I would like to say I am very grateful for the opportunity to see so many of you here, and I would like to introduce Peg Fayé, who is at the table, representing the minority staff. To give you a bit of background, the Senate Committee on Aging has Democratic and Republican members. The Democrats are in the majority at the present time, so we have more people, that means Peg and the people with her have to work a lot harder than we do. She is representing Senators such as Edward Brooke, Charles Percy, and Hiram Fong from Hawaii, the ranking member of our committee. If in the next election, the Republicans should gain control of the Senate, Senator Fong would be the chairman of the Committee on Aging, and most likely I would be grossly overworked or looking for work, one or the other. But at the present time, the committee in its daily dealings is nonpartisan. We work together very well, united in our attempt to help older Americans. If I may, I would like to turn the presentation back to Dr. Bruce Walter, and I hope I can prevail on Dr. Melvin White to come back to the table, with Mr. Peterson and his people. Ultimately I would like to have all of you sitting back here so you could help receive any questions after Dr. Walter is through with his presentation. Thank you. Dr. WALTER. I wish to make the presentation this afternoon informal, as informal as possible. If there is anything that you would like to ask in the way of a question during the presentation, please do so. I am going to present a short course in Medicare and Medicaid, and some related information on various health care programs. This will be an overview of the programs. We will be very happy to answer questions. We have Mr. Peterson here who can give you almost any information concerning Social Security programs. I would like you to examine the initial slide carefully for one reason. This is the key in the medical programs as far as facilities are concerned in the care of people in hospitals and nursing homes, and so forth. 1. Hospital care: A. Intensive. B. Acute. C. Advanced. 2. Skilled nursing care: EXHIBIT I-LEVELS OF CARE A. Hospital S.N.F. (E.C.F.) B. Freestanding S.N.F. (E.C.F.) 3. Intermediate-High. 4. Intermediate-Low. (Personal care in Utah.) 5. Residential health care: A. Supervised. B. Managed. C. Guided. D. Day, night, clinic (<24 hrs. care). It is important for cost and quality of medical care. It is a key that Senator Moss has to be concerned with every time he writes legislation. The use of these facilities are associated with dollars, and also the use of them are tied to the quality of medical care, because they each give a different kind of care. The whole point and whole purpose of a medical program, when it comes to institutions, is placing the patient in the right kind of facility so the patients may receive the care they need. It is that simple. However, regulating this is not too simple. I would like to just go through this and give you the information because it will have some bearing on your questions. First of all, these are the five levels of care which the Association of State and Territorial Health Offices has endorsed. They have printed 7,000 copies of this concept and its explanation. Essentially, at the top you see hospital care. As far as hospital care is concerned, we have intensive care. Some hospitals intensive care may run somewhere between $100 and $200 a day, so hospital care then, in an intensive care unit is a consideration that everyone has to think about, because it is very costly. It is also very essential for those that belong there. Acute care is the standard hospitalization, and advanced care is a new concept where an effort is being made to reduce the amount of nursing needed while still in the hospital. It saves about 20 percent on the hospital bill. The next is skilled nursing care. This is also known as in the past as ECF care. We still have the ECF name present, but all are called skilled nursing care at present. The slang term in Government is SNF. This particular type of care can be delivered in a hospital, in a section, or it may be in a free-standing nursing home. In many of the hospitals of the State, some 25 of them have skilled nursing services in these hospitals. This is by grace of a project which Senator Moss has helped bring to us. The next is the intermediate care, that is a level of nursing home care also, and intermediate low or personal care in Utah is another. There are, three nursing home levels of care, two, three, and four on the chart. The welfare program is an example. It gives you an idea of costs, the board and room costs only pays $16.59 for number two, about $10.50 for number three, and around $8.50 for item number four. That is board and room only. All other services are extra. LEVELS OF CARE Now, we get down to the fifth level of care in an area that we are developing in this State, and it exists elsewhere as well, which is a particular living area for those people who need a little supervision, or a little help, but really do not need nursing care. We have three levels of this type of care, we call supervised, managed, and guided. They are less expensive homes, and they will probably run somewhere in the general area of $5 a day. The next one has to do with day care, we have geriatric day care, day care for mental patients, day care for children, and there also is care for people at night who do various activities in the day time, but spend time in an institution at night. So this gives you sort of a general idea of the entire system that we have for delivery care to people who need institutional type services. There it is, the whole thing. The "machine" that runs this is called the utilization review program. They indirectly regulate the levels of care of where the patient should be. Some of you may well have been involved with utilization review, if you have been in the hospital. This is when your doctor said, "the committee says you have to go home." That is utilization review, and that is what protects this system. There is the whole story of levels of care on one slide. I am going to describe Medicare and Medicaid to give you an idea of what they are. Some of you may have some problems as to what these particular programs are, who they benefit, who could use them, and just how they were developed. This slide will give you an idea of some of the regulations that came out on the occupational safety and health agency, and believe it or not, the person who is on this horse underneath all of this is supposed to be a cowboy. These are the restrictions they placed on the cowboy to make it safe for him to do his job, and, as you can see, there is a net all the way around him. Cowboy after O.S.H.A. The Environmental Protection Agency has provided him with a cart to go along behind to catch the droppings. There is of course a seatbelt, headlights, a horn when the horse cannot hear, and of course there are hearing aids for the horse and all kinds of other things to make absolutely sure he does not have an accident. I can see him catching a calf. I would like to give you an idea of these programs. Medicare, of course, is a program that most all of you are very familiar with. I want to make sure that you know that it is an insurance program. It is not an appropriation type program. It has limitations, and the moneys come from the Social Security trust fund. Medicaid, however, is a different type of program. It is an assistance program for people who qualify for it by virtue of lack of income and lack of assets. The money comes from taxes, and it comes from the Federal Government, the State government, and county government as well, under some circumstances. I agree that in our particular State, the majority of the money comes from the Federal Government. Medicaid is for certain needy and low income people. Essentially, it is a complete care program for everyone, whether they are 100 or whether they are 1 day old, in our State. You will see a little quip on the bottom where it says, "Some States also at State expense, service other needy people." In our State, where some people who are not on welfare have a very major illness, Medicaid can help them. This is called medical assistance only. It will help people who have low incomes, but are not on welfare as long as they qualify under the provisions of the program. It is still a low income program, however. Medicare is actually a Federal program. It is the same all over the United States. The benefits come and the arrangements are the same. Medicaid, however, is of great importance to you, because it is basically a State-run program. It does vary, and, for example, if you are eligible for Medicaid in the State of Utah, you may not have any eligibility in the State of Colorado, whereas with Medicare, you are. This is very important. In Utah, our particular Medicaid program is very comprehensive. It takes care of almost everything. We are, I believe, one of two States that have very comprehensive and complete programs. Again, Medicare is everywhere in the United States. Medicaid is almost everywhere. Medicaid was operational in only 48 States, and in certain territories. Alaska has the program, and we understand that Arizona, the last remaining State, has opted for the program. We will have Medicaid in 100 percent of the States. |