he extent that older women need care for their prevalent chronic lnesses, they are not well served by the existing system. The budget cuts proposed in fiscal year 1984 will not change this ocus, and will only exascerbate the problems older women face in aining access to affordable health care. Mr. RINALDO. Thank you very much. Mr. Keiserman, you brought up the article on early discharges nder New Jersey's DRG system that was in yesterday's Star edger? Mr. KEISERMAN. Yes, sir. Mr. RINALDO. I would like to request unanimous consent that at article be included in full in the record. Mr. KEISERMAN. I would appreciate that, Congressman. Mr. RINALDO. So ordered. It will be in the record. [The material submitted by Mr. Keiserman follows:] Nurse of for By JOAN WHIT New Jersey hospital nancial pressures to mo as soon as possible an many patients are being SOOD The New Jersey Agency Assembly, and home nursing agencies, are complaining that too are being sent home b ready and one result h crease in relapses and the hospitals. The agency has ask to provide hard data on One major home has collected such infor ing to Nancy Sweeney MCOSS Nursing Servi (formerly the Monmout zation of Social Servi went to visit one patie person was discharg pital. the "That patient ha blockage that had not b the hospital. We walke was and sent that pati the hospital," she said. "The utilization r (which monitors length pital) came marching t clipboards one day. hour's notice that he charged. He was a str newly diagnosed diabe As the man was pital, someone realiz been taught how to gi injections-as he woul day at home. According to S ended up showing hin techniques in the hosp was leaving." She said a cance charged from a hos e group accuses hospitals rcing patients to go home WHITLOW pitals are under fi- move patients out e and some claim being sent home too sey Home Health an organization of cies, said members at too many patients me before they are sult has been an inand readmissions to as asked its members ta on its contentions. home nursing agency information. Accordeeney Stanhope of the Service of Red Bank nmouth County OrganiServices), her nurses e patient the same day ischarged from the hosent had an intestinal ad not been picked up in walked in, saw what it at patient right back to e said. cation review committee given a special catheter, a tube which extends from the site of the tumor through the skin so that cancer-killing drugs can be injected directly into the tumor. is a form of treatment which can be done at home, Stanhope said, but the patient was sent home without being told what to do to keep the tube open. Nor was any referral made to a home care agency to prove the needed care after discharge. "We just happened to find out about that patient," she said. She said part of the problem is that New Jersey's system for paying hospitals, diagnosis by related groups or DRG, financially rewards hospitals if a patient's stay falls within certain limits and financially punishes hospitals when the patient runs over the average. "With the shortened length of stay, people are starting to fall through the cracks," she said. She said that in the case of the cancer patient, the discharge was not handled properly because "the doctor never filled out the right form, the hospital social worker did not fill out the form, my coordinator at the hospital did not fill out the form. "We all missed, and that makes me wonder if he didn't come out of the hospital too quickly." Stanhope said she did not want to name the hospitals involved because "it is nobody's fault; it is a combination of all our faults." Agencies like hers say they are seeing sicker patients than ever before, patients who are coming home from the hospital on respirators, patients who need intravenous feedings, patients coming home much sooner after surgery than in years past with wounds that need a kind of care home nurses never used to provide.. The agencies say that it is appropriate to get patients out of the hospital as soon as possible, and new technology does make it possible to care for more complicated problems in the home, but only if the patient and family are properly prepared. Discharge planning and home care also worked for the Richardson family of Irvington. Lucille Richardson is a stroke patient. Her hus'band, Joseph, said that when it was time for her to leave Irvington General Hospital, "The doctor gave me two choices: He said she could go to a nursing home or she could come here to her home. This is my wife. She has a home. I said bring her he hospital arranged for the necessary equipand contacted CNS which provided a nurse to The family and supervise Mrs. Richardson's care erapy. he way was carefully prepared for Mrs. Richto come home, where her husband provides for ily care, feeding her through a nasogastric tube mes a day and irrigating a catheter twice a day. hildren and grandchildren frequently pop in to her and help provide the stimulation that is g her relearn