CONTENTS PUBLIC WITNESSES Bethel Deaconess Hospital, Marvin E. Ewert, administrator__ Chaney, Dr. E. J., Belleville, Kans. Davidson, Ernest, Iola, Kans___ Davis, Alfred, student, University of Kansas__. Erickson, Curtis C., executive director, Great Plains Lutheran Hospitals, Ewert, Marvin E., administrator, Bethel Deaconess Hospital_ Great Plains Lutheran Hospitals, Inc., Phillipsburg, Kans., Curtis C. Erickson, executive director___ Harris, Dr. Larry, O.D__- Health Planning Association of Western Kansas, Randy Hempling_ Metzler, Dwight, secretary, Kansas Department of Health and Environment Newman, Wm. A.. Reed, D. Cramer, M.D., University of Kansas School of Medicine.... Stone, Dave, University of Kansas__ Taylor, Dr. Tom, Salinas, Kans_. Walsh, Dr. Richard, dean, Kansas University Medical School.. Wiersma, Mary J., director, Rural Health Department, Kansas Farm Wilson, Dr. Jim, director of health, State of Kansas__. 5 COMMUNICATIONS Gentry, Frank L., president, Kansas Hospital Association_. 111 Harvey, Elaine B., R.N., Ed. D., dean, School of Nursing, Fort Hays State 106 Simonich, Dean, executive director, Health Systems Agency of Southeast 110 Thompson, Ron, administrator, Morris County Hospital, Council Grove, 109 ((11) RURAL HEALTH CARE DELIVERY SATURDAY, JANUARY 28, 1978 U.S. SENATE, SUBCOMMITTEE ON HEALTH OF THE COMMITTEE ON FINANCE, Manhattan, Kans. The subcommittee met, pursuant to notice, at the Student Union Building, Kansas State University, Hon. Robert Dole presiding. Present: Senator Dole. Senator DOLE. I first want to say that we are very pleased to be here, and certainly appreciate many of you coming rather long distances on a Saturday, which is not probably your best day, but it does give us an opportunity to discuss what I believe is a very important matter. It's well to point out, first of all, that this is an official hearing of the Subcommittee on Health of the Senate Finance Committee. I am the ranking Republican on that subcommittee, and the chairman is Senator Herman Talmadge of Georgia. I would hope today to obtain some information that might be helpful to all of my colleagues in the Senate, particularly those in the Senate Finance Committee, Health Subcommittee. And I think it might be helpful, just as a matter of information for some who may not be totally familiar with the committee to review the jurisdiction of our subcommittee. The Health Subcommittee of the Finance Committee deals with medicare, medicaid and the maternal and child health program, as well as the various national health insurance proposals. Medicare and medicaid are, of course, the committee's major health programs. While many of the health programs, such as the health manpower, planning and research, are not within the jurisdiction of the Finance Committee, I am nonethless involved and concerned with those areas. After hearing from many of you concerning the proposed planning guidelines, I wrote Secretary Califano and indicated my concern about the guidelines and my belief in the need for an emphasis on local planning and decisionmaking. I think, as many of you know, that HEW has responded with revised planning guidelines, taking into account the needs of rural areas as well as providing for more local control over the planning process. These revised guidelines were published in the Federal Register on Friday, January 20. I think we have a limited number of the revised guidelines which will be available to anybody who would like to look at them and hopefully to comment on them for our benefit. (1) Now, I certainly understand and agree with the need to avoid duplication of facilities and services, particularly in view of the tremendous increases in the costs of health care in this country. I think it's well to emphasize, as often as we can, the costs, because medicare and medicaid alone, for example, will cost more than $47 billion during this fiscal year, which is some $9 billion more than the last fiscal year; and I think we all agree that we have to find some way to reduce health care costs or to face having to reduce benefits but, in working on ways to control costs, I guess it's fair to say we don't want to throw the baby out with the bath water. During 1977 the Committee on Finance held hearings and discussed numerous legislative proposals to improve our medicare and medicaid programs. Two such proposals were enacted into law, the Medicare and Medicaid Anti-Fraud and Abuse Amendments, and legislation designed to assist rural areas by reimbursing clinics staffed by nurse practitioners and physician assistants who worked under the general direction of a physician. A third proposal which has carried over into this session is the medicare and medicaid administrative and reimbursement reform bill, S. 1470. Among other things, this bill would provide an opportunity for efficient hospitals to earn incentive payments above their costs. The bill seeks to encourage cost moderation and to encourage and reward efficiency in providing proper care. This is in contrast to the flat price controls or percentage limitations as is being proposed by President Carter and his administration. There is also a provision in the bill which would encourage small rural hospitals which are located in areas where there is a shortage of long-term care beds to utilize their excess beds for long-term care services. In the past many of you have written me regarding your concern with the increasing number of rules and regulations governing health care. Because of these letters, this past week I joined with the chairman of the Health Subcommittee, and the vice-chairman of the permanent Subcommittee on Investigations in sending a letter to the General Accounting Office requesting a review and evaluation of all the requirements applicable in hospitals, Federal, State, local and voluntary, which deal with the licensure certification, data requests, nonstandard claims forms, health and safety requirements for patients and employees and related matters. And I think this may be very helpful. We would hope that the GAO report would give us some basis either for statutory revision or administrative changes, legislative changes, some way to consolidate the activities and maybe eliminate some of the requirements, and establish procedures that assure that requirements are essential and cost effective. We specifically suggest that they solicit the views of State, local, and voluntary agencies concerned. I guess that's enough comment from me. I didn't ask you here to listen to me this morning, because I want to hear about your problems and concerns regarding rural health care. Now, with me today is my legislative assistant, Ms. Sheila Burke, a R.N. by training, and John Kern from the staff of the Finance Committee, who also happens to be a trained hospital administrator. |