How do you intend to address this issue in designing this policy? Mr. Berman: We agree with you that outpatient payment reforrn should not include any biases against rural, or for that matter any groups of hospitals. In our prior report on payment for ambulatory surgery services, we did not recommend treating rural hospitals differently than urban hospitals. There is another aspect to outpatient payment policy that is creating financial pressure on rural as well as urban hospitals. In OBRA 1990, Congress reduced cost based reimbursement for hospital outpatient services for all hospitals. Since rural hospitals rely on outpatient revenue to greater extent than urban hospitals, the reduction will have a greater impact on rural hospitals. Any assessment of the impact of outpatient reform must recognize that Congress has enacted several legislative changes to reduce the growth in outpatient spending for all hospitals. Paperwork Burden Senator Harkin: I'd like to focus for a moment on some of the recommendations included in your annual report to Congress that was submitted earlier this month. One of your recommendations concerns implementing uniform data collection and coding requirements for all providers of outpatient care. We have talked in the past about the "paperwork" burden that is required for Medicare reimbursement and the need to streamline this process. How would implementation of these uniform requirements impact Mr. Berman: The Commission is concerned about the paperwork burden facing providers and considered this impact in developing recommendation. We do not believe that the recommendation will substantially increase the burden after the recommendation is implemented. The major focus of the recommendation is on obtaining consistent information rather than increasing the total amount of data collected. Further, uniform reporting will result in more consistent payment policies which is to the advantage of providers. Office of Rural Health Policy Senator Harkin: Last fall, the Committee included report language directing ProPAC to provide technical assistance to the Federal Office of Rural Health Policy (ORHP). The rationale here was that ProPAC has developed data base systems essential for ORHP's impact analysis of Medicaid and Medicare regulations. Sharing this technical information would alleviate the need for ORHP to create a parallel data base. What is the status of this collaboration? Mr. Berman: ProPAC's policy is to share data bases with other Federal agencies, consistent with the legal requirements of the data licensing agreements we sign to obtain the data. In addition, we try to make the findings from our analyses widely available to other agencies as well as the public. We have not previously used our limited resources to develop analysis plans, computer specifications and programming for the mainframe computer for agencies and individuals outside ProPAC. We have, however, collaborated with other agencies on projects of joint interest. To date, the Office of Rural Health Policy has not asked us for data tapes, technical assistance, or specific computer analyses. U.S. SOLDIERS' AND AIRMEN'S HOME STATEMENT OF MAJ. GEN. DONALD C. HILBERT, U.S. ARMY (RETIRED), GOVERNOR ACCOMPANIED BY: COL. JOHN W. GHEEN, U.S. ARMY (RETIRED), DEPUTY GOVERNOR COL. ROBERT J. GRIDER, U.S. ARMY (RETIRED), DIRECTOR, ADMINISTRATION ELIZABETH J. WALKER, BUDGET OFFICER BUDGET REQUEST Senator HARKIN. The next panel is the U.S. Soldiers' and Airmen's Home. The home's total fiscal year 1992 request for operations and maintenance is $42.1 million. This is an increase of $1.5 million over last year. There is also a capital outlay request of $4.2 million for construction and renovation of the physical plant. The home was established in 1851 for the relief and support of retired and disabled soldiers. The 2,200-bed facility is located in Northwest Washington. It is my pleasure today to welcome Maj. Gen. Donald C. Hilbert before the committee. In June 1990, Major Hilbert was appointed by the President as the 25th Governor of the home. I also want to congratulate you on your recent retirement from the U.S. Army. I understand you completed 35 years of military service this past spring. Congratulations on both, your service to your country and other service to your country as head of the home. Welcome. Your statement will be made a part of the record in its entirety. Please proceed to summarize your statement for us. INTRODUCTION OF ASSOCIATES General HILBERT. Thank you, Mr. Chairman. I would like to introduce the folks that I have brought with me. On my left is Col. Wes Gheen who took over the job of Deputy Governor in November of 1990. He has been with the home for about 8 years. On my right is our new Director of Administration, Col. Jeff Grider, who retired also from the Army the end of September; and Mrs. Betty Walker, who has been our Budget Officer since February 1988. On behalf of the distinguished veterans of the U.S. Soldiers' and Airmen's Home, I appreciate the opportunity to meet with you today. This is my first appearance before Congress as the Governor of the home, but I am well aware of your subcommittee's strong support in the past for improving the home's standards of living and care for our membership. EVALUATION OF ORGANIZATION AND MANAGEMENT I have spent the past several months evaluating the organization and management of the home and reviewing the several oversight reports from outside agencies which have been received in the recent past, the latest being the Department of Defense inspector general report and the Department of Defense general audit. All of the recommendations of both reports have been resolved either through agreement with the inspector general, overcome by the new legislation that has been passed, or corrective action has been or is in the process of being taken. One of the major