Article I, section 8 of the United States 
Constitution, H.R. 1848 is authorized by Congress' power to 
``provide for the common Defense and general Welfare of the 
United States.''

                  APPLICABILITY TO LEGISLATIVE BRANCH

    The Committee finds that H.R. 1848 does not relate to the 
terms and conditions of employment or access to public services 
or accommodations within the meaning of section 102(b)(3) of 
the Congressional Accountability Act.

              STATEMENT ON DUPLICATION OF FEDERAL PROGRAMS

    Pursuant to section 3(g) of H. Res. 5, 114th Cong. (2015), 
the Committee finds that no provision of H.R. 1848 establishes 
or reauthorizes a program of the Federal Government known to be 
duplicative of another Federal program, a program that was 
included in any report from the Government Accountability 
Office to Congress pursuant to section 21 of Public Law 111-
139, or a program related to a program identified in the most 
recent Catalog of Federal Domestic Assistance.

                   DISCLOSURE OF DIRECTED RULEMAKING

    Pursuant to section 3(i) of H. Res. 5, 114th Cong. (2015), 
the Committee estimates that H.R. 1848 contains no directed 
rulemaking that would require the Secretary to prescribe 
regulations.

             SECTION-BY-SECTION ANALYSIS OF THE LEGISLATION

Section 1. Short title

    Section 1 of the bill would provide the short title for 
H.R. 1848, as the ``Veterans Affairs Medical Scribe Pilot Act 
of 2017''.

Section 2. Department of Veterans Affairs Medical Scribe Pilot Program

    Section 2(a) of the bill would require the Secretary to 
carry out a pilot program to increase the use of medical 
scribes at Department of Veterans Affairs medical centers.
    Section 2(b) of the bill would require the pilot program 
established by Section 2(a) of the bill be carried out at ten 
medical centers of the Department
    Section 2(b)(1) would require four medical centers 
established by Section 2(b) to be located in rural areas.
    Section 2(b)(2) would require four medical centers 
established by Section 2(b) to be located in urban areas.
    Section 2(b)(3) would require two medical centers 
established by Section 2(b) to be located in areas with need 
for increased access or increased efficiency, as determined by 
the Secretary.
    Section 2(c)(1) of the bill would require the Secretary to 
hire 20 medical scribes as Department employees and enter into 
contracts with appropriate entities to employ 20 medical 
scribes, with four medical scribes assigned to each of the 
medical centers identified by Section 2(b) of the bill.
    Section 2(c)(2) of the bill would require the Secretary to 
assign four medical scribes to each pilot site established by 
Section 2(b).
    Section 2(c)(2)(A) of the bill would assign two scribes to 
each of two physicians participating in the pilot established 
under Section 2(a).
    Section 2(c)(2)(B) of the bill would require thirty percent 
of the scribes participating in the pilot established by 
Section 2(a) to be employed in an emergency care setting.
    Section 2(c)(2)(C) of the bill would require seventy 
percent of the scribes participating in the pilot established 
under Section 2(a) to be employed in specialty care setting, 
prioritized by longest wait times or lowest efficiency ratings, 
as determined by the Secretary.
    Section 2(d)(1) of the bill would require the Secretary to 
submit a report to the House and Senate Committees on Veterans' 
Affairs on the pilot program established by Section 2(a) of the 
bill by not later than 180 days after the date of the 
commencement of the pilot, and every 180 days thereafter for 
the duration of the pilot, including a separate analysis with 
respect to medical scribes employed by the Department and those 
performing Department functions under contract, and stipulates 
which metrics are to be included in the report.
    Section 2(d)(2) of the bill would require the Comptroller 
General to submit a report to Congress no more than 90 days 
after the termination of the pilot established under Section 
2(a), to include a comparison of the pilot program with similar 
programs carried out in the private sector.
    Section 2(e)(1) of the bill defines the term ``medical 
scribe.''
    Section 2(e)(2) of the bill defines the terms ``urban'' and 
``rural.''
    Section 2(f) of the bill would stipulate that no additional 
funds are authorized to be appropriated to carry out the 
requirements of Section 2 of the bill, and the requirements of 
Section 2 of the bill are required to be carried out using 
amounts otherwise authorized.

         CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

    If enacted, this bill would make no changes in existing 
law.

                                  [all]