Table Of Content

BUDGET ISSUES RELATING TO MEDICARE Y 4. W 36: 103-15 llNvjO Budget Issues Relating to Hedicare*... „a:.xvâE the SUBCOMMITTEE ON HEALTH OFTHE COMMITTEE ON WAYS AND MEANS HOUSE OF REPRESENTATIVES ONE HUNDRED THIRD CONGRESS FIRST SESSION Payment Under Part A of the Medicare Program and Pajnnent for Hospital Outpatient and End-Stage Renal Disease Services MARCH 18, 1993 Payment Under Part B of the Medicare Program for Phy- sician Services, Clinical Laboratory Tests, and Durable Medical Equipment MARCH 25, 1993 Payment Under Part B of the Medicare Program for Clin- ical Laboratory Services, Durable Medical Equipment, Physician Ownership and Referral Arrangements, and Other Medicare Reconciliation Issues APRIL 20, 1993 Serial 103-15 Printed for the use of the Committee on Ways and Means BUDGET ISSUES RHATING TO MEDICARE HEARINGS BEFORE THE SUBCOMMITTEE ON HEALTH OF THE COMMITTEE ON WAYS AND MEANS HOUSE OF REPRESENTATIVES ONE HUNDRED THIRD CONGRESS FIRST SESSION Payment Under Part A of the Medicare Program and Payment for Hospital Outpatient and End-Stage Renal Disease Services MARCH 18, 1993 Payment Under Part B of the Medicare Program for Phy- sician Services, Clinical Laboratory Tests, and Durable Medical Equipment MARCH 25, 1993 Payment Under Part B of the Medicare Program for Clin- ical Laboratory Services, Durable Medical Equipment, Physician Ownership and Referral Arrangements, and Otner Medicare Reconciliation Issues APRIL 20, 1993 Serial 103-15 Printed for the use of the Committee on Ways and Means U.S. GOVERNMENT PRINTING OFFICE 67-707CC WASHINGTON : 1993 ForsalebytheU.S.GovernmentPrintingOffice SuperintendentofDocuments,CongressionalSalesOffice,Washington,DC 20402 ISBN 0-16-0A1267-6 COMMITTEE ON WAYS AND MEANS DAN ROSTENKOWSKI, Illinois, Chairman SAM M. GIBBONS, Florida BILL ARCHER, Texas JJ. PICKLE, Texas PHILIP M. CRANE, IllinoU CHARLES B. RANGEL, New York BILL THOMAS, Cali'jmia AFNORDTYNJEAYCOPBEST,EJrS.T,AIRnKd,iaCnaalifornia ED.OCNLSAUYNSDHQAUWI,STJ,r.,TeFnlnoersisdaee HiUlOLD E. FORD, Tennessee NANCY L. JOHNSON, Connecticut ROBERTT. MATSUI, California JIM BUNNING, Kentucky BARBARA B. KENNELLY, Connecticut FRED GRANDY, Iowa WILLIAM J. COYNE, Pennsylvania AMO HOUGHTON, New York MICHAEL A. ANDREWS, Texas WALLY HERGER, CaHfomia SANDER M. LEVIN, Michigan JIM McCRERY, Louisiana BENJAMIN L. CARDIN, Maryland MEL HANCOCK, Missouri JIM McDERMOTT, Washington RICK SANTORUM, Pennsylvania GERALD D. KLECZKA, Wisconsin DAVE CAMP, Michigan JOHN LEWIS, Geoiâ LF. PAYNE, ViTBinia RICHARD B. NEAL, Massachusetts PETER HOAGLAND, Nebraska MICHAEL R. MCNULTY, New York MIKE KOPETSKI, Oregon WILLIAM J. JEFFERSON, Louisiana BILL K. BREWSTER, Oklahoma MEL REYNOLDS, Illinois Janice Mays, ChiefCounsel and Staff"Director Charles M. Brain, Assistant StaffDirector Phillip D. Moseley, Minority ChiefofStaff" SUBCOMMnTEE ON HEALTH FORTNEY PETE STARK, California, Chairman SANDER M. LEVIN, Michigan BILLTHOMAS, California BENJAMIN L. CARDIN, Maryland NANCY L. JOHNSON. Connecticut MICHAEL A. ANDREWS, Texas FRED GRANDY, Iowa JIM McDERMOTT, Washington JIM McCRERY, Louisiana GERALD D. KLECZKA, Wisconsin JOHN LEWIS, Georgia (II) CONTENTS PAYMENT UNDER PART A OF THE MEDICARE PROGRAM AND PAY- MENT FOR HOSPITAL OUTPATIENT AND END-STAGE RENAL DIS- EASE SERVICES—MARCH 18, 1993 Page PressreleaseofThursday,March 11, 1993, announcingthehearing 2 WITNESSES U.S. Department ofHealth and Human Services, WilliamJ. Toby, Jr., Acting Administrator, Health CareFinancingAdministration 5 Prospective Payment Assessment Commission, Stuart H. Altman, Ph.D., Chairman, and DonaldYoung, M.D., Executive Director 16 American Association ofKidneyPatients, A. PeterLundin, M.D 