criticisms in the past and repeated in the audit report was the accounting system at the home. We are in the process of converting to a new accounting system obtained through a reimbursable agreement with the Department of Treasury Financial Management Services. This system will place us in full compliance with GAO standards. I am also happy to report that in October 1990, the home's Benjamin King Health Center received an additional 3-year accreditation from the Joint Commission on Accreditation of Health Care Organizations. This was in recognition of its long-term care stand ards. I have also been involved in evaluating the Armed Forces Retirement Home Act of 1991. As you are aware, the new legislation makes several changes in admission policy, the governing boards, the appointment of officers, and the trust fund of the home. CAPITAL OUTLAY PROJECTS Next I would like to summarize the status of our principal capital outlay projects. The construction of the intermediate care facility is approximately 50 percent complete, and all work is on or ahead of schedule. The current contract completion date is April 1992. However, the contractor is planning to complete the work 1 or 2 months early. Our capital outlay request for fiscal year 1992 is $4,220,000. The individual projects are outlined in our budget submission. There is no request for funds to continue the renovation of dormitories in the fiscal year 1992 budget. As recommended by the Department of Defense Inspector General, prior to major capital outlay projects, we will conduct an economic analysis. Currently we are conducting an economic analysis in conjunction with the Office of Management and Budget to determine the best alternatives to provide housing for our members and the sequence for renovating the remaining dormitories. OPERATION AND MAINTENANCE The home's operation and maintenance budget request for fiscal year 1992 is $42,123,000, which is $1,542,000 greater than the fiscal year 1991 appropriation. A major portion of the increase is to provide pay raises for the personnel employed. This budget will fund an employee level of 970 personnel. In that context, there have been several studies in the past that have addressed manpower levels for health care. However, since there were differences of opinion as to their validity, I decided to look at not only health care staffing levels, but staffing for the entire home. We are just completing our review of studies by teams from the U.S. Army Force Integration Analysis Agency and the U.S. Air Force Management Engineering Activity. We are currently in the process of obtaining a contract with Circle, Inc. to evaluate the manpower staffing requirements in the professional services division, health care directorate. When these have been completed, we will have a good handle on the staffing requirements needed to operate the home in an efficient manner. PREPARED STATEMENT Evaluation of past operations indicates that there are some areas and programs at the home that need attention. An equipment replacement program needs to be developed. This was pointed out to us by the Department of Defense inspector general. A preventive maintenance program is required. An ongoing maintenance and repair program for ancillary buildings is necessary because of the age of these buildings. And the way we budget for the purchase of pharmaceuticals needs to be reviewed. Sir, this completes my statement. I'll be very happy to answer any of your questions. [The statement follows:] STATEMENT OF MAJ. GEN. DONALD C. HILBERT PURPOSE The purpose of this statement is to furnish information on the Home which may be of interest during the committee's consideration of the Home's fiscal year 1992 budget request. Included is pertinent information on the Home: its mission, administration, physical plant, financing, and members. The statement also provides a general description of the fiscal year 1992 budget request as compared with the fiscal year 1991. It is also important to note that under the provision of Public Law 101510, Title XV-Armed Forces Retirement Home, several changes regarding the Home occurred in fiscal year 1991; however, most will occur in fiscal year 1992. The Armed Forces Retirement Home Act of 1991 incorporates the United States Soldiers' and Airmen's Home and the United States Naval Home into an independent establishment in the Executive branch to be known as the Armed Forces Retirement Home. Each facility will be maintained as a separate establishment for administrative purposes. MISSION The Home was established by Congress in 1851 for the relief and support of retired, invalid, or disabled soldiers of the Regular Army. Until fiscal year 1992 membership has been a benefit for former warrant officers and enlisted personnel of the Regular Army and Air Force with the following qualifications: (1) honest and faithful service for twenty years or more as warrant officers or enlisted personnel, or (2) service-connected disabilities rendering them unable to earn a livelihood, or (3) nonservice connected disabilities rendering them unable to earn a livelihood, provided they have had service during a war. Under the provisions of Public Law 101-510 effective in fiscal year 1992 membership criteria changes. Membership will be a benefit for persons who served as members of the Armed Forces, as long as at least onehalf was not active commissioned service, with the following qualifications: (1) honest and faithful active service for twenty years or more and are age 60 or over, or (2) service-connected disabilities rendering them unable to earn a livelihood, or (3) non-service connected disabilities rendering them unable to earn a livelihood, provided they have had service in a war theater during a time of war declared by Congress or were eligible for hostile fire special pay under section 310 of title 37, United States Code. |