CONTENTS Department of Health and Human Services, Health Care Financing Adminis- tration, Carolyne K. Davis, Ph. D., Administrator; Robert Streimer, Acting Director, Office of Coverage Policy, Bureau of Program Policy; and Martin Kappert, Deputy Associate Administrator for Operations....... Bland, Calvin, St. Christopher's Hospital for Children in Philadelphia Freeman, Richard M., M.D., National Kidney Foundation and University Hospital Department of Medicine, Iowa City, Iowa...... Green, Robert L., Community Psychiatric Centers, San Francisco, Calif.. National Association of Children's Hospitals and Related Institutions, Inc., Northern California Hospital Dialysis Providers, Robert Fortner, M.D., and Thompson, Ann, M.D., American Hospital Association Travenol Laboratories, Inc., G. Marshall Abbey, Karl D. Nolph, M.D., and SUBMISSIONS FOR THE RECORD General Accounting Office, statement.......... American Association of Nephrology Nurses and Technicians, statement Arizona, University of, David A. Ogden, M.D., letter. Association of American Medical Colleges, John A. D. Cooper, M.D., letter Axelrod, David, M.D., New York State Department of Health, letter Page 279 289 291 293 294 264 422 Beth Israel Hospital, Harvard Medical School, David Dolins, letter and Robert 300 Brown, Robert S., M.D., Beth Israel Hospital, Harvard Medical School, letter... 301 306 Clark, James E., M.D., Clinical Renal Associates, Ltd., letter. 386 386 Cooper, John A. D., M.D., Association of American Medical Colleges, letter 294 383 307 Dialysis Foundation of Southern Arizona, Inc., Andrew D. Guy, letter and attachments.... 314 Dolins, David, Beth Israel Hospital, Harvard Medical School, letter. 300 379 Forum of ESRD Networks, Dominic E. Gentile, M.D., letter and attachments .. 322 322 307 Guy, Andrew D., Dialysis Foundation of Southern Arizona, Inc., letter and attachments.. 314 Hamilton, Jacqueline, Kenner, Louisiana, letter 370 Haygood, Thomas A., M.D., Northern Colorado Kidney Center, letter. 438 371 Hospital Association of New York State, statement.. 375 Iowa Hospital Association, Donald W. Dunn, letter 379 Kidney Center of Chester County, Ltd., Hardy L. Sorkin, M.D., letter. 385 Kidney Center of Delaware County, Ltd., A. Leo Coyle, letter 383 King, Sheldon S., Stanford University Hospital, letter 445 Kingsport Dialysis Center for High Blood Pressure and Kidney Diseases, 388 Krivit, William, M.D., University of Minnesota, letter 399 Lewis, Jacob R., Jr., Michael Reese Hospital and Medical Center, letter and attachments... 391 Luetzelschwab, Earl F., Touro Infirmary, letter... 447 Mauer, S. Michael, M.D., University of Minnesota, letter. 399 399 Michael Reese Hospital and Medical Center, Jacob R. Lewis, Jr., letter and attachments..... 391 Minnesota, University of, William Krivit, M.D., S. Michael Mauer, M.D., Alfred F. Michael, M.D., John S. Najarian, M.D, Robert L. Vernier, M.D., joint letter. 399 Moncrief, Jack W., M.D., Austin Diagnostic Clinic, statement. 264 Moukheibir, Nabil, M.D., Kingsport Dialysis Center for High Blood Pressure and Kidney Diseases, statement... 388 Najarian, John S., M.D., University of Minnesota, letter. 399 New York, State of, Department of Health, David Axelrod, M.D., letter. 422 306 Nolph, Karl D., Austin Diagnostic Clinic, statement.. 264 Northern Colorado Kidney Center, Thomas A. Haygood, M.D., letter. 424 Ochsner Clinic, Frank A. Riddick, Jr., M.D., letter and attachment.. 442 293 Popovich, Robert P., Austin Diagnostic Clinic, statement. 264 Pyle, W. Keith, Austin Diagnostic Clinic, statement.... 264 Riddick, Frank A., Jr., M.D., Ochsner Clinic, letter and attachment.. 442 371 Sorkin, Hardy L., M.D., Kidney Center of Chester County, Ltd., letter.. 385 Stanford University Hospital, Sheldon S. King, letter Touro Infirmary, Earl F. Luetzelschwab, letter.... Turner, William M., M.D., Anderson, S.C., letter and attachment. Vernier, Robert L., M.D., University of Minnesota, letter.. Page 445 447 451 399 The subcommittee met at 10:10 a.m., pursuant to notice, in room B-318, Rayburn House Office Building, Hon. Charles Rangel (chairman of the subcommittee) presiding. [The press release follows:] [Press Release of Thursday, Apr. 8, 1982] HON. CHARLES B. RANGEL, DEMOCRAT OF NEW YORK, CHAIRMAN, SUBCOMMITTEE ON OVERSIGHT, COMMITTEE ON WAYS AND MEANS, U.S. HOUSE OF REPRESENTATIVES, ANNOUNCES A HEARING ON THE PROPOSED REGULATIONS GOVERNING REIMBURSEMENT UNDER THE MEDICARE END-STAGE RENAL DISEASE PROGRAM The Honorable Charles B. Rangel, Chairman of the Ways and Means Committee's Subcommittee on Oversight, announced today that the Subcommittee will hold a hearing on the proposed end-stage renal disease regulations which have been the subject of intensive scrutiny by both the Oversight and Health Subcommittees. The hearing will be held on April 22, 1982, in Room 1100 Longworth House Office Building, beginning at 10 a.m. Under legislation enacted in 1978 and subsequently amended in 1981, the Secretary of Health and Human Services is required to develop and implement an incentive reimbursement system to assure the cost-effective delivery of renal dialysis services and to encourage use of home dialysis by suitable candidates. The statute requires the Secretary to establish prospectively determined rates on the basis of composite weighted formulas for hospital-based and for independent facilities that take into account the proportions of patients dialyzing in facilities and at home, as well as the relative costs of providing services in each setting. On February 12, 1982, the proposed regulations setting forth the new payment system and rate-setting methodologies were issued. However, these proposed regulations have become the subject of widespread controversy and criticism; serious questions have been raised about their objectivity, equity and potential effect on the continuing stability of the program. In announcing the hearing, Chairman Rangel indicated that there is considerable Congressional concern as well. "We do not believe," he said, "that such widespread concern should be taken lightly. The reservations raised about the objectivity of the rate-setting methodology, the adequacy of the data base, the absence of a reasonable transition period and exception process, and several other provisions warrant serious and thorough reevaluation of the regulations.' Due to time restrictions, the hearing will be limited to testimony from the Administration and invited witnesses representing providers of renal dialysis and transplant services, administrators of facilities, physicians and patients. The Subcommittee will also be receiving a detailed report from the Secretary on the voluminous correspondence received by the Department during the prescribed comment period. Nonetheless, the Subcommittee welcomes written statements for inclusion in the (1) |