123 American Health CareAssociation, BruceYarwood andRobert Deane 107 American HospitalAssociation, Rick Pollack andJim Bentley 40 AssociationofAmerican Medical Colleges, SpencerForeman, M.D 67 CaliforniaAssociation ofHospitals andHealth Systems, C. Duane Dauner 100 Central Florida Kidney Center, Orlando, Fla., Maureen Michael 114 GreaterNewYorkHospital Association, KennethE.Raske 88 Montefiore Medical Center, Bronx, N.Y., SpencerForeman, M.D 67 NationalAssociation ofPublicHospitals, LarryS. Gage 47 National Renal Administrators Association, Maureen Michael and Gwen Gampel 114 , SUBMISSIONS FOR THE RECORD American NephrologyNurses'Association, statement 129 National Association of Long Term Hospitals, Edward D. Kalman, letter and attachment 131 National Kidney Patients Association, Perry S. Ecksel and Robert D. Rosen, letter 136 National Medical Care, Inc., statement and attachment 138 New York State Council on Graduate Medical Education, Lambert N. King, M.D., statement 144 Renal PhysiciansAssociation, statement 148 (in) IV Page PAYMENT UNDER PART B OF THE MEDICARE PROGRAM FOR PHYSI- CIAN SERVICES, CLINICAL LABORATORY TESTS, AND DURABLE MEDICAL EQUIPMENT—MARCH 25, 1993 PressreleaseofThursday, March 11, 1993, announcingthehearing 152 WITNESSES U.S. Department of Health and Human Services, WUliam Toby, Jr., Acting Administrator, Health CareFinancingAdministration 156 Physician Payment Review Commission, Richard V. (Dick)Anderson, Interim Chairman, andPaul Ginsburg, Executive Director 167 AmericanAcademyofFamilyPhysicians,JohnM. Tudor,Jr., M.D 226 AmericanAcademyofOphthalmology, AllanJensen, M.D 254 American AcademyofOrthopaedicSurgeons,Rufiis F. Stanley,Jr., M.D 231 American College ofPhysicians, H. Denman Scott, M.D., FA.C.P 214 American College of Radiology, K.K. Wallace, M.D., and James Morefield, M.D 270 American College ofSurgeons, George E. Block, M.D., FA.C.S 221 American MedicalAssociation, P.JonnSeward, M.D., andBruce Blehart 192 American SocietyofAnesthesiologists, PeterL. McDermott, M.D 275 American Society ofInternal Medicine, Richard D. Ruppert, M.D., and Allan R. Nelson,M.D 245 CollegeofAmerican Pathologists, DonaldA. Senhauser, M.D 284 SUBMISSIONS FOR THE RECORD American Association ofNurseAnesthetists, statement 299 American College ofRheumatology, statement 309 American PhysicalTherapyAssociation, statement 313 AmericanSocietyofClinical Oncology, statement 316 Association of Freestanding Radiation Oncology Center, Diane S. Millman, statement 319 ContinentalMedicalSystems,Mechanicsburg, Pa., statement 321 Renal PhysiciansAssociation, statement 324 PAYMENT UNDER PART B OF THE MEDICARE PROGRAM FOR CLINI- CAL LABORATORY SERVICES, DURABLE MEDICAL EQUIPMENT, PHYSICIAN OWNERSHIP AND REFERRAL ARRANGEMENTS, AND OTHER MEDICARE RECONCILIATION ISSUES—APRIL 20, 1993 Pressreleases announcingthehearing 330 WITNESSES AmericanAssociation ofBioanalysts, Alvin M. Salton 333 American Association ofContinuityofCare, Irene Paige, R.N 398 American Clinical LaboratoryAssociation, Hope S. Foster 341 American Orthotic & Prosthetic Association, John M. Yarbrough, and David Schultz 386 CommunityMedical Laboratory, Metuchen, N.J., Alvin M. Salton 333 LikenMecficare Center, Pittsburgh, Pa.,James W. Liken 378 National Alliance forInfusion Therapy, Alan K. Parver 392 National Association ofMedical Equipment Suppliers, James W. Liken, and Corrine Propas Parver 378 Home Care Coalition, Irene Paige, R.N 398 Trautman's Minneapolis Artificial Limb Co., and Rochester OrthopedicAppli- ances, Minneapolis, Minn., John M.Yarbrough 386 SUBMISSIONS FOR THE RECORD American Association forClinical Chemistry, Inc., statement 411 American