Tom Leary, MA, CAE, FHIMSS, Senior Vice President and Head of Government Relations at HIMSS, joins host Rachel Wilkes to share critical insights in a time of unprecedented policy change and funding uncertainty. Tom and Rachel discuss the One Big Beautiful Bill, the Rural Health Transformation Program, potential Medicaid and Medicare cuts, AI and interoperability policies, and more. In a time of constant change, Tom Leary offers healthcare leaders advice on how to navigate evolving policies and position their organizations for success in the next era of healthcare. (Recording took place on 9/18/25).
00:00:00:02 - 00:00:02:19 Welcome to another episode of the Meditech podcast.
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We're the leader in healthcare technology,
empowering you
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to be a more informed health care
consumer and provider.
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Hear the latest
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from our friends and colleagues on topics
we think you should know about.
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I'm Rachel Wilkes, director of Meditech,
and today I'll be your host.
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I'm joined by Tom Leary,
the senior vice president
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and head of government relations
for hands,
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where he leads the organization's
digital health policy development.
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Tom also serves
as the executive director of the Hims
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Foundation,
which is a philanthropic arm of Hims.
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The Hims Foundation enriches
the public discourse on public policy,
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advances
clinical informatics and data science,
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and presents undergraduate
and graduate level scholarships.
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This fosters
partnerships to advance equity, access
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and inclusion in the health information
and data management science workforce.
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Welcome, Tom.
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you. Hi, everybody.
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I'm a public policy person.
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I'm a patient.
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I'm a family member who enthusiastically
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tells parents and relatives
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and whoever else to use electronic health
care and believe in it.
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So can we start off
by talking a bit about hims?
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Tell me how long you've been
with the organization,
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and can you speak to the mission
and goals of Hims?
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I think it's important to understand
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who Hims is as an organization
and why we get up in the morning.
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I've been with hims for 22 years,
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but for about 17 or 18 of those years,
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I blow past the vision and mission
like, hey,
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you can read it on the website
or whatever.
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But our board of directors
and CEO realize the full health
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potential of every human everywhere.
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We're serious about it, and we leverage
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all of you as hims members
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or potential Hims members
to try and achieve that vision.
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The mission
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of reforming the global health ecosystem
through the power of information
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and technology.
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So it's not just the technology,
not just hims.
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It's actually the
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actionable
information that comes from the data
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that allows for providers, health system
and individuals
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to be involved
and to improve the outcomes.
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That's why we get up in the morning.
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We work in an inherently dynamic industry,
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but with the latest federal policy changes
and the One Big Beautiful Bill act.
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The last few months have really set
a new precedent.
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Can you provide a sort of lay of the land
for us?
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Can you talk about what to expect
and what health care professionals
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need to know going forward So there's one
big, beautiful bill that consumed
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everybody's attention for quite some time
and culminated on July 4th.
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The AI sandbox act,
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which was just introduced
on Tuesday morning, and then Trump
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administration actions to follow
CMS Health Tech Ecosystem
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living, HHS open Data
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policy, the AI Action plan, and then ask
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and see
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what we've
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seen with the Trump administration coming
in, is a doubling down on the idea
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that issues like cybersecurity
and artificial intelligence
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and information sharing and cyber
certification still very important,
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still very foundational
to the success of health care delivery.
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IT and all digital health transformation.
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So the things in health care
that we need to be
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concerned about are in some key areas.
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Medicaid funding reducing funding.
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And the Congressional Budget Office
is talking about $1
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trillion over ten years in reduction.
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Some of the other issues
they're focusing on
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within the legislation
is telehealth and digital access.
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We have until September 30th
to continue the expansion
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of telehealth services as they were
identified during the pandemic.
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So if you remember, on March the 13th,
they declared the public emergency.
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So on March the 12th and prior,
a majority of the country
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did not have access
to telehealth services.
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Pandemic.
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Thanks to a lot of conversations
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that Hims and others
had had with the government.
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The Secretary was given the authority
to expand telehealth services
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to allow for access to care,
while not exposing people
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to the emergency rooms and not overrunning
the emergency rooms, etc.
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those telehealth services
have continued beyond the pandemic,
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and Congress
has extended them year over year.
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The most recent is through
The One Big Beautiful Act.
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So I think what's important for all of you
to understand from a policy perspective
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is that CMS has figured out
every which way they can
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to make sure that remote patient
monitoring and some telehealth
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services are covered under Medicare.
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There is a requirement
for legislative relief
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that legislative relief
means Congress needs to act.
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They've acted through September 30th,
and there's
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some indication that they'll extend again
through December.
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So the action that I would suggest
that you take
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is making sure
that your member of Congress and senators
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understand the importance of
and the transformative way that telehealth
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has been incorporated into health care
delivery across the country.
