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Johns Hopkins Hospital, Robert M. Heyssel, M.D., letter..

Johns, Varner J., Jr., M.D., San Bernardino County (Calif.) Medical
Society, letter.

Johnson, Kenneth C., McKay-Dee Hospital Center, letters and state-

ment..

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465

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Mercy Hospital (Williston, N. Dak.), Irvin "Mike" Krause, letter
forwarded by Senator Quentin N. Burdick..

444

Moore, Hon. W. Henson, a Representative in Congress from the State
of Louisiana, statement--

311

Naples (Fla.) Community Hospital, Laurence J. Hoffman and Warren E.
Connelly, letter___

411

454

205

378

New York Hospital Association, George B. Allen, letter and statement--439, 441

Nichols, T. K., M.D., Ellington Memorial Clinic, letter..
Noroian, Edward H., Presbyterian University Hospital, mailgram for-
warded by Congressman William S. Moorhead_

Northampton-Accomack Memorial Hospital, Nassawadox, Va., R. A.

Cramer, letter to the Commissioner of Social Security forwarded by

Congressman Thomas N. Downing- - -

North Dakota University Medical Center Rehabilitation Hospital,

Kenneth W. Aitchison, letter forwarded by Senator Quentin N. Burdick

Ogren, Stuart D., Virginia Hospital Association, letter forwarded by

Congressman Thomas N. Downing-

Oregon, State of, Gov. Robert W. Straub, correspondence with Thomas J.
Underriner, St. Vincent Hospital and Medical Center, forwarded by
Chairman Al Ullman.

458

312

Pembina County (N. Dak.) Memorial Hospital, Ruth Hollis, R.N., letter
forwarded by Senator Quentin N. Burdick

449

Redlands (Calif.) Community Hospital, George A. DeLange, letter--.

Richardton (N. Dak.) Community Hospital, Sister Helen, letter forwarded
by Senator Quentin N. Burdick.

445

Roberts, Lynn N., St. Luke's Hospital, letter forwarded by Senator
Quentin N. Burdick..

444

Ryba, Gary M., Griggs County (N. Dak.) Hospital and Nursing Home,
letter forwarded by Senator Quentin N. Burdick.

448

St. Alexius Hospital, Sister M. Joanne, letter forwarded by Senator
Quentin N. Burdick..

447

St. Aloisius Hospital, Leo Geiger, letter with enclosure forwarded by
Senator Quentin N. Burdick_.

449

St. Anthony Hospital, Sister Anne L. McNamara, letter to Hon. Michael G.
Thorne, forwarded by Chairman Al Ullman..

314

St. David's Community Hospital, Joseph M. Guinn, letter forwarded by
Congressman J. J. Pickle_

216

St. Gerard's Community Hospital, Gene Hoefs, letter forwarded by
Senator Quentin N. Burdick

452

St. John's Hospital, Robert Wolter, letter forwarded by Senator Quentin
N. Burdick..

445

St. Joseph's Hospital, Sister Anita, letter forwarded by Senator Quentin N.
Burdick.

446

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Seton Medical Center, Sister Damian, letter forwarded by Congressman
J. J. Pickle...

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Smith, Henry J., Magec-Womens Hospital, letter forwarded by Congress-
man William S. Moorhead..

458

Smith, Leslie A., New Hampshire Hospital Association, statement for-
warded by Congressman Norman E. D'Amours

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Stanley (N. Dak.) Community Hospital, Charles Kramer, letter forwarded
by Senator Quentin N. Burdick.

451

Stengel, LeRoy, Mason (Tex.) Memorial Hospital, Inc., letter forwarded
by Congressman Omar Burleson.......

314

Straub, Gov. Robert W., State of Oregon, correspondence with Thomas J.
Underriner, St. Vincent Hospital and Medical Center, forwarded by
Chairman Al Ullman...

312

Stringfield, C. David, Baptist Hospital, Nashville, Tenn., letter..
Swenson, James P., Bismarck (N. Dak.) Hospital, letter forwarded by
Senator Quentin N. Burdick_

330

448

Thompson, William M., M.D., American Medicorp, Inc., Medical Advisory
Council, statement..

