71 months because it is already delayed 1 year. It is based on the previous year's increases. So seniors have always been at least 1 year behind. Now they will be a year and a half behind in this cost-ofliving increase. So in a sense this actually will not help seniors in any way that way. Mr. RINALDO. Mr. Miller, are there any members of your organization who feel we can increase copayments for beneficiaries? Mr. MILLER. No. As I testified in my written statement here, I would like to go back to the previous question, if I can make a comment about that. Mr. RINALDO. Sure. Mr. MILLER. We get into a vicious cycle about taxation and who pays for it in the end. It comes down basically to the consumer. We are consumers. And every time you raise the taxes on the corporation or on the workers, they are going to get their money back. They are going to pass on those costs. When they pass on those costs, we have to pay them. And we keep going down, which might be termed inflation, but the basic cause is, is taxing the product and taxing the workers. That does not help the senior citizens in any way. As I said, I think the senior citizens that are affiliated with our Council feel that the problem does not exist as a result of income. The problem exists because of not containing the cost to hospitals or the exorbitant fees of the doctors. Mr. RINALDO. Well, how about inflation? Mr. Keiserman in his statement seemed to indicate that the Federal Government and not the medicare beneficiary ought to absorb all the impact of health care inflation. Is that putting it correctly? Mr. KEISERMAN. No, I did not say that. We are paying an increase in our cost insurance monthly. The deductible has gone up. The coinsurance on hospitalization has gone up. So actually I dispute that statement by you, Congressman, respectfully, of course. Mr. RINALDO. How do you think we should pay for increased costs? How do you think we should handle it? Do you think any of the costs should be passed on to the medicare beneficiary? Mr. KEISERMAN. I think the only organization that is capable of making medical care cost effective, efficient, at a reasonable cost, is the Federal Government. It cannot be done on a local basis. And by just raising rates constantly to meet cost increases without looking toward making this whole program more efficient, and rendering better health care, is just ridiculous. It is just a dog chasing its tail going in a circle. And that is exactly what is happening. Mr. RINALDO. Well, do you think we can make it more efficient, render better health care, not increase the cost to any beneficiary, and still handle a projected shortfall of up to $400 billion by 1995? Mr. KEISERMAN. I do not know if we could actually address that big a deficit, but I do know we can make a big dent in it. I have made a number of recommendations. Home health care service, for example, would reduce hospitalization tremendously at a much lower cost. This hospice program that Congress passed to take effect next November, why they delayed it a year and a half, I do not know. It will keep terminal cases out of hospitals, in homes, and reduce the cost to members. have no schools of gerontological medicine really worth talk- ere is so much that can be done that must be done on a na- KEISERMAN. No, sir. Not at all. But I would like to see some ative ways tried, which is all that is happening now and you from the budget proposals by the administration, that all are doing is raising the share to seniors and that is it. They ot doing anything to actually cut the costs. RINALDO. Mr. Miller, is your organization-what would you re the most important priorities that your organization has up with, if any, to improve medicare? . MILLER. Why do you not make a contract with the doctor not with the senior citizens? Why do you not set a schedule of ? Make it a voluntary program. Any doctor who wants to join olan, he knows in advance what he is going to get for certain ments. And if you did that, you can control the doctor. ht now, he keeps on increasing his rates and that adds to the or the senior citizen. w much more can we stand? We are on fixed income. Every you add to us reduces us for something else. We must make ices. . RINALDO. Thank you. Mr. Smith. SMITH. Thank you, Mr. Chairman. First of all, we have I some very strong objections from the panel to hospital coents to some strong objections to raising the part B medicare ium to 35 percent, and also I think, among all of you perhaps, ort for including general revenue moneys, as part of the mix e equation for financing medicare. o have a few questions, and I think, Mr. Chairman, you covmost of them, but I will ask my remaining questions. . Miller, you spoke of inclusion of comprehensive eligibility for oursement to home care, and we were just having a discussion at. Could you elaborate on that? Exactly what kind of services ou see the proposal taking. Mr. Miller, and then Mr. Keiserbecause you were also sharing