with certain suggestions which we believe will make the enactment of such legislation more effective. The greatest need in health facilities construction in the District of Columbia is for extended care facilities both long term and short term. HR 6526 includes Grants to assist in the modernization of public or nonprofit private hospitals and in the construction or modernization of public health centers, long-term care facilities, diagnostic or treatment centers, rehabilitation facilities, facilities for the mentally retarded, and community health centers. While continuing to update and increase all health facilities is important, primary emphasis in this supplementary-grants bill should be on facilities designed to relieve the load on the general hospital. Despite all efforts by the medical profession to help reduce hospital costs to the family, to insurers, and to government, we all recognize that many patients could be released earlier from general hospitals to less costly facilities, either the short term requiring less expensive personnel and equipment, or the long-term nursing home type with a general hospital affiliation. This situation will be aggravated when title XIX of the Social Security Act is implemented in the District of Columbia. Whether such emphasis or priority can be included in HR 6526 or should be made a part of the intent of Congress, is a matter for your committee to ascertain. We do believe, however, that some such emphasis or priority is essential to best serve the immediate needs. With reference to the terminology as presently stated in the bill, I would like to make this comment. The medical society objects to the "long-term" phraseology because what hospital boards and hospital administrations and the medical profession are trying to develop in these days is progressive care. This range is in the spectrum from the intensive care unit to the domiciliary care type for elderly people who are unable to care for themselves. The greatest gap in this chain of progression from intensive care of a seriously and a critically ill patient to the well patient is in the extended care phase of movement. The general hospital is still taking care of people who do not require the sophisticated nursing care and equipment that exists on the acute wards. They are not quite able to go to self-care units which have been developed in a number of hospitals. So, they are kept in the standard ward environment and it is not only costing them more but they are depriving other potential patients from entry into our already overcrowded hospital system. Therefore, we would prefer to see the term "extended care" substituted for the term "long care." I would be happy to answer questions, if there are any. Mr. SISK. Thank you, Dr. Ecker. Does the gentleman from North Carolina have any questions? Mr. SISK. Thank you, Dr. Ecker. I appreciate your statement this morning. I believe there will be no questions at this time. Now we have the Hospital Council of the National Capital Area. You may proceed, Mr. Bucher. STATEMENT OF WILLIAM M. BUCHER, EXECUTIVE VICE PRESIDENT AND DIRECTOR, HOSPITAL COUNCIL OF THE NATIONAL CAPITAL AREA, INC., ACCOMPANIED BY: DR. CHARLES W. ORDMAN, PRESIDENT OF THE MEDICAL STAFF, WASHINGTON HOSPITAL CENTER; RICHARD M. LOUGHERY, ADMINISTRATOR, WASHINGTON HOSPITAL CENTER; FATHER R. BYRON COLLINS, VICE PRESIDENT FOR PLANNING AND PHYSICAL PLANT, GEORGETOWN UNIVERSITY; AND WALLACE WERBLE, PRESIDENT, CHILDREN'S HOSPITAL Mr. BUCHER. Mr. Chairman, my name is William M. Bucher. I am the Executive Vice President and Director of the Hospital Council of the National Capital Area, Inc. If I may, I would like to call the next four witnesses to sit with me here. They are: Dr. Charles W. Ordman, Mr. Loughery, Father Collins, and Mr. Wallace Werble. I have a statement which I would like to have entered into the record, and I would like to make other housekeeping comments as we proceed. Mr. SISK. I believe there are four statements. You have a statement, Mr. Bucher, and there are statements by Dr. Charles W. Ordman, Richard M. Loughery, Father Collins, and Mr. BUCHER. Mr. Werble. Mr. SISK. I don't have one for Mr. Werble. Mr. SISK. Actually there are five statements? Mr. BUCHER. Yes. Mr. SISK. Without objection, those five statements will be made a part of the record at this point. STATEMENT OF WILLIAM M. BUCHER, THE HOSPITAL COUNCIL OF THE NATIONAL CAPITAL AREA, INC. Mr. BUCHER. Mr. Chairman, my name is William M. Bucher, Executive Vice President and Director of the Hospital Council of the National Capital Area, Inc. I am pleased to have the opportunity to testify in support of HR6526 as the subject matter of this proposed legislation is of considerable importance to the continued provision of economical health care in the District of Columbia. My statement will be brief and will cover primarily the urgent need for this enabling legislation at the earliest possible date. Within the District of Columbia there are only a token number of extended care facilities available for the treatment of patients who do not require expensive acute general hospital services. For example, the only non-governmental facilities which could