to talk and make her way on the recovery. or Eva Screen of East Orange, her mother's Coming was a different matter. They dumped my mother on my doorstep like so garbage. It's like they just threw her away," n said. Mellow Screen is 49 and recovering from a stroke has left her mentally disoriented. Screen said her mother was admitted to East ge General Hospital earlier this month. In less than 'a week, Screen said, she recieved a at work and was told her mother had been dised and was at the daughter's apartment. According to Screen she came home to find her er, who did not have a key to the apartment, ing in the apartment lobby. Mrs. Screen had ved all of her clothing, except for a blouse, and wet with her own urine. Screen claimed the only thing the social service rtment told her, after her mother had already sent home, was that it would be hard to find a ng home for her. Lois Young, assistant director of nursing for CNS, discharge planning is "going in the right direction" ost of the Essex County hospitals. The main problem is nursing home placements. e is a severe shortage in the area, and hospitals patients who need such placements have no place nd them, she said. The state claims as many as 3,000 people are ting such placement at any given time, but Young no one really has a good count or knows exactho those people are and where they are. An East Orange General Hospital administrator Mellow Screen's physician determined that treatt had been completed and discharged the patient. The administrator said the discharge protocol was Owed and claimed Screen had been notified of the harge, something Screen denies. He said a hospital social worker determined the cher "was alert and aware of time, place and per son" at the time of discharge. Some claim things are getting better, not worse. In July, Rosmary Cucarro, executive director of the Visiting Nurse and Health Services of Union County, testified before Sen. Bill Bradley (D-N.J.) at a Special Senate Commitee on Aging hearing. Asked if she had seen a difference in the kind of home health patients her agency was getting, she said: "Certainly. The very acutely ill, some of them don't even make it home in the ambulance, senator." Pressed for more information, she said: "We have had two patients die on the way home from the hospital in the ambulance. I am not really being very critical. I just think that everybody is very much in an economic bind...I think sometimes people are being discharged a little too early from the hospitals." Asked if that statement reflects today's situation, Cucarro said, "Things have improved. That was a year ago." Y But according to Dr. Howard Slobodien, president of the Medical Society of New Jersey, physicians are being pressured by hospitals to get their patients out of the hospital as soon as possible. "Yes, they're being pressured. It's 'doctor, get your patient out.' And if you say the patient still needs care, or the patient can't be treated at home, it's still 'doctor, get your patient out." " "I can't prove it, I can't disprove it, what I hear is anecdotal, but I hear that it is creating a revolving door effect, that patients are coming out of the hospital and going right back in," Slobodien said. At present there is no easy way to track such a trend, he noted. Louis P. Scibetta, president of the New Jersey Hospital Association, admitted that hospitals are trying to reduce the length of stay. But, he said, they have been criticized for years for running up health care costs, partly because patients who could have had tests done on an outpatient basis and patients who could have been cared for at home were spending extra days Lin the hospital. Mr. RINALDO. or your friends Jersey's DRG s man? Mr. KEISERMA Mr. RINALDO. Mr. BOND. I H Mrs. ABRAMS Mr. RINALDO which I think i discussed earlie Do you belie should make a accept assignm ment as payme Mrs. ABRAMS. Mr. RINALDO. Mr. MILLER. in Bergen Coun opposition from Monmouth Cou the New Jersey lished the name Let us publis which doctor w they find out we Mr. RINALDO. one means of re Mr. MILLER. A Mr. RINALDO. Mr. KEISERMA five persons wh 1,000 doctors in that they woul Monmouth Cou with the Monm such a book. It is HCFA, in fact members and go Simon, the dire made available our format, how oped. Unfortunately they would acce conditions under doctors we conta from all patient homes only, pati tions like that, that is being cove it next year. Mr. RINALDO. S DO. I would like to ask each member of the panel, since is an important point that was made, have any of you nds had an experience with early discharges under New G system that you would like to testify to? Mr. Keiser ALDO. I would like to ask the panel the next question nk is fairly important, and it deals with something we arlier with Dr. Davis. believe that the Health Care Financing Administration ke available the identity of those physicians which gnment, that is, those that accept medicare reimburseyment in full? Suppose we start