MR. CHAIRMAN, Members of the Subcommittee, my name is Philip Adler, D.0., President of the American Osteopathic Association. With me is Mr. John P. Perrin who is Director of the Washington Office of AOA. We are most pleased to have the opportunity to present our views on the Health Planning and Resources Amendments of 1978. The American Osteopathic Association has had the privilege of appearing before this subcommittee on many occasions, but never have we come to address an issue of as great importance to the osteopathic profession, its patients and institutions as that which we shall address first in our statement, today. That issue is need certification for osteopathic services and facilities. At the time the National Health Planning and Resources Development Act of 1974 was under consideration, we were satisfied that the minimum criteria required to be developed in state certificate-of-need programs would surely include an affirmative requirement that the need for the expansion or modification of an osteopathic facility would have to be viewed against the need for and availability of such osteopathic services within the health service area. In implementing the certificate-of-need provision of the planning law, the Secretary of HEW failed to include this as a specific requirement in the final regulations. In the preamble to those regulations, the Secretary acknowledged the "pervasive concern" for such a provision and stated that "because of his concern about discrimination against populations who wish to be served by osteopathic services and facilities in their communities, strongly encourages state agencies and HSAs to incorporate consideration of the needs of the population being served by such services into their health plans." We were appreciative of the Secretary's cognizance of the issue, and his articulated sensitivity for the needs of populations groups being served by osteopathic services and facilities. However, the failure to require positive assurance that osteopathic facilities' and services' requests for certificates-of-need will be reviewed in light of -2 osteopathic demand for such services, exposes the profession and its patients to the unacceptable risk that local planning bodies may not be as sensitive as the Secretary to insuring access to adequate osteopathic services and facilities by its patients. Such lack of sensitivity (or outright discrimination) has already manifested itself in a number of instances through the decisions of local HSAS with respect to application for certificate-of-need by osteopathic facilities. Some of those occurrences have been documented for you by our hospital association, in their testimony. We would also note that we have had indications from several states that the absence of a specific requirement for seperate consideration of osteopathic facilities has been construed by state health authorities as prohibiting such a provision in their state program. This very unfortunate interpretation is currently being advanced in Florida, where the State Department of Health is seeking the removal of the existing separate consideration provision, from the state code, for "nonconformity with the federal law and regulations." Where insensitivity to the needs of our patients exists, it negates the freedom of choice of the patient and fails in the essential objective of the planning law to institute a program of comprehensive and sound health planning, assuring access to quality care at reasonable costs, in response to actual health care requirements. It is our sincere belief that this objective cannot be accomplished without taking into consideration the present structure of the health care delivery system which includes osteopathic and allopathic physicians practicing in osteopathic and allopathic institutions, in response to patient desire or demand for such services. D.O.s The osteopathic profession is a politically and philosophically separate and educationally independent school of medicine. comprise 5 percent of the physician population but care for 10 percent of the population or about 20 million patients. In order to guarantee -3 the osteopathic patient his right to select the provider of his choice, he must have the choice of treatment facility. The American Osteopathic Association recognizes and concurs with the philosophy of the certificate-of-need legislation to regulate the growth of hospitals as a means of controlling health care costs. We further agree with the existing criteria applied in making need certification decisions. What we are asking is that such criteria be applied separately to osteopathic facilities and services. To accomplish that end we respectfully request that Section 1532 (c) (3) of PL 93-641 be amended to read "The need that the population served or to be served has for such services; the need to construct, expand or modify an osteopathic facility shall be determined on the need and availability in the community for osteopathic services and facilities." The AOA has consistently supported sound health planning programs. Our request for the suggested amendment to the certificate-of-need provision is wholly consistent with the congressional intent of the planning legislation to insure the availability of all necessary quality care. Failure to address this issue can only serve to create new problems in the system of health care delivery. Our remaining concerns, in the planning structure and process, under the law as now written, relate to the composition of the HSA Boards. In order to insure that health planning decisions are predicated on the best possible information, drawn, at least in part, from the practical medical expertise within the HSA region, we believe that some modification of the provider representation provisions needs to be made. Specifically, we recommend the following amendments, with respect to provider participation in the health planning process: 1. Amend Section 1503 (b) (1) To require at least one physician representative, selected from active practice, as a member of the National Council. 25-122 O 78 pt. 2 10 -4 2. Amend Section 1512 (b) (3) (C) (2) So as to (a) require inclusion of at least one representative from a hospital, or hospitals, located in the area; and (b) require inclusion of at least one physician engaged in active practice in the area. 3. Amend Section 1524 (b) (1) (C) So as to (a) Require that at least three-fourths of provider members be direct providers, and (b) include at least one representative from each of the provider categories enumerated in Sec. 1512 (b) (3) (C) (11). We believe that the foregoing changes will upgrade the provider input to health planning decisions, without dominating them. We respectfully request that you give them favorable consideration. We thank you for the opportunity to present our views on these very important issues. American Psychiatric Association 1700 Eighteenth Street, N.W., Washington, D.C. 20009 Telephone: (202) 232-7884 Joint Commission on Government Relations Robert J. Campbell. III, MD. Chairperson Francis de Marneffe, M.D. Lewis Kurke, M.D. John J. McGrath, M.D. James L. Cavanaugh, Jr., M.D. Hayden H. Donahue, M.D. Harold E. Mann, MD. Frederick A. Lewis, Jr., M.D. Robert W Gibson, MD. Shervert H. Frazier, M.D. Liaison with Joint Commission on Public Affairs Division of Government Relations Jay B Cutler, J.D. Special Counsel & Director Theodora Fine Szabo, M.A. Assistant Director Edmund J. Perret, II, M.A. March 2, 1978 The Honorable Edward M. Kennedy Subcommittee on Health & Scientific Research Senate Human Resources Committee Washington, D.C. 20510 Dear Senator Kennedy: Enclosed for the consideration of the Subcommittee on Health and Scientific Research is the prepared statement (including proposed amendments) of the American Psychiatric Association with respect to the Subcommittee's deliberations on S. 2410, reauthorizing the National Health Planning and Resources Development Act of 1974. We commend you and your staff for recognizing the need to integrate mental health planning activities with HSA and State-wide health planning activities, and for developing amendments to accomplish such a goal. The amendments appended to the statement were developed by the Task Force on Planning of the Liaison Group for Mental Health in response to the request by Subcommittee staff. It would be appreciated if the statement and attachment could be made part of the hearing record. |