Association for Clinical Endocrinologists, statement and attachment 413 American Association ofNurse Anesthetists, statement and attachment 416 PsffB American Payroll Association, Carohm M. Kelley, letter and attachment (for- warded by the Honorable Jim McDermott, a Representative in Congress fromthe StateofWashington) 426 American Society of Clinical Pathologists, Thomas A. Bonfiglio, M.D., state- nient 429 American Society ofInternal Medicine, statement 433 Council ofNursinpHome Suppliers, Neal Thrift, statement 435 NationalAssociation fortheSupportofLongTerm Care, statement 438 BUDGET ISSUES RELATING TO PAYMENT UNDER PART A OF THE MEDICARE PRO- GRAM AND PAYMENT FOR HOSPITAL OUT- PATIENT AND END-STAGE RENAL DISEASE SERVICES THURSDAY, MARCH 18, 1993 House of Representatives, Committee on Ways and Means, Subcommittee on Health, Washington, D.C. The subcommittee met, pursuant to notice, at 10 a.m., in room 1100, Longôrth House Office Building, Hon. Fortney Pete Stark (chairman ofthe subcommittee) presiding. [The press release announcing the hearing follows:] (1) . FOR IMMEDIATE RELEASE PRESS RELEASE /6 ' TBORSOAY, MARCH 11, 1993 SUBCOMMITTEE OM HEALTH COMMITTEE OM WAYS AMD MEANS O.S. HODSE or REPRESEMTATIVES 1102 LOMGWORTH HOUSE OFFICE BLDG. WASHINGTON, D.C. 20S1S TELEPHONE: (202) 225-7785 THE HONORABLESUPBECTOEMMSITTATREKE (ODN.,HECAALLTIHF,.), CHAIRMAN, COMMITTEE ON WAYS AND MEANS, U.S. HOUSE OF REPRESENTATIVES, ANNOUNCES A HEARING ON BUDGET ISSUES RELATING TO PAYMENT UNDER PART A OF THE MEDICARE PROGRAM AND PAYMENT FOR HOSPITAL OUTPATIENT AMD END-STAGE RENAL DISEASE SERVICES SubcomTmheittHeoenoroanblHeealPteht,e CStoamrm)ictt(eD.e,onCalWiafy.s),andChaMieramnsa,n,U.S. House of Representatives, announced today that the Subcommittee will hold a hearing on budget issues relating to payment to providers under Part A of the Medicare program, and payment for hospital outpatient and end-stage renal disease (ESRD) services. This hearing will be held on Thursday, March 18, 1993, beginning at 10:00 a.m., in the main Committee hearing room, 1100 Longworth House Office Building. Oral testimony will be heard from Invitad wltn«8s«a only However, any individual or organization may submit a written - statement for consideration by the Subcommittee and for inclusion in the printed record of the hearing. BACKGROUND ; The President's budget proposals would achieve $48.3 billion in savings under Medicare over a five-year period, according to preliminary estimates by the Congressional Budget Office (CBO) This hearing will focus on proposals that would affect payments to hospitals and nursing homes under Part A, as well as payments for hospital outpatient and ESRD services. CBO estimates that the President's plan would achieve S161 billion in savings under Part A over the five-year period. Testimony will be presented by the Prospective Payment Assessment Commission, which is required to report on March 1 of each year regarding the Commission's recommendations on policies concerning payments to hospitals and other facilities under the Medicare program. DETAILS FOR SUBMISSION OF WRITTEN COMMENTS : For those who wish to file a written statement for the printed record of the hearing, six (6) copies are required and must be submitted by the close of business on Friday, April 2, 1993, to Janice Mays, Chief Counsel and Staff Director Committee on Ways and Means, U.S. House of Representatives, 1102 Longworth House Office Building, Washington, D.C. 20515. ~' additional supply of statements may be furnished for distribut.— to the press and public if supplied to the Subcommittee office. 1114 Longworth House Office Building, before the hearing begins.