provide the acute general hospital some relief in the care of such patients are nursing homes which are continually occupied at capacity. However, even if nursing home beds were available, this type of facility does not meet the specific needs of most extended care facilities. It has been estimated in the Washington metropolitan area that upwards of 20% of our patients could be moved immediately into an extended care facility, if it were available. I am sure you will appreciate the tremendous savings to be effected by the construction of extended care facilities rather than general hospital facilities when you are aware of the difference in cost. The average cost of construction of an extended care bed is less than 35% of the cost of an acute general hospital bed. In addition, the expense per day to the patient may run as little as one half of the expense of care in an acute general hospital. This principle was soundly recognized by the Medicare legislation which provides for benefits within the extended care facility. Also, placement of patients in an extended care facility will enable acute general hospitals to ease the shortage of nurses and other limited personnel categories by using such individuals where they are needed most-in the care of the acutely ill. Because the District of Columbia is a unique Federal jurisdiction. the remedies available to the states do not solve the problems here. Under the Hill-Burton Hospital construction program, the District of Columbia receives an extremely limited annual allocation of approximately $400,000 per year for all types of health facility construction. We support the contention of the Metropolitan Washington Health Facilities Planning Council in that the existence of neighboring State boundaries contiguous to the District of Columbia is inconsequential when related to service programs of our Washington hospital centers. You will recall that the Presidential Commission on Hospital Costs called for sweeping innovations in the health care system to reduce the costs involved. We believe that this program for construction of extended care facilities coordinated with or adjacent to the major hospital centers is just such a dynamic new approach. I should like to express, on behalf of myself personally and on behalf of the entire hospital community, our deep appreciation and thanks to House District Committee Chairman McMillan for his continuing interest and effective assistance over the years in assisting this community to meet its health care facility needs. STATEMENT OF DR. CHARLES W. ORDMAN, PRESIDENT OF THE MEDICAL STAFF WASHINGTON HOSPITAL CENTER Dr. ORDMAN. Mr. Chairman, thank you for the privilege of appearing at this hearing. My name is Charles W. Ordman. I am President of the Medical Staff of the Washington Hospital Center and I appear with our Administrator, Mr. Richard M. Loughery, to testify in favor of HR 6526 because of this community's real need for this proposed legislation. The Washington Hospital Center is a private voluntary nonprofit hospital and serves in fact the greater Metropolitan Washington ares some 50% of our patients coming from outside the District of Columbia itself. The Center has now approximately 820 beds, and since its opening has kept abreast of the changing needs of medical practice and advancements in patient care by its addition of several units: Self Care, Medical and Surgical Intensive Care and Coronary Care and a recently endowed research facility. Because of the virtual exp' sion in knowledge pertaining to diagnosis and treatment of disease and the facility requirements concurrent in this progress, we are planning to enlarge and expand those areas for the treatment of the acutely ill patient. We have conducted our activities with some modicum of success in the past and will, hopefully, continue to do so as the science of medicine and care of our patients advance. What we have not been able to do is to provide that facility required for after-care. The subacute patient whose condition has been stabilized in the acute hospital and who now needs controlled convalescence and/or rehabilitation before being referred to a nursing home or to his own home. This facility gap has caused a break in our being able properly to implement the concept of progressive patient care. This concept, providing for the right care at the right time at the right place and at the right price, means that the patient admitted to the hospital acutely ill needs more vigorous care than he does as his illness wanes and that he can be exposed to decreasingly intensive yet graded care as he convalesces. We who practice in general hospitals are forced to keep our patients in the general acute hospital at regretably higher costs than necessary for a longer period than necessary simply because there is no appropriate facility available for that period of their care preceding their ability to be self-sufficient or to be cared for at home or in a nursing home. These patients no longer need the intensity of services provided in the acute hospital, but they do need professionally conducted and controlled care for an extended period of time. This phase in our patients' program