on that. . MILLER. And the question is? . SMITH. The question is: Specifically, what kinds of home h care services, if you could itemize some of those services, you share that with us? . MILLER. Well, we feel many doctors are required to make a mination or a diagnosis of a condition, the first thing is they to get all the best equipment that is available to them, and that is in the hosp involved in that. If the hospitals equipment, it would is there, we go back case in point. This have such and suc There is somethin judgment. They sh judgment he did th judgment, but we and saying: We ar ment. This should be lo Mr. KEISERMAN. care is the questi services that docto can be furnished i nurses, licensed n when I say that ev people. And there midwives. And this is the trained technician can come into th lower cost than d keep a lot of seni care today, either pital. If this can trained persons, and out of doctors As I pointed ou assignment does money. But the money is still bei and nurses whose mendous sums of lion that is being but I resent it, th announced how b Mr. RINALDO. 1 Office. Mr. KEISERMA sound tremendou just as the "savi promise. Nobody seen some other somewhat. I did would have liked $18 billion, whic other Congress nothing to do wi But what I an know if they are ospitals. I think there is another containment cost als were not required to have all of this modern ould not be available to the doctor. But as long as it pack again to malpractice. As long as it is there, one his doctor was asked during a trial, did this hospital such equipment? Yes. Did you use it? No. Guilty. thing wrong here. Doctor's judgment is a doctor's y should not be subjected to a suit later on, if in his id the right thing. I think we all make mistakes in we are not subject to somebody coming along later e are taking you to court. You made a wrong judg be looked into very thoroughly by Congress. MAN. In home health care, to address home health estion, I would like to refer to the fact that many doctors render that patients have to go to doctors for, hed in the home by technicians, therapists, registered ed nurses, licensed practical nurses. You may laugh at even maternity is covered by medicare for disabled chere has been a tremendous saving by the using of s the type of savings that can be obtained by having nicians, nurses, persons who work with seniors, who to the home, furnish necessary services, at a much han doctors will charge in their offices. Also, it will f seniors out of hospitals. Seniors, to get this type of either has to go to a doctor or has to be taken to a hoscan be furnished by technicians, licensed, registered, sons, it would definitely keep people out of hospitals octors' offices. ed out to Congressman Rinaldo, the utilization through does not save the program money. It saves the senior the senior would still be using the assignment, the ill being paid to the doctor. If you can use technicians whose rates are far lower, this of course would save trems of money. It could possibly even save the $400 bilbeing thrown at us. I do not know if it is a scare tactic, t it, these tremendous sums that are thrown at us. They how bad the social security program was. ALDO. These figures came from the Congressional Budget SERMAN. I don't dispute these figures. The thing is they mendous when you hear them, but they can be addressed "saving" of social security was gotten through this comNobody was hurt too badly. I would have liked to have other things that would be done. Everybody was hurt . I did not like certain parts of the program, as I said. I we liked to see other things done. One of them was that 1, which the Government admits it owes, but somehow or ngress neglected to include that in the package. It has do with what we are discussing now, of course. at I am trying to bring out is that these figures, I do not hey are thrown out to scare seniors so that they are happy cept whatever is given to them, or whether or not actually it ot be addressed and saved with some of these simple things I am referring to. . SMITH. If you could write the regs, if you were in that posito say what would and would not be included in a home health provision, what specifically-you mentioned midwifery, and ossibility of children being born at home? What other kind of ces? . KEISERMAN. I had mentioned others. Nurses coming into the , rendering services, dressing after an operation. A person can home, if a registered nurse can come in and render the servneeded, for instance, to rebandage, to dress wounds, to bathe atient, things of that sort. e senior citizen organizations, every major one, fortunately, we all alined and affiliated. In fact, we will be meeting this esday again. Has come out with home health care as its forepriority. Home health care is our foremost priority here in tate of New Jersey and for some reason Congress has never essed it. And every organization is pushing for it. . RINALDO. I am hoping we can get the committees to move