report this summer. Can you tell us when exactly that will report, and do you envision then at that point, having on ready to send to Capitol Hill? Because certainly if anys going to be implemented, I think the realities of the would at least indicate to me that that it is going to be diffienact any reforms next year, in an election year, so you are I up to 1985 at the earliest. Would you give me your views n the Council is going to report and whether or not you ensending legislation to Capitol Hill? DAVIS. Yes. The initial date that was given to the Council report due in July. However, by statute, they must have the in by next January. The date was simply arrived at when uncil was initially set up. They had a couple of months delay ually getting started. re was some question as to whether they had to meet the of July. Secretary Schweiker did indicate to the Council that y needed an additional month or two that would be appropri elieve that they plan on completing their work sometime g the summer, so I would anticipate that we would be getting report in the early fall. e would obviously take a look at that and would sit down with Department and think through the kinds of recommendations they have. We would incorporate many of those suggestions, I d expect, into our legislation for 1985, which we will be workon in August and September. r. RINALDO. So you would be submitting legislation in 1985. the Council recommends the use of general revenues, would then support that approach? r. DAVIS. I cannot speak for the administration at this time on t approach. If they would recommend that, we obviously would e it under advisement. But I, as you know, would not presume nake the final decision for the administration at this time. Mr. RINALDO. Since you are obviously opposed to using general enues, would you then say that the entire shortfall has to be de up primarily by program cuts or reduction in benefits or by a nbination of reduction in benefits and other revenues? And, if what revenues? Dr. DAVIS. I think it is premature to make a final determination out what the change in behavior would bring, but, as I indicated rlier, it probably would need to be a careful balancing of both a duction in the outlays, as well as looking at how one can finance Mr. RINALDO. Have you or the Department investigated any alernative methods of finding revenue sources for medicare? Dr. DAVIS. No. At the moment, we have been concentrating most f our resources on the development of reimbursement reform. The prospective payment system took us about a year to develop because it is a brand new system. After 16 years of paying in a retrospective way, one does not change that overnight. Second, we then tackled the whole area of looking at restructuring the third-party financing mechanism for health care benefits with a tax cap and the other health incentive reforms for this year. 1 n confident that as soon as we get the Council's report, we will down and look further in this area. just received a note from Tom Burke who indicates to me that Council is now on record as opposing the use of general rev es. Mr. RINALDO. I cannot make a decision about the Congress, but at I am looking for is an overall plan, and while I think it is dable to say there are going to be behavior changes, I think y are very difficult to implement. Just take a look at what haped with social security. There were no major changes. While e people who supported the plan stated it is going to carry us ough the next 25 or 30 years, I very much doubt that. And I nk long, long before that, Congress is going to be faced with the blem of grappling with social security again. ust like in 1978, President Carter said that if we increase the es at that point in time, it will take care of the social security blem for another 100 years. It only lasted 5 years. So he was ng there. et me go onto another topic that I think is important. You retly made a decision with regard to releasing the name of docs who accept assignment. Do you not feel that by releasing these nes we might help to promote health competition such as the ninistration has suggested? Dr. DAVIS. You indicated that we recently made a decision relae to this. I am not aware of the fact that we did make that deci. But one of the problems that one does have in looking at the ole issue of physicians' assignment is that it is done on a claimclaim basis, so that you really cannot accurately portray those sicians that take assignment all of the time versus those who e it part of the time. Indeed the same beneficiary may go back o the same physician on a second or a third time for a different nent and may find that the doctor accepted assignment at one nt and not the next. think what is needed is a significant study looking at the entire al, customary, and reasonable fee for service. And I am putting ether a small study group now of physicians to help advise us. as you well know in the new legislation that Congress just sed, there is a request that the Health Care Financing Administion study physician reimbursement with an eye towards incorating that component into the DRG type system. And they did e us a target date of 1985 to complete that report. Mr. RINALDO. I asked that question because I have in my possesn here, which I would like to submit into the record, a copy of a mo that you sent out on January 29 to regional administrators hholding the assignment information. My understanding is that I decided, or the Department decided, not to make the informapublic to the Gray Panthers. Would you be willing to supply that information to this commit Dr. DAVIS. I understand what you are referring to now. I believe t the decision not to make it public was based upon the fact t we do not have that kind of data in the format that they had uested. And under the Freedom of Information Act, if one does From: Car Subject: Pc To: Region In recen Informatio cepting ass normally Costs-for been subst I have r computer Act. Any a FOIA, sinc Departmer against a tached. Nc dent. As a ma (or any oth of the req FOIA pert. be so advis Attachm Hon. MARC Secretary, I Washingto DEAR MA available t accept assi ment, he o hat data, in that kind of a format, we are not required to pecifically for that purpose. Igo back to the fact that because it is on a claim-by-claim - difficult to identify. NALDO. In other words, what you probably have to do is pecial computer program, and you are not willing to do use of the cost involved, I assume? VIS. That is a part of that, yes. NALDO. Can you give me any other reasons why you are ng to do that or why you do not think it is a good idea? AVIS. Frankly, I stopped at that point, when it was a cost ut you are asking me to make a policy decision in the abnd I would want to take a look at it again before I made decision. That is why I am hesitating. I would be happy to er the issue. INALDO. I would appreciate it if you would, particularly in the fact that the cost may be outweighed by the savings. that is so, that would be one way to effectuate just a small DAVIS. I will look at it again, but I would like to reserve judgn what my final decision would be. material