of care could be more properly served and it could be served at considerably reduced cost to the patients and to the community. We of the Medical Staff of the Washington Hospital Center have been vitally interested in this potential for many years. Through appointed committees of the Medical Staff we have conducted research and an analysis of our patient's needs and have developed evidence indicating the true extent of this problem and the urgency for its recognition. Although the average stay of an acutely ill patient in the Center is less than 8 days, detailed analysis of our patients staying in the general hospital over three weeks showed their length of stay to be from 34 to 55 days, with an average of 41 days. Our Utilization and Audit Committees point out that this is an improper use of our acute hospital beds. There is usually little need for the orthopedic patient following a hip nailing, the medical patient who is recovering from a coronary attack or admitted because of uncontrolled diabetes and its complications, or for many others with postoperative situations whose conditions are stabilized to remain in a high cost facility were an extended care facility available. Our analyses further showed that the specialties of Medicine, Surgery and Orthopedics accounted for some 75% of these longer-staying patients and that 50+ percent of them would be ambulatory in a facility encouraging convalescence and rehabilitation. Our surveys were conducted exclusively on the Hospital Center's patient population. They indicated then a potential of some 75,000 patient days annually at the Center alone. This situation pertains to other Area hospitals and the magnitude of our patients' need becomes quite impressive. Should the plans of our Medical Staff and the administration of our hospital become a reality through favorable action of this proposed bill, it would be our intent to serve as much of the Washington community's Area hospitals' total need as is possible. Thank you, Mr. Chairman, for this opportunity to express on behalf of our Medical Staff our concern and interest in this bill. STATEMENT OF MR. RICHARD M. LOUGHERY, ADMINISTRATOR Thank you, Mr. Chairman, for the privilege of appearing at this hearing. Today, hospitals are faced with increasing pressures to find ways and means to reduce the costs of hospital care. These are legitimate pressures. We for some time have been deeply concerned with rising hospital labor costs needed to keep pace with wages paid in the community as well as those increasing costs caused by the rapid progress of medical science. It is an acknowledged fact that the quality of care and the saving of lives have advanced notably in the last decade alone. We in hospital management have not been able to institute some of the measures which would control these rising costs. Dr. Ordman has indicated the professional views of our Medical Staff, their justifiable concerns for their patients, and their efforts to determine a better way to serve their patients. Concurrent with the actions of the Medical Staff, we began planning in the early 1960's with the assistance of nationally known consultants and architects to design a facility appropriate for the extended care patient. This planning cost in excess of $30,000 but did result in a program and detailed plans for appropriate and effective medical care at reduced costs. Our research further indicated that: 1) A survey by the Hospital Advisory Council to the District of Columbia Department of Public Health showed only 26% of needed long-term care beds were available in 1964 and recommended 300 to 400 convalescent rehabilitative beds at the Hosiptal Center. 2) Survey of District of Columbia Medical Society physicians showed doctors overwhelming urged expansion of long term (extended) care beds. 3) 25% of the Hospital Center's patient days were represented by patients who could be better and more economically served in an extended or after-care facility. 4) Professional activity study of patients 65 years and older in 100 U.S. short term general hospitals showed a 21% rise in bed use by our elderly, Medicare patients (this trend will continue). In August of 1967, our studies showed that for the first six months of that year we could have, with the right kind of facility, provided "extended care" for over 2000 of these patients at considerably reduced costs for the over 32,000 days they required in our hospital. This situation is costly to the patient, the community, and the taxpayer. Further it is an inefficient system for providing needed health care and should be improved. Our proposal is simply to preserve crucial, highly trained medical manpower and avoid duplication of facilities by extending these existing adequate services of our general acute hospital to our planned convalescent-rehabilitative care facility. By this I mean the whole range of supportive services, i.e. dietary, housekeeping, engineering, computerized accounting and reporting, medical records, purchasing, laboratory, X-ray, and so on-to name but a few. By doing this we are able to provide a very real savings to the patient and the community. We expect these savings-consistent |