on I agree with you. It is important. I am a strong supporter and ave been pushing it and I think it is certainly one item that I I will contribute dramatically to a reduction in costs. I have sored legislation to promote initiatives for home health care. . MILLER. I do not think we should be specific when we write ome health care legislation. Use the doctor's judgment, whathe feels is necessary. Let medicare put that in their coverage. - SMITH. I am suggesting that there would be some parameters would be allowed and not allowed. - MILLER. I think if my doctors said: Well, rather than you in the hospital here, I will take you home now that you have d the crisis and you can be treated at home. But, again, I say, after the equipment. If I have a wheeze in my chest and I go m, he says, I want to take an X-ray. He does not have an Xmachine. He sends me to the hospital because the equipment is . Home health care should be reimbursed by medicare. Keep atients out of the hospital. Most of us do not want to go to the tal in the first place. . SMITH. Mr. Miller, as part of the record, I am very strongly pport of home health care inclusion and I have been for quite time and join our chairman in that concern. u mentioned the situation of hospices. I have been to a hospice ed Bank hospice, and I have seen the kind of care that can be ded to our terminally ill patients, those people who have enthe irrevocable process of dying. And I was greatly impressed e love, support, as well as by the cost-effectiveness of the hosprogram, again emphasizing the need for a re-direction into ome health care area. . MILLER. Still, it was passed last year and it does not take I until November of this year. Why? . RINALDO. One of the problems is, while Congress passed it year, it is incumbent upon the agency to come up with the and regulations. And that is what really seems to be the contributing factor to the delay in implementing it. I do not think an program implemen where we are face abused. So that is they are moving ah Mr. KEISERMAN. Mr. SMITH. Mr. H tive reimbursement Mr. KEISERMAN. are not against rei actions are taken t But just to keep in program, and that We would like to things done. Mr. SMITH. Well on page 6, "the N Mr. KEISERMAN By the way, ma savings been take dous deficit? Mr. SMITH. I am already, that wou have one piece of Mr. KEISERMAN level would end a tion of the Secreta The second poi dent of the Healt and Jeffrey Wass ganization on the ed in December o Mr. SMITH. I wo What I would l but I know here i a certificate of n anybody here would want to see any governmental mented hastily, and perhaps then create a situation faced with exorbitant costs and the program is is the reason for it. And my understanding is that g ahead as quickly as possible. AN. I hope so. Ir. Keiserman, is your organization against prospecment? AN. We are against unnecessary reimbursement. We c reimbursements if they are necessary and if other en to cut costs and to make the program more valid. ep increasing the costs to seniors at a savings to the that is all that is happening, we are opposed to that. e to see some innovative ideas tried, some other Well, as was pointed out in testimony previously, een-we have the New Jersey experience on the Mr. Bond indicated in his testimony, I think it was he New Jersey study convinces us that proper safel-payer nationwide prospective reimbursement system will help control rising costs." And apparently he à favor of it. That is correct. I think it may provide a way of keeping a control on 5. The key is having a program, of course, that is fair e and does not result in some doctors opting not to be à the services. your testimony, the reason I am asking the question, I whether or not you are for the DRG. RMAN. I was all for it until I read yesterday's Star re hospitals are being encouraged to save money by prematurely ill patients. 1. Of course an abuse can creep into any good and wellprogram. Has the council taken a position on DRG? RMAN. There has been no study made of the results of we? I am hoping a position, a study will be made. ay, may I ask the Congressmen, has this DRG program n taken into consideration in speaking of this tremen ? H. I am sure an analysis can be drawn up, if one has not at would show the savings if it was adopted fully. We do iece of information, $12 billion of savings over 3 years. ERMAN. The prospective reimbursement at the national end after 2 years, and then it would be at the discreSecretary to set the rates, so that is one point. nd point is there has been a study by Joel May, presiHealth, Research and Educational Trust of New Jersey, y Wasserman, vice president for Research of the same oron the New Jersey DRG evaluation and it was complet-mber of 1982. TH. I would appreciate a copy of that, if possible. would like to add-I do not know nationally if we have it, w here in New Jersey we have, that hospitals must obtain te of need before they can build, expand and spend a lot |