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“Harnessing Biomedical Innovation: Modernizing VA Healthcare for the Future”

House Veterans Affairs Committee Hearing

April 1, 2025 (recording here)

HEARING INFORMATION

Witnesses & Written Testimony (linked):

• Mr. Will Gray: Vice President, Marketing, Commercial Operations, and Government, Boston Scientific

• Dr. Jon Bloom: Chief Executive Officer, Podimetrics

• Mr. Jeff DiLullo: Executive Vice President and Chief Regional Leader, Philips North America

• Dr. Sai Parthasarathy: Director, Center for Sleep, Circadian and Neuroscience Research, University of Arizona Health Sciences

Keywords mentioned:

• Healthcare, technology innovation, VA procurement, medical equipment, staffing shortages, cost containment, artificial intelligence (AI), telemedicine, PTSD treatment, research, budget cuts, patient outcomes

IN THEIR WORDS

OPENING STATEMENTS FROM THE COMMITTEE

• Chairman Mike Bost recognized that the VA has made progress in modernizing healthcare, but more work is needed to ensure veterans have access to the best healthcare technology available, regardless of their location or service history. He said that bureaucracy and delays should never prevent veterans from receiving life-saving care. Chairman Bost underscored the importance of eliminating waste, improving acquisition processes, and partnering with industry and academic leaders to push the VA into a modern agency.

• Ranking Member Mark Takano stated that veterans deserve top-tier healthcare, the latest medical innovations, and a fully staffed VA to deliver quality care. He criticized the Trump administration and Secretary Doug Collins for budget cuts that force VA leaders to make impossible decisions between staffing and technological investments. The Ranking Member argued that VA facilities are struggling to meet basic care requirements due to reduced resources, making it difficult to implement new medical technologies.

SUMMARY OF KEY POINTS

• Mr. Will Gray discussed Boston Scientific’s focus on developing medical technologies to address major health issues affecting veterans, such as pain, heart disease, and neurological disorders. He illustrated successful partnerships with the VA, including the Medical/Surgical Prime Vendor (MSPV) Program, which incorporates clinician input into purchasing decisions. Despite some progress, he said that technology adoption is still hampered by staffing shortages, budget unpredictability, and inefficient procurement processes. He recommended reforms to improve transparency, staffing, contract flexibility, and innovation pathways to ensure veterans receive timely access to advanced technologies.

• Dr. Jon Bloom spoke on Podimetrics’ development of a remote temperature monitoring program aimed at preventing diabetic foot ulcers in veterans. His collaboration with the VA, supported by the 2020 CARES Act, has already shown significant results, including early detection of foot ulcers and substantial cost savings. He said, however, that scaling this program to reach all eligible veterans remains challenging, particularly for rural and low-income veterans. He identified budget silos, limited access to podiatric care, and inadequate incentives for preventive care as barriers to broader implementation.

• Mr. Jeff DiLullo mentioned Philips North America’s commitment to serving veterans by providing innovative technologies such as TeleCritical Care programs and AI-enabled diagnostic imaging. He praised the VA’s efforts in implementing digital infrastructure to improve care delivery but argued that more could be done to expand these technologies across the entire VA network. Mr. DiLullo advocated for creating radiology command centers to enhance diagnostic efficiency and using AI to improve patient throughput and reduce costs.

• Dr. Sai Parthasarathy, a specialist in sleep medicine, discussed the importance of implementing biomedical research innovations to improve veteran healthcare. He elaborated on the impact of sleep apnea and insomnia on veterans' health and described how AI-driven tools can assist healthcare providers in diagnosing and treating these conditions more effectively. Dr. Parthasarathy also called for better integration of AI tools within the VA system to address chronic health issues more efficiently.

• Chairman Bost asked Mr. DiLullo about his experience with the VA acquisition process at both the national and facility levels. Mr. DiLullo responded that most of their contracts are at the VISN or below level, with limited national-level acquisitions. He noted that software and advanced AI capabilities should be handled at the enterprise level and suggested further exploration with the VA to demonstrate the economic value of these solutions.

• Chairman Bost asked if the variety of contracts Boston Scientific engages with the VA is appropriate or if the process should be streamlined. Mr. Gray replied that while the MSPV Program works well with clinician input and product updates, the prosthetics contract is more challenging. He urged for improved processes to add products more efficiently and timely.

• The Chairman turned to Dr. Bloom, inquiring how his company’s work helps prevent long-term complications and reduce hospitalizations among diabetic veterans. Dr. Bloom explained that preventing diabetic foot ulcers can prevent related complications like heart attacks, strokes, and other costly health issues. He noted that the VA's program saves approximately $16,000 per patient per year by identifying issues early and providing timely care.

• Chairman Bost then asked Dr. Parthasarathy how his work is helping veterans with posttraumatic stress disorder (PTSD) and chronic pain treat their sleep disorders. Dr. Parthasarathy explained that technologies using AI can assist with both diagnosis and treatment, including cognitive therapy delivered through machine-based approaches.

