HSA STATEMENT 12. Because of HSA rationing of beds, already large hospitals are seeking out Pediatric "Children's Hospitals" or OB Hospitals to take over as the Planners in HSA's do not allow hospitals to expand. By incorporating these other specialty hospitals, more general beds are freed in the institution. But this is not progress, this is a forced relocation of services without regard to better care for the patients in the smaller X specialty hospitals. The community and patients suffer when the goals of the large general hospital overshadows those best for the patients of the specialty hospital. 13. The HSA Guidelines create health monopolies and abolish competition. Competition is essential to progress, yes especially in hospitals, regardless of what "planners" pontify. 14. 15. 16. The larger the hospital, in general, the less its efficiency. My 13 years experience as a neurosurgeon at a then 3000 bed hospital (Charity Hospital of Louisiana) showed the huge odds against efficiency in large hospitals. 200-300 bed size hospitals should be encouraged for better patient care, because patient care depends on personal care and attention, hardly the landmark of bureaucratized hospitals. If doctors decide to practice in rural area hospitals, according to The central fact, Mr. Secretary, is that modern medicine cannot be practiced without hospitals, and we need more rural and more suburban hospitals to help our sick, not mammoth academic health monopolies in the cities. It is government regulation and inept planning that is pushing up costs: 17. The miracle of modern medical technology is the true saver of money and of priceless lives. A CAT Scanner will now save 27% of patients from operations no longer needed after the CAT's diagnosis. The CAT Scanner will again pay for itself in patients not hospitalized, thanks to the CT diagnosis. As a neurosurgeon, I received last week an offer for a high quality new scanner for $95,000. Compare this to the $500,000 it cost just one year ago! 18. The Guidelines quotas per hospital per unit for service 200 cases for heart surgery, etc. ignore the central fact that the expertise is in 7 HSA STATEMENT the physician or surgeon, not in the "hospital heart unit", albeit recognition of "team experiences." A heart surgeon or a neurosurgeon working in several hospitals may do "x" operations a year. The guidelines will now force him to do all these operations in one hospital. Good for the hospital! Convenient to the doctor! But, is the forced travel, inconvenience and disruption better for the patient and the family? No! And as the "units" work to capacity and "occupancy" goals, lives will again be lost in the waiting list. Recall the 700,000 patients in the waiting lists each year in England and all socialized countries, whose beds are "always full" at the "centers" which are "well planned". The 19. Planning by the "local" HSAs can never succeed. Only with the full knowledge within a given institution's board and medical staff, with appropriate consultation, can reasonable planning decisions be made. "Planning Boards" are essentially political bodies where the needs of patients are soon lost to "statistics". Just compare the empty beds of the VA and PHS hospital, despite the long length of stay of the political hospitals. As an example, hospitals were "denied" cobalt units by the planning agency in many areas. The hospital that built them anyway soon had more work than they could handle. A second cobalt unit was then needed. That is the story of area planning in Louisiana. Furthermore, when HSA's are successful in initially denying hospital expansion, they end up in huge escalation of the cost when the facility is constructed later due to the delays of the HSA. 20. How can we reconcile the rationing and reduction of services resulting from the guidelines, (fewer beds, fewer services, fewer diagnostic and treatment units) with the avowed aims of HEW and Congress towards "preventive medicine"? 21. The current high cost of hospitalization is partially a result of the patients' demand to return to work with as short a hospitalization as possible. Diagnostic tests are therefore done with great efficiency in a very short time, but this does drive up costs per diem. But this is not due to "increasing costs of hospitalization" - it is a deliberate artifact of "intensive services per day" - efficiency! Yet, doctors and hospitals are being penalized by punitive regulations which disrupt our hospitals, because of the "higher costs". It's less cost to the patient! 22. Ambulatory care is not necessarily more desirable from the patient's standpoint. Numerous tests in a short hospitalization can result in quicker diagnosis and prompter treatment at savings to the patient's health, family, finances, and job security. This is important to the patient. 23. The miracle of modern drugs have emptied thousands of beds. Tranquilizers emptied mental hospitals; antibiotics and chemotherapy, tuberculosis hospitals etc. Therefore, in planning to reduce the costs of 8 HSA STATEMENT 24. 25. hospitalization by planning guidelines, the use of high quality and effec- Guidelines should include the revaluation of cost-effectiveness of many government imposed services and financial practices in hospitals, which have driven up costs and artificially created huge new industries. Hospital's actively pursue, at government prodding, much superfluous home health care, rehabilitation, inhalation therapy, expanded pharmacy services, public relations departments, leasing practices; use of loans to use government money instead of hospital capital; all these government inducements have escalated costs. As an example of the "obstetrics guidelines" application, there are only 26. These Guidelines make regulators out of the HSA's not planners; they establish "top-down" planning, not "grassroots" community input. 