APPENDIX E

National Health Insurance Resource Book prepared by the Staff of the Committee on Ways and Means for the Use of the Committee, April 11, 1974, page 85.

SOURCE: Statistical Abstract of the U.S. 1973. Bureau of the Census, U.S. Department of Commerce, July 1973.

APPENDIX F

National Health Insurance Proposals, Hearings Before The Committee on Ways and Means House of Representatives October and November 1971, page 61.

APPENDIX F

National Health Insurance Proposals, Hearings Before The Committee on Ways and Means House of Representatives October and November 1971, page 65.

(Louisiana State Medical Society House of Delegates, Approved 5-2-71)

RESOLUTION #406

Introduced by: Jose L. Garcia-Oller, M.D., W. Charles Miller, M.D., Christopher Bellone, M.D., F. Michael Smith, M.D., Kenneth Ritter, M.D., Robert Meade, M.D., Wesley Segre, M.D., and Edward Hyman, M.D.

Subject: Concerning Release of Medical Information to Insurance Companies, Service Contract Corporations, Government "Carriers," and Government Agencies, from Medical Records Departments and Hospitals.

Resolved, that all inquiries for medical information will be accompanied by a properly executed and current authorization for release of information signed by the patient or his proper representative. Upon receipt of an inquiry, the Medical Record Department will submit information in the fact sheet of the chart, which includes identification data, the admitting and final diagnosis, and the name of the operations performed, including the verified pathological diagnosis, if any. If an insurance company requires additional information, the insurance representative will be referred to the attending physician. Requests for the "entire medical record" or "photostatic copies of the history, physical, and progress notes" are considered unethical and unacceptable; and be it further

Resolved, that it is recognized that an insurer may request under the "contestability clause" specified by the law in most states, specific antecedent information during the period of contestability. This request to the physician shall identify the specific information requested from the history of the present illness. On requests for past history, a list of such antecedent information as may be related and pertinent to the insurance policy in question will be provided by the insurer. The physician may then review the medical record(s) and can then provide the pertinent information. Operative report and pathology tissue report copies should not be necessary since the surgery is clearly listed in the front sheet and is self-explanatory as to the procedure involved and the verified pathological diagnosis, if any. Reports of X-rays, EKG or other laboratory aids used by the physician in establishing the clinical diagnosis should not be necessary; and be it further

Resolved, that for the purposes of financial audits and government provider audit programs, "the provider need only show the auditor that part of the records relating to the physician's authorization for services and not the notes made by nurses and physicians or diagnostic data which are confidential information”; and be it further

Resolved, that the physician may honor requests for unusual information of a technical nature which the patient himself may not be able to provide and not covered in 2 above; and be it further

Resolved, that certifications and recertifications are to be filed separately from the body of the medical record and shall be made available to the carrier or government agency. These should not be entered on the progress notes; and be it further

Resolved, that implementation of this Resolution shall be the responsibility of the Medical Records Committee of the medical staff.

APPENDIX H

[From Internal Medicine News, July 15, 1971]

"DECEPTION" CHARGED TO HEW IN MEDICARE, MEDICAID CHANGES

WASHINGTON.-The Council of Medical Staffs has confronted officials of the Department of Health, Education, and Welfare with evidence to show that deception was used in promulgating new regulations requiring earlier certification of Medicare and Medicaid hospital patients.

A showdown came at a meeting here presided over by Rep. Hale Boggs of New Orleans, the Democratic majority leader.

Dr. Jose Garcia Oller, president of the Council, said news releases from HEW erroneously implied that there was widespread cheating by practicing physicians in treating Medicare and Medicaid patients. He noted that data which do not exist were cited to justify a proposal to require physcian certification of Medicaid patients on the 12th and 18th days of their hospital stays rather than on the 14th and 21st as regulations now provide.

The Council asked that the proposed 12- and 18-day regulation for Medicaid patients not be adopted and that a similar regulation for Medicare, which went into effect in 1970, be rescinded.

Thomas Laughlin Jr., associate commissioner of HEW's Social and Rehabilitation Service, and Thomas M. Tierney, director of HEW's Bureau of Health Insurance, said the Council's request would be studied.

The Council unsuccessfully opposed the regulation for Medicare when it was announced late in 1969. A news release from the Social Security Administration, dated Oct. 13, 1969, was challenged as being deceptively misleading.

The release said the new regulation "is expected to shorten hospital stays and thus reduce Medicare costs."

"To illustrate the potential cost savings to the program," the release continued, "Secretary (Robert H.) Finch noted that if each hospital stay by a Medicare beneficiary during 1970 is shortened by one day, Medicare costs will be reduced by approximately $400 million."

Dr. Garcia Oller said the $400 million figure used in the release was allowed to stand despite specific advice from Robert J. Myers, then chief actuary for HEW, that the actual savings would not be more than $5 million.

Vertical axis indicates number of patients discharged on the left column and discharge ratio on the right column. Horizontal axis indicates day of hospitalization since admission.

The curve shows 109,053 patients were discharged on the 13th day and 106,761 on the 14th day. This actual drop in discharges is a small shoulder in the cure of discharges (HEW), but becomes a peak in HEW's "discharge ratio." The tiny rise at 21 days and the unnoticeable rise at 28 days are also amplified into peaks by HEW and scribed to "certification." Yet there is no certification on the 28th day, a Council spokesman notes.