referred to by Mr. Rinaldo follows:] [Memorandum] DEPARTMENT OF HEALTH AND HUMAN SERVICES, Carolyne K. Davis, Administrator, by Paul Willging. Policy decision on Gray Panther fee waiver requests under FOIA. ional administrators. cent months the Gray Panthers have made requests under the Freedom of ation Act (FOIA) for lists of physicians in certain areas accepting or not acassignment under Medicare. In addition, they have requested waiver of fees lly charged of FOI requestors. Regions II and III have granted waivers. -for retrieval of the requested data from our contractors' computers-have ubstantial. ave now been advised that information which can only be retrieved from a a matter of policy, I ask that any similar FOIA requests by the Gray Panthers n. MARGARET M. HECKLER, CONGRESS OF THE UNITED STATES, HOUSE OF REPRESENTATIVE, retary, Department of Health and Human Services, shington, D.C. DEAR MADAME SECRETARY: We are writing to ask you to improve the information ailable to Medicare beneficiaries about physicians in their communities who cept assignment. As you know, when a physician agrees to take Medicare assignent, he or she agrees to accept the Medicare reasonable charge as payment in full agrees not to charge the beneficiary any additional amounts above the statu20 percent coninsurance. he problem is that beneficiaries have difficulty determining which physicians in ir communities usually, or even sometimes, accept Medicare assignment. If eficiaries had this information, they would be in a position to decide whether a nge of physicians would enable them to protect themselves against excess rges. order to better inform beneficiaries, a number of organizations have attempted assemble directories listing physicians who are willing to accept assignment. ese directories have generally been based upon surveys of individual physicians. wever, the results have been less than satisfactory, since there is little incentive physicians to respond to the surveys and there is no way of readily varifying the ponses received. he Part B carriers, in carrying out their claims processing responsibilities, rouely collect and maintain this information. In the past, the Department has hond Freedom of Information Act requests for such information and waived fees for profit organizations representing the elderly seeking this information. This has mitted the dissemination of a highly successful directory on physician assignnt practices in the Washington, D.C., metropolitan area. has come to our attention that the Department has recently reversed itself and un denying Freedom of Information Act requests for information listing which sicians participating in Medicare always accept assignment, sometimes accept gnment, and never accept assignment. Several organizations representing the elly, and at least one local public official, have already been denied access to this ormation, either formally or informally. We do not believe that the Department's new policy is in the best interest of the dicare program or its beneficiaries, and we do not believe that it is consistent h the Freedom of Information Act. We urge you to comply with requests for this information and to continue to ve fees in the case of nonprofit organizations representing the elderly. We understand that the Department, as a general matter, strongly supports comition in the health care system. By enabling Medicare beneficiaries to make an ormed choice among physicians in the community, the dissemination of this data uld, we believe, promote more cost-conscious behavior on the part of physicians I beneficiaries alike. 'hank you for your consideration of this matter. We look forward to hearing from at your earliest possible convenience. ANDY JACOBS, Jr., Chairman, Subcommittee on Health, Chairman, Subcommittee on Health and Long-Term Care, Select Com- HENRY A. WAXMAN, Chairman, Subcommittee on Health GLENN ENGLISH, Chairman, Subcommittee on Govern- Mr. RINALDO. Congressman Smith. Dr. DAVIS. I would hope not. Physicians make, on the average, be diffe that wo all othe develop Mr. S and my operate affect th result o Dr. D are com our trer acceptir Again are acce in 1982 Mr. S Dr. D 1977 of Mr. S why? It ing. Dr. D sicians other. A country ing assi formed group o were wi those gr look ahe numbers to see m Mr. S that ove ums so my und 35-perce Dr. D 24 perce to move way the Mr. S Dr. D year ove level. Mr. S it even Dr. D 35-perce Again medicar ce of about $1.50 in an office visit. It seems to me that be a small sacrifice on the part of physicians. And since egments of the health care industry are being asked to plan, we would hope that they would do likewise. TH. Since we were having a problem with assignment, nderstanding is something like 50 percent of physicians nder the assignment program, how do you think would t? Do you see more physicians declining assignments as a he freeze on reimbursement? WIS. Actually no, because the number of physicians that g into practice is increasing every year, and if you look at I over the last 4 or 5 years, we have had more physicians assignment each year. the 50-percent figure means that 50 percent of all claims oted for assignment. I think that the assignment rate itself tands at 53 percent. MITH. And more physicians have been? AVIS. Yes. More physicians have been. It was at a low in 50 percent. So it is gradually increasing. MITH. Has there ever been a study or an analysis as to is good news to hear that more physicians are participat AVIS. I think that, frankly speaking, as there are more phyout there, they are becoming more competitive with each And, for example, I know some communities around the y where physicians are now advertising that they are acceptsignment. Recently in New York City, there was a group that went on the radio and indicated that they were a of physicians who were specializing in geriatric care and villing to take assignment. I think we are finding more of groups around the country now. And I suspect that if you head, and we recognize the fact that there will be increasing ers of physicians over the next decade, that we will continue more individuals interested in assignment. SMITH. A few more questions. The Department has suggested over the next 5 years we gradually increase the part B premiso that it covers 35 percent of part B program costs. Now, it is nderstanding currently it is about 25 percent. How was the rcent figure arrived at? DAVIS. Because we currently are at the rate of approximately ercent, and initially it was 50 percent. The decision was made ove that closer to the initial 50 percent, and yet not all of the there. r. SMITH. Would that be an immediate or phased in? r. DAVIS. No, it is a phase in, about 2.5 percent increase each over the next 5 years until 1988 it would be at the 35 percent 1. Ir. SMITH. Do you see any need on the further out years to raise ven higher to get closer to the 50 percent? r. DAVIS. Our assumption was that if we moved it back to the percent that we would hold it that level in 1988. Again, reflecting back on the fact that the initial intent when dicare was developed under the medical insurance program was |