322

Towers, John L., San Antonio Community Hospital, letter.

464

Towner County (N. Dak.) Memorial Hospital, Sister M. Arnoldine, letter
forwarded by Senator Quentin N. Burdick.

449

Tresnowski, Bernard R., Blue Cross Association, statement..

333

Ulrich, Rev. Larry K., Church of the Brethren General Board, statement__
University of Maryland Hospital, Shirley L. Milke, letter-

363

403

Utah State Hospital Association, John R. Walker, letter forwarded by
Congressman Gunn McKay.

308

Utah Valley Hospital, Grant C. Burgon, letter forwarded by Congressman
Gunn McKay..

309

Vierra, Richard, G. N. Wilcox Memorial Hospital & Health Clinic, letter...
Von Ehren, Warren R., Wisconsin Hospital Association, letter..
Waggendorf, Sister Madonna, Garrison (N. Dak.) Memorial Hospital,
letter forwarded by Senator Quentin N. Burdick..

Walker, Joel H., Central Vermont Hospital, letter. -

Walker, John R., Utah State Hospital Association, letter forwarded by

Congressman Gunn McKay.

497

498

445

325

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Wightman, D. D., Dakota Hospital, letter forwarded by Senator Quentin
N. Burdick

451

445

SELECTED ISSUES IN MEDICARE PROGRAM POLICY

THURSDAY, JUNE 12, 1975

U.S. HOUSE OF REPRESENTATIVES,

SUBCOMMITTEE ON HEALTH,

COMMITTEE ON WAYS AND MEANS,

Washington, D.C.

The subcommittee met at 10:40 a.m., pursuant to notice, in the committee hearing room, Longworth House Office Building, Hon. Dan Rostenkowski (chairman of the subcommittee) presiding.

Mr. ROSTENKOWSKI. The Subcommittee on Health will come to order.

I have prepared a statement underlying this hearing and I ask unanimous consent that that statement and the press release announcing this meeting be included in the record at this point. Without objection.

[The documents follow:]

OPENING REMARKS OF CHAIRMAN ROSTENKOWSKI, HEARINGS OF SUBCOMMITTEE ON HEALTH, ON MEDICARE REGULATIONS, JUNE 12, 1975

The purpose of today's oversight hearing is to receive testimony from representatives of the professional community and the Department of Health, Education, and Welfare on four recently promulgated regulations relating to the medicare program. Each of these four regulations-to impose new utilization review requirements, to terminate the inpatient routine nursing salary cost differential, to revise the limit on reasonable costs for inpatient routine services, and to tie recognition of reasonable charge increases to an economic index-has given rise to substantial controversy and widespread adverse criticism from hospital and medical associations. The significance of the issues raised by these regulations is such as to warrant careful appraisal by the Subcommittee of their policy and administrative implications in the light of congressional intent relative to the conduct of the medicare program.

While much of the discussion has revolved around the objections raised by segments of the professional community--and these views and interests are certainly of major importance-the Subcommittee is very much concerned about the impact and consequences of these regulations for medicare beneficiaries. Central to any consideration of regulatory changes in the program must be an evaluation of the likely effects on the availability, quality and cost of services furnished to beneficiaries. The Subcommittee wants to be sure that the interest of the beneficiaries is not lost sight of and that the discussion remains firmly focused on their status and needs.

Clearly the issues raised by these regulations have sweeping implications. The utilization review regulations would introduce substantial changes in the scope and conduct of hospital and physician review activities. The Department has indicated, in promulgating these requirements, that they are intended to bring about a single, uniform review system for both medicare and medicaid and to bring utilization review activities more closely into line with the PSRO program. It is also asserted that these requirements are consistent with and implement the provisions enacted in the 1972 Social Security Amendments. Hospital and medical spokesmen have argued, however, that the utilization review regulations not only exceed the authority granted to the Secretary to issue regulations but introduce requirements that many hospitals, particularly rural hospitals, will not be able to meet, with potentially dire consequences for those hospitals and medicare beneficiaries.

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