• Ranking Member Takano expressed concern about the cost of new medical technologies in light of VA workforce cuts and asked the witnesses if they would provide detailed product and pricing information to the Committee. Mr. Gray stated that much of the requested information is proprietary, while Mr. DiLullo agreed to provide contract-related information. The Ranking Member underlined the need for transparency, stating that the American public deserves to know the costs of innovations purchased for veterans.

• Ranking Member Takano shared additional concerns that VA research and innovation are being outsourced to private companies while internal research capabilities are being undermined. He stated that Congress needs to push for better investment in the VA’s own research infrastructure.

• Rep. Greg Murphy echoed concerns about past inefficiencies at VA facilities, including poorly planned equipment purchases, and asked each panelist how they are addressing cost containment. Mr. Gray noted that the VA’s contracting process already rigorously controls costs. Dr. Bloom stated that preventive measures, like avoiding amputations, lead to significant savings. Mr. DiLullo described using AI to reduce costs by improving radiology efficiency. Dr. Parthasarathy emphasized that diagnosing and treating sleep apnea reduces long-term cardiovascular costs.

• Rep. Julia Brownley questioned Mr. Gray about the stability of the VA’s procurement process amidst workforce cuts. Mr. Gray stated that maintaining adequate staffing for procurement is crucial to ensure that products reach veterans efficiently.

• Rep. Brownley also asked the witnesses if contract instability with the VA impacts their willingness to continue working with the department. Mr. DiLullo responded that Philips is committed to serving veterans despite contractual uncertainties, pointing to their long-term partnership with the VA.

• Rep. Tom Barrett asked about the potential of GLP-1 medications for diabetes prevention and treatment. Dr. Bloom acknowledged their promising impact but pointed out challenges related to access and cost.

• Rep. Barrett also discussed the importance of preventing disease progression and asked Mr. DiLullo about integrating radiology records to reduce duplicative tests. Mr. DiLullo explained that Phillips is working on interoperability solutions to integrate existing VA systems, helping reduce unnecessary scans and costs.

• Rep. Sheila Cherfilus-McCormick questioned whether the VA has the necessary processes and staff to ensure veterans receive optimal care from innovative technologies. She was disappointed that the department was not in attendance.

• Rep. Cherfilus-McCormick then asked if the witnesses believed they had the resources necessary to deal with preventative care. Dr. Bloom spoke about efforts to incentivize adequate staffing and ensure providers have the tools they need to dedicate their time appropriately.

• Rep. Abe Hamadeh asked about the Rapid Analysis of Threat Exposure (RATE) program, a pilot project with the Department of Defense (DOD). Mr. DiLullo explained that RATE uses wearable devices to monitor health metrics, predicting illnesses before symptoms appear. This technology helps maintain readiness and could potentially benefit VA healthcare staff by identifying health risks early. Rep. Hamadeh followed up and inquired about privacy considerations. Mr. DiLullo confirmed that the program anonymizes personal data.

• Rep. Hamadeh then asked how AI is used to enhance patient care. Dr. Parthasarathy referenced an application to sleep apnea and how clinicians can better treat patients despite busy schedules. He also spoke about the patient-facing benefits of these algorithms and capabilities.

• Rep. Nikki Budzinski expressed concerns about VA workforce cuts and their impact on healthcare delivery. She asked Mr. DiLullo if he knew how many non-clinical staff members were needed to maintain and repair Philips products. Mr. DiLullo admitted that he did not know but offered to provide the information later. Rep. Budzinski underscored that non-clinical staff are essential to sustaining the VA’s healthcare mission.

• Rep. Amata Coleman Radewagen asked about the consequences of untreated sleep apnea and what sleep apnea therapy non-adherence entails. Dr. Parthasarathy explained that untreated sleep apnea leads to strokes, heart attacks, heart failure, motor vehicle accidents, depression, anxiety, increased hospitalizations, and higher mortality rates. He confirmed that the VA had systems in place to securely collect and monitor usage data from devices used in patients’ homes.

• Rep. Radewagen shifted to the causes of diabetic foot ulcers and the consequences if they were left untreated. Dr. Bloom explained that diabetic foot ulcers occurred due to poor blood flow, nerve damage, high glucose levels, and infection. He noted that untreated ulcers could lead to severe infections, amputations, depression, and even suicide.

• Rep. Morgan McGarvey praised the VA’s innovation efforts and referenced the potential for procurement processes similar to DARPA. He asked Dr. Bloom about the challenges facing Potometrics when scaling innovation with the VA. Dr. Bloom responded that venture capitalists had historically avoided investing in companies focused on the VA due to past negative experiences. He explained that an advanced market commitment by the VA could encourage private investment, as companies would be more willing to take risks if there was a structured commitment to purchase their innovative solutions.