27. The National Planning Act aims to force the medical profession and our hospitals into becoming "regulated public utilities" - an euphemism for socialization and state control. The National Guidelines confirm the intent of central regulation by the Secretary of HEW, the antithesis of local health planning. Our hospitals will sink into mediocrity, and our citizens will suffer second class assembly line medical care, as they await their turn to be bused to the distant approved regional center hospital emerging from these Guidelines. Letter to Congress from PDA HSA'S WAR AGAINST PATIENTS MAY 12, 1978 Dear Congressman: "CMS Private Doctors of America" represents 42,000 doctors from 48 states. Our "Letter to Congress" program is a Fact Sheet from our socioeconomic research on issues vital to our member doctors in your state. Last month in our first letter, we extensively documented how the government's cost-control program for medical care, PSRO (P.L. 92-603), will cost $1.24 billion when fully implemented, yet not saved a penny since 1972. We asked that you vote not to fund PSRO in the budget bill now in Congress. This month's Letter spotlights the colossal error we believe the Dept. HEW PHS have made in declaring war against technology thru the local HSA's (Health Service Agencies) under the aegis of "cost control" and "certificate of need". I will give you a precise example of how disastrous this certificate of need policy is for your constituents. I will demonstrate how the free market has made a phenomenal breakthrough in cost control, making rationing by HSA's moot. The example is the "CAT Scan" - which I am sure you have seen on TV and other media that remarkable marriage of computer to x-ray which provides cross section views of the human body without risk. And we hope that you will vote against the Rogers bills (H.R. 6575 & H.R. 11488) or the Kennedy bills (S. 1391 & S. 2416) sections requiring such "certificates of need". As a private neurosurgeon with subspecialty in x-ray studies for the past 25 years, I realized instantly when it was invented in 1972, that "CAT Scan" was the most revolutionary breakthrough since x-ray was introduced. Its promise has now been fulfilled: many thousands of lives are saved, unnecessary surgery avoided, suffering alleviated Today it is indispensable to the daily practice of neurosurgery. It has saved millions of dollars in unnecessary hospitalization, truly lowering the cost and increasing quality of medical care thru technology, not rationing. One would think that after this dramatic scientific advance, government would have promptly assisted to expand access to every corner of our land. Instead, Mr. Califano, the HSA's, the PHS and Mr. Nader have waged war against the Scanner, as a "too expensive technology" that must be rationed and denied thru "certificate of need". The FTC should take note that HSA's, in denying this equipment except to a "few Hospitals”, are restraining trade, establishing monopolies and engaging in price fixing! In England, where the CAT Scanner was invented, the national health insurance (NHS) system has allowed only a few scanners for all Britain! In the U.S. 470 scanners were sold in 1976, 240 in 77 - but government now wants to stop the free market. Let's look at the economic miracle performed by a free industry: in the past three years, while HEW, HSA'S and Congress were trying to stop the scanner to lower costs by prohibition, the cost of the Scanner has fallen from $500,000 to $85,000. The problem has been solved by free enterprise, competition, and duplication. When PDA testifed before the Kennedy Subcommittee on Hospital Costs last year, we remarked that the cost of the PSRO program would pay for a free CAT scan to every hospital every 3 years that same week the cost went down to $225,000 - enough for 5555 hospitals of the 5,977 private hospitals in the US. (of total 7,174) Last week in New Orleans at the neurosurgical convention, I was offered a total body scanner for $85,000! Would you rather see every hospital and radiologist be thus equipped to save lives, than denied? If you agree, please vote against the Rogers - Kennedy planning bill amendments which require a "certificate of need" for scanners for either hospitals or doctors. Mr. Congressman, the Scanner story again merely restates the caveat: Freedom in medicine saves lives, lowers costs. Please share with me, if your time allows, your questions or comments, and any suggestions that could make this Letter to Congress effort more helpful to you. Members of Congress: Major Media outlets, U.S. Sincerely, Brunidh Jose L Garcia Oller, M.D President, CMS PDA Secs. 110, 122 DORNAN AMENDMENTS AMENDMENT TO H.R. 11488 OFFERED BY MR. ROBERT K. DORNAN [LOBBYING] Page 89, insert after line 16 the following: (e) Section 1513(a) is amended by adding after the first sentence the following: "A health systems agency may not use any funds provided under this title or title XVI to, directly or indirectly, influence the issuance, amendment, or revocation of any Executive order or similar promulgation by any Federal, State, or local agency or to influence the passage, amendment, or defeat of any legislation by the Congress or by any State or local legislative body, except that this sentence does not apply to the use of such funds by a health systems agency in making its views known on any matter upon the request of any Member of Congress, committee of Congress, or any other Federal, State, or local governmental authority." Page 119, insert after line 8 the following: (g) Section 1523 is amended by adding at the end the following: "(d) No funds made available under a grant under section 1525 may be used by a State Agency to, directly or indirectly, influence the issuance, amendment, or revocation of any Executive order or similar promulgation by any Federal, State, or local agency or to influence the passage, amendment, or defeat of any legislation by the Congress or by any State or local legislative body, except that this subsection does not apply to the use of such funds by a State Agency in making its views known on any matter upon the request of any Member of Congress, committee of Congress, or any other Federal, State, or local governmental authority." Sec. 115 AMENDMENT TO H.R. 11488, AS REPORTED [HIPPOCRATES] Page 97, insert after line 24 the following: (1) Section 1513(b) is amended by adding at the end the following: "(5) The HSP of a health systems agency shall include a statement of the effect that achievement of the goals of the HSP will have on the requirements placed on the practice of medicine by the Oath of Hippocrates (as restated in Geneva, Switzerland, in 1948 by the World Medical Association), and the AIP of a health systems agency shall include a statement of the effect that achievement of the objectives in the AIP will have on such requirements." |