Copyright 1999 Federal Document Clearing House, Inc.
Federal Document Clearing House Congressional Testimony
March 17, 1999, Wednesday
SECTION: CAPITOL HILL HEARING TESTIMONY
LENGTH: 5418 words
HEADLINE:
TESTIMONY March 17, 1999 NANCY-ANN DEPARLE ADMINISTRATOR HEALTH CARE FINANCING
ADMINISTRATION SENATE FINANCE MEDICARE & CHOICE &
MEDICARE FEE - FOR - SERVICE
BODY:
TESTIMONY OF
NANCY-ANN DEPARLE, ADMINISTRATOR HEALTH CARE FINANCING ADMINISTRATION on
MEDICARE PAYMENT REFORMS before the SENATE FINANCE COMMITTEE March 17, 1999
Chairman Roth, Senator Moynihan, distinguished Committee Members, thank you for
inviting me to discuss the Health Care Financing Administration's (HCFA)
progress in implementing Medicare payment reforms enacted under the Balanced
Budget Act of 1997 (BBA). I would like to also thank the Medicare Payment
Advisory Commission for its advice for ensuring that Medicare continues to make
appropriate payments and protects beneficiary access to care. Medicare is the
nation's largest insurer, covering some 38 million of our nation's elderly and
disabled. Medicare processes about 900 million fee-for-service claims each year,
is the nation's largest purchaser of managed care, and accounts for 11 percent
of the federal budget. We have implemented more than half of the 335 BBA
provisions affecting HCFA programs, and many more are partially implemented. In
the past year, we published 92 regulations and Federal Register notices
implementing important Congressional directives, beneficiary protections, the
Medicare+Choice program, and savings in the BRA that are critical to extending
the life of the Medicare Trust Fund. We have made major strides in fighting
fraud, waste and abuse, and cut our payment error rate in half in just two
years. We also have converted the vast majority of Medicare HMOs to the new
Medicare+Choice program and implemented a carefully planned National Medicare
Education Program to help beneficiaries make informed health care decisions. At
the same time, we are tackling one of the most difficult Year 2000 computer
challenges in government. This must be our highest priority. Unfortunately,
meeting the Year 2000 challenge has forced us to make difficult decisions
involving some BBA provisions. The vast majority of BBA provisions do not have
to be delayed. However, on the advice of independent computer experts, we made
the difficult decision last year to delay projects that could interfere with
Year 2000 work. This Included BBA provision as the hospital outpatient
prospective payment system that we very much want to implement. We will make
every effort to implement these provisions as quickly as our Year 2000
obligation allows. I have brought a new team of leaders to HCFA to help us meet
our BBA and Year 2000 challenges. - Gary Christoph, Ph.D., a computer scientist
and security expert from the Los Alamos National Laboratory, serves as our
first-ever Chief Information officer and heads our information technology team
and Year 2000 efforts. - Robert Berenson, MD, an internist who helped establish
a private sector preferred provider organization health plan, now leads our
Center for Health Plans and Providers. - Jeffrey Kang, MD, a geriatrician who
was a private sector managed care plan medical director, is our Chief Clinical
Officer and heads our Office of Clinical Standards and Quality. - Carol Cronin,
Ph.D., a gerontologist who ran a private sector firm devoted to helping
corporations educate their workers on health care, is leading our Medicare
beneficiary education program. - Marjorie Kanof, MD, a physician who has worked
as a Medicare contractor medical director, is in charge of implementing much
stronger oversight of Medicare claims processing contractors. FEE-FOR-SERVICE
BENEFITS AND PAYMENT REFORMS The BBA includes important new Medicare
fee-for-service preventive benefits, as well as payment system reforms that are
critical to extending the solvency of the Medicare Trust Fund. We are making
good progress in implementing these changes. For the new preventive benefits, we
have: - expanded coverage for test strips and education programs to help
diabetics control their disease; - begun covering bone density measurement for
beneficiaries at risk of osteoporosisl - begun covering several colorectal
cancer screening tests; - expanded preventive benefits for women so Medicare now
covers a screening pap smear, pelvic exam and clinical breast exam every three
years for most women, and every year for women at high risk for cervical or
vaginal cancer; and, - begun covering annual screening mammograms for all women
age 40 and over, and a onetime initial, or baseline, mammogram for women ages
35-39, paying for these tests whether or not beneficiaries have met their annual
deductibles. We have made solid progress in implementing fee-for-service payment
reforms. For example, we have: - modified inpatient hospital payment rules; -
established a prospective payment system for skilled nursing facilities to
encourage facilities to provide care that is both efficient and appropriate; -
refined the physician payment system, as called for in the BBA, to more
accurately reflect practice expenses for primary and specialty care physicians;
and - initiated the development of prospective payment systems for home health
agencies, outpatient hospital care, and rehabilitation hospitals that will be
implemented once the Year 2000 computer challenge has been addressed; and, -
begun implementing an important test of whether market forces can help Medicare
and its beneficiaries save money on durable medical equipment. We are prepared
to begin a test in Polk County, Florida of competitive bidding as a way to get
the best quality and price for durable medical equipment and supplies.