• Rep. Mariannette Miller-Meeks asked all witnesses if technology was disruptive and whether advancements could impact employment at the VA. Mr. Gray stated that some jobs could be lost due to technological advancements but believed that new positions would be created. Dr. Bloom explained that preventive technologies could reduce the need for certain clinicians but noted that resources could be reallocated to other areas. Mr. DiLullo stated that technology allowed clinicians to work at the top of their licensure, thereby enhancing efficiency. Dr. Parthasarathy emphasized that implementation science should be phased in rather than disruptive to ensure proper integration.

• Rep. Delia Ramirez echoed her colleagues’ frustration at the absence of VA representatives at the hearing. She criticized the hearing for feeling like a sales pitch rather than a genuine discussion about innovation, voicing concerns about the Trump administration’s influence and potential privatization of the VA.

• Rep. Ramirez asked Mr. DiLullo if Philips could operate effectively if 15% of its workforce were cut, as the VA was proposing. Mr. DiLullo responded that Philips would struggle if 15% of its workforce were cut but would work to use technology to automate processes and address gaps.

• Rep. Jack Bergman asked why approximately 61% of AFib procedures in civilian hospitals used pulse field ablation technology, but only about 10% of VA hospitals had access to it. Mr. Gray explained that the limited adoption in the VA system was due to budget uncertainty at the hospital level and inefficiencies within the prosthetics contract. He noted that VA medical facilities were unsure whether they would have the necessary budget or infrastructure to adopt the technology, which created hesitation.

• Rep. Bergman also asked about the importance of clinical input in the procurement process. Mr. Gray stated that clinical input was critical and necessary, regardless of whether the procurement process was occurring within the VA or in civilian hospitals. He underlined that including physicians in the decision-making process led to better outcomes for patients.

• Rep. Bergman inquired how the VA’s procurement process compared to the DOD, particularly regarding implementation timelines. Mr. Gray explained that the DOD’s procurement process was similar to the VA’s MSPV process, allowing new products to be added relatively quickly. However, he noted that the VA’s prosthetics contract was slower and more cumbersome, creating challenges in bringing new technologies to veterans.

• Rep. Maxine Dexter criticized the hearing for proceeding without the VA’s participation and expressed concern over private industry representatives presenting without adequate oversight from the VA. She asked Mr. Gray about the validity of the study he cited regarding pulse field ablation technology. Mr. Gray acknowledged that the study was a non-inferiority trial financed by Boston Scientific. Rep. Dexter warned that the evidence presented was not independently verified and was designed to show the new technology was no worse than existing options, rather than proving it was better.

• Rep. Juan Ciscomani asked about the potential taxpayer savings generated by Potometrics’ remote temperature monitoring program. Dr. Bloom stated that the VA reported approximately $16,000 in savings per veteran participant per year, primarily through avoiding hospitalizations and outpatient visits. He explained that only a small percentage of eligible veterans were enrolled in the program, citing limited access to VA podiatry care and inadequate infrastructure as major challenges.

• Rep. Ciscomani turned to Mr. DiLullo, asking how innovative technology could help better serve veterans with lung disease and respiratory disorders. Mr. DiLullo explained that their imaging technology could detect lung conditions faster and at a lower cost than traditional methods, allowing for earlier intervention and improved health outcomes.

• Rep. Herb Conaway acknowledged the potential benefits of new technology but was cautious about the lack of resources for critical medical equipment already needed within the VA. He also raised concerns about the VA’s ability to implement new technologies effectively with current staffing challenges. He asked about the inefficiencies in the VA’s prosthetics procurement process. Mr. Gray stated that the VA’s prosthetics contract lacked designated time periods for adding new products, unlike the MSPV Program, which allowed for product updates twice a year.

• Rep. Tim Kennedy expressed frustration that the VA was not present at the hearing and argued that the absence of VA representatives hindered efforts to address gaps in care and modernize the system effectively. He questioned how the VA could properly maintain and operate new technologies with a drastically reduced workforce, citing the planned cuts of 80,000 employees. He voiced appreciation for the witnesses’ efforts but reiterated that their testimony could not replace insight from the VA itself.

• Ranking Member Takano criticized Secretary Collins for not meeting with Democratic Committee members and for providing only superficial responses to letters sent by Committee Democrats. He argued that the VA’s absence prevented meaningful discussion about acquisition processes and other critical issues. The Ranking Member reiterated that the VA must be fully staffed to implement new technologies effectively and stated that the hearing was unproductive without the VA’s participation.

• Chairman Bost defended the VA against allegations of avoiding oversight and addressed concerns about planned workforce cuts. He asserted that the proposal to cut employees was merely a memo, not a final decision. He claimed that the VA had been transparent about its plans and emphasized that the purpose of the hearing was to focus on innovation. The Chairman acknowledged past instances where the VA had not attended hearings under previous administrations but stressed that the VA would have the opportunity to answer questions when the President’s budget was presented.

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