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Because if we don't extend,
Medicare is required to go back to March
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the 12th, 2020, where telehealth
services are only covered.
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Hawaii, Alaska
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and some very remote areas of the country.
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It really comes down to who is eligible
not only for Medicaid,
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but for care delivery. Overall.
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And then finally establishing the $50
billion Rural Health Transformation Fund,
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requiring states to submit improvement
plans by December of this year.
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Those are all key components
that impact health care.
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That is,
got a lot of people scared and scrambling.
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You touched on this a bit already,
but one thing that's been a major concern
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for health systems and patients alike
has been a looming cuts to Medicaid.
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What do listeners need to be aware of
with these cuts looming?
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What is HEMS anticipating?
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week at a meeting that I was at,
there were several health system
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individuals, as well as some current
and former government folks
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that are saying
we're correcting the over reach
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on Medicaid
that occurred as part of the pandemic.
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And we'll agree that during the pandemic,
it was important
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to not have people without health
care as they were losing their jobs.
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But the amount of time
that we kept people on
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the rolls
has really overstressed the system.
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So there's this market correction.
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To me,
that's really the underlying discussion
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that we've got happening in this country
since the election is the idea of,
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are we heading down a path
that $1 trillion in cuts
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to Medicaid over ten years
is going to be completely devastating,
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or the path of better
efficiencies can actually
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make the
programs better, make for better outcomes.
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So from a policy
perspective, Hims is anticipating,
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and it's got to be somewhere
in the middle. Right.
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Because we can't go back
prior to Obamacare.
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So if we're trying to find a balance, it's
going to require
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all of us working together on
what are the technology efficiencies,
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what are the other things
that can be leveraged to help
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care continue to be available,
as well as making
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sure that some of the efficiencies
are starting to be put in place?
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At Meditech?
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Our customers range from large
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multi entity health systems
to rural and critical access hospitals.
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What should rural health care leaders
know about the $50 billion in funding
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that's been allocated by the Rural Health
Transformation Program?
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As far as the rural health
program is concerned.
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The announcement by CMS on Tuesday
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was that there is going to be a process
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for an application at the state level
to be able
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to be eligible for any of the $50 billion.
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So I strongly encourage folks
to get involved,
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reaching out to your state officials,
reaching out to your governors
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and understanding how your state
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is going to be putting together
their proposal for the submission.
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But right now, every state is scrambling,
trying to figure out
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how are we going to approach it.
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What's our submission going to look like?
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So if you're in a health system,
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whether it's connecting with Meditech,
connecting with Hims, connecting
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with your state hospital,
whatever your avenue into advocacy
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and policy makers at the state level,
making sure that your voice is heard.
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It's $1 billion,
but it's only $1 billion, right?
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It's $1 billion is a lot of money
until you start trying
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to divide it into a whole state plan
from a policy
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and engagement perspective,
making sure that you're engaged,
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whether you're the CEO
or you're taking you back to your CEO
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and your government relations
person, is connecting into the state
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to understand how your individual state
is going to be applying for those
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Can you
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share your perspective on how
AI is being used across health care today,
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and how policies at the federal, state,
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and even international levels
are evolving to keep pace?
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What key trends or implications
should health care leaders
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be aware of as they navigate
this really rapidly changing landscape?
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So you've got the tech community
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that's full speed ahead on the use of AI,
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and you've got other parts
of the community that's, hey,
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we need to implement AI
and we all know the benefits of AI,
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but there are certain
things that we're still unsure of.
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And so what states are starting to do
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is in the absence of a national strategy
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around artificial intelligence,
what states have been doing
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is, is looking at on the horizon
and seeing that the European Union
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had passed the AI act for 26
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countries that are part of the EU,
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and they're seeing what impact
that has for multinational corporations
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that they will end up
building towards the EU's requirements.
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And they're saying, wait a minute,
we learned the lesson of privacy.
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If you go to any website
in the United States now,
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you get the the whole message
around cookies that you have to click on.
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Yes, we understand, etc.
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that's a direct result of the European
Union's GDPR.
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You know, privacy laws
that were put in place around 2015.
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And because the United States
didn't take action on a national approach
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to privacy,
the de facto law was compliant with GDPR.
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So what states are seeing
is there's this opportunity.
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Again, we don't have a national strategy
around AI.
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So the states are starting to say
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this is the framework
that I believe should be developed.
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So state legislation
is is popping up in different places.
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If you're a technology company, Meditech
and others, you have to comply
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with the 50 different approaches
of the 50 states plus the jurisdictions.
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What Senator Cruz is suggesting is a pause
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on state action
until we get federal action.
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And I think what all of us
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need to understand
is that's great if there's federal action,
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but if there's not federal action,
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then we have this de facto
from other parts of the world.