with you, Mrs Abrams. RAMS. Yes, I think we should. ALDO. Mr. Miller. LER. Absolutely. We have been trying to get the doctors County to accept assignment. And we are meeting stiff from the Bergen County Medical Association. But in n County, our Monmouth County Council, a member of ersey Council, made a thorough review of this. They pub names. publish those names, and let us decide as senior citizens tor we will go to. The others will soon fall in line when out we are not patronizing them. VALDO. You think that would be helpful and it would be s of reducing costs? LLER. Absolutely. ALDO. Mr. Keiserman. CISERMAN. I am from Monmouth County. I am one of the ons who worked on this project, where we contacted over tors in Monmouth County and found 400 who replied to us y would accept assignment. This was done through the th County Senior Citizens Council. And in conjunction Monmouth County Office on Aging. And we published Dok. It is available throughout Monmouth County. , in fact, sent a representative up to one of our committee s and got a copy of it to see what we had done, and Sister the director of the Monmouth County Office on Aging, vailable to every office on aging in the State, our letters, hat, how we went about it, and copies of the book we devel tunately, only 400 doctors of the 1,000 replied to us that uld accept assignment. But most of them had only certain ns under which they would accept assignment. Of the 1,000 we contacted, I would say no more than 75 take assignment Il patients. The others limited it to patients in nursing only, patients in hospital care cases only, and other restricke that, which limited the amount of assignment actually being covered. This we did last year and we hope to update year. RINALDO. So you feel that the list has proven helpful? 70 Mr. KEISERMAN. Yes. I live in a condominium where we have over 3,000 residents, and we made it available to all of our resi dents and people I know very well, and almost all of them have used it to very good advantage. Mr. RINALDO. Do you feel that it has reduced costs? That it helps to reduce the overall costs to the program? Mr. KEISERMAN. Whether it reduces the costs to the program, I do not know. It may make the cost to the program higher because medicare only pays assignment rates regardless of if a doctor accepts it or not. It reduces costs to the senior citizen. Mr. RINALDO. Mr. Bond, do you want to comment? Mr. BOND. I have no further comments beyond those that have been made, except to point out that in this particular community of Princeton, it is almost impossible to find any physician accepts assignment. Mr. RINALDO. Thank you. While general revenues may not be used to make up any deficits in the hospital trust fund, several advisory councils on social security as far back as 1938 and 1948, have recommended the use of general revenues for benefits under social security. It was recommended in 1965 for medicare benefits for those already retired or disabled. In 1971 it was recommended that one-third of parts A and B taken as a whole ought to be funded by general revenues. The 1975 council recommended using general revenues in medicare, and reallocating a portion of the hospital insurance tax to the retirement fund. In 1981, the National Commission on Social Security also recommended the use of general revenues in medicare and reallocating a portion of the hospital insurance tax to the retirement fund. I understand from the testimony we received earlier that the current advisory council is not going to recommend the use of general revenues. Mr. Keiserman, do you think general revenues should be used to pay part of the cost of hospital insurance? Mr. KEISERMAN. I think it would only be fair because general revenues have been using social security money in devious ways, that I consider devious ways, such as the $16 billion that has not been returned to the trust fund, which covered soldiers from World War II through to the Korean war. The fact that we get the lowest possible return on the trust fund moneys, which is actually helping subsidize general revenues and other ways. There are dozens of other little ways that general revenues have profited using the social security funds. I do not say they misused the actual funds, but they have taken advantage of issues there. You yourself, pointed out that in the last 2 years $4 billion was lost to the social security fund by the use of investments giving us lower returns. I have a newspaper article quoting you on that. So these are some of the facts. I do not see any harm from instead of abusing us, possibly helping us for once. Mr. RINALDO. Thank you. When medicare first started in 1966, general revenues and premiums were about 50/50. Why do you think now that 35 percent is too high? Mr. Keiserman. Mr. KEISERMAN. I feel it is too high based on the income of seniors. They have just delayed for 6 months the cost-of-living increase. And by the way, the delaying of it only delays it another 6 |