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So we're going to be paying very close
attention to that.
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As interoperability standards evolve,
how do you see Cms's recent policies
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aligning with
or maybe diverging from the earlier
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frameworks
like the 21st Century Cures Act?
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Are these new efforts building continuity
or creating additional layers
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to navigate for providers and vendors?
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And really, what does this mean
for patients and their access
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to their own data?
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important for all of you is that
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all of these ideas around interoperability
and making sure that the patient
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has access to their data,
and that clinicians have access
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to the data and actionable information
as quickly as possible.
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There's concern that we're not going fast
enough.
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So CMS has used the power of their size,
their ability
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to impact payments, and, you know,
all the different things that CMS impacts.
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And they're saying,
we want to move forward on
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making sure that patients
have access to their data
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and they're doubling down on the idea
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of leveraging the technology community
to make sure that we find faster ways
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to get information to the patient,
and faster ways of making sure
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that the correct information
gets to providers.
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So no longer
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concerned
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necessarily
about the certification process
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that has been put in place
since meaningful use
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no longer necessarily concerned
with all of the structure
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that's been put in place
over the last decade, trying to figure out
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ways to get health systems
to buy in, to being more innovative,
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and technology
companies to be more innovative.
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So it's critical for us to understand that
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they're using the the power of CMS
for those activities
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and having a interoperability pledge
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and a new program for information sharing.
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There's confusion in the marketplace
right now whether or not
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the qualified health information networks
that are run through
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the office of the National Coordinator
and through the Sequoia project
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that was put in place
as a result of the 21st Century Cures Act.
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Whether or not this new CMS
structure is leveraging that structure,
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or are they creating a competing system
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for the first four months of the Trump
administration?
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CMS seem to be only doing things
that they wanted to do,
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only engaging in the health tech
ecosystem,
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pushing for this information
as fast to the patient as possible,
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and not thinking about the structure
that was put in place.
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What they've more recently talked about
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is leveraging the certification program
that Aspo and CE has been responsible
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for since the beginning of meaningful use,
way back in 2010, 2011.
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What's key there is the information
blocking requirements
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in the 21st Century Cures Act, Congress
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required the office of the Inspector
General and O and C to define
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what is not information blocking
and what the exemptions were.
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If I'm ready to information share,
but the receiver is not ready
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to gather the information, if they don't
meet the security requirements
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that I've put in place
or that are standard across the industry,
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I can not accept information coming in
or I can not send information out.
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And there were a total of eight
00:15:27:11 - 00:15:31:12
different exemptions
that were put in place to try and address
00:15:31:12 - 00:15:34:12
some of the concerns around
who am I sending it to?
00:15:34:18 - 00:15:38:18
So point being,
now is that the certification program,
00:15:39:07 - 00:15:43:04
they're looking at modifying
that to focus on APIs
00:15:43:04 - 00:15:48:08
instead of EHRs and other certified
electronic health products.
00:15:48:15 - 00:15:52:01
So changing the scope of O
and C's approach,
00:15:52:01 - 00:15:56:07
but also 21st Century Cures Act,
if you're an information blocker
00:15:56:07 - 00:16:00:01
and you don't meet those eight
exemptions, it's $1 million
00:16:00:04 - 00:16:03:19
per instance that's identified
by the office of the Inspector General.
00:16:04:03 - 00:16:07:23
So what happened
last week was the secretary team
00:16:08:19 - 00:16:10:23
and ASP and OIG
00:16:10:23 - 00:16:14:03
said,
we've had this enforcement capability.
00:16:14:03 - 00:16:16:12
We're now leaning into it.
00:16:16:12 - 00:16:20:10
So we need to be paying very close
attention to what that all means.
00:16:20:16 - 00:16:25:04
And if there's modification in the eight
that shrinks down to five or whatever,
00:16:25:05 - 00:16:25:22
it's going to be something
00:16:25:22 - 00:16:29:04
that's very important for all of us
to be paying close attention to.
00:16:29:23 - 00:16:33:03
We appreciate you walking us through
the ever changing health care landscape
00:16:33:09 - 00:16:36:17
and touching on important policies
like the One Big Beautiful Bill act,
00:16:37:03 - 00:16:40:03
as well as the funding via
the Rural Health Transformation Program.
00:16:40:08 - 00:16:42:01
And onto the future of telehealth.
00:16:42:01 - 00:16:45:23
And I thank you for joining us today, Tom,
and sharing your valuable insights.
00:16:46:17 - 00:16:48:08
I appreciate it. Thank you.
00:16:48:08 - 00:16:49:17
Thanks for tuning in.
00:16:49:17 - 00:16:52:23
Stay informed and subscribe
to the Medi Tech podcast, and we'll talk
00:16:52:23 - 00:16:53:14
to you next time.