Atoll-free hotline(888-289-0710)is available to answer beneficiary and provider
questions about the project. Inpatient Hospital Payment We have implemented 74
percent of the inpatient hospital-related changes included in the BBA in updated
regulations. These include substantial refinements to hospital Graduate
Medical Education payments and policy to encourage training of primary
care physicians, promote training in ambulatory and managed care where
beneficiaries are receiving more and more services, curtail increases in the
number of residents, and slow the rate of increase in spending. We also froze
inpatient hospital payments in fiscal year 1998, as required under the BBA,
resulting in substantial savings to taxpayers and the Medicare Trust Fund. We
notified Congress last year that we may need to postpone the payment update
scheduled for October 1999 because of the Year 2000 challenge. However, if we
sustain our current rate of progress in meeting that challenge, we may be able
to implement the October 1999 update on schedule. Physicians As directed by
the-BBA, we have taken concrete action to refine and implement the resource
based system for practice expenses under the physician fee schedule. We
published the final regulation in November 1998, and began implementing the new
system in January 1999, with a transition to full implementation by 2002. We
were required by the BBA to implement the new system in a budget-neutral
fashion. This will inevitably cause some physicians to see payment increases
while others see decreases. The methodology we used addresses many of the
concerns raised by physicians and meets the BBA requirements. We used the
American Medical Association's actual cost data to reflect all of a specialty's
practice expenses, not just those linked with specific procedures. Our expert
accounting contractor, KPMG Peat Marwick, attests that our methodology followed
reasonable cost accounting principles. The General Accounting Office also is
largely supportive of our methodology. We fully expect to update and refine the
practice expense relative value units in our annual regulations revising the
Medicare fee schedule. We welcome and encourage the ongoing contributions of the
medical community to this process, and we will continue to monitor beneficiary
access to care and utilization of services as the new system is fully
implemented. The Balanced Budget Act also requires that we implement a
resource-based system for malpractice relative value units. We currently are in
the process of developing the system and plan to include it in this year's
proposed rule. We notified Congress last year that, in order to ensure that all
Year 2000 work is done correctly we may need to freeze our computer systems
bring a critical period of Y2K work, and would therefore have to delay the
January 1, 2000, physician updates. We will know more about whether we may be
able to do these updates on schedule after we have reached the government's
March 31, 1999, Year 2000 compliance deadline. We share physicians' concern
about these possible delays, and we want to work with physicians and Congress to
evaluate our options and ensure that any necessary delays do not create a
hardship and that any interim measures fairly reimburse physicians. Skilled
Nursing Facilities We have made substantial progress in implementing the new
skilled nursing facility prospective payment system. The old payment system was
based on actual costs. The new system uses mean-based prices adjusted for each
patient's clinical condition and care needs, as well as geographic variation in
wages. It creates incentives to provide care more efficiently by relating
payments to patient need, and enables Medicare to be a more prudent purchaser of
these services. The BBA mandated the implementation of a per them prospective
payment system for skilled nursing facilities covering all routine, ancillary,
and capital costs related to covered services provided to beneficiaries under
Medicare Part A. In accordance with the BBA, we implemented the new payment
system July 1, 1998. We fully understand the concerns raised by providers about
this new system, particularly those related to outlier and non-therapy ancillary
services. The new payment system is complex, and we are working with providers
to address these concerns. We know that this is not a static system and that it
will require ongoing refinements. We strongly believe the Resource Utilization
Groups (RUGs), which are a key component of the system, must be periodically
evaluated to ensure they appropriately reflect changes in care practice and the
Medicare population. We are working closely with an expert research contractor
to examine potential refinements to the RUGs model, particularly those
associated with medically complex patients and non-therapy ancillary services,
such as medications. We expect to have the results of this research by January
1, 2000, and to be able to make refinements shortly thereafter. In addition to
this research effort, we plan to host a Town Hall meeting next month with
interested industry and consumer stakeholders to seek their first-hand advice on
refining the current RUGs model. We will take the suggestions of the industry
and the results of our contractor's research into consideration as we make
necessary refinements. I want to assure beneficiaries, providers, and Congress
that we appreciate the importance of this task and are committed to fairness and
ensuring continued access to care. Home Health The BBA mandated a number of
changes in the way Medicare pays for home health services to curtail
unsustainable spending growth and fight what was widespread fraud, waste, and
abuse. These changes are vitally important and have been a long-standing
priority for HCFA and this Administration. Medicare spending on home health more
than tripled in the 1990s, while the number of beneficiaries receiving home
health services doubled. The new payment systems create incentives to provide
home health care efficiently as well as control spending growth. Congress wisely
postponed the final implementation date for the home health prospective payment
system because of our need to address the Year 2000 computer problem. We are
working hard to develop the prospective payment system and believe that we are
on track to meet the October 1, 2000 implementation deadline. This October, we
expect to publish a proposed regulation for the prospective payment system so we
can begin receiving and evaluating public comments. We anticipate that the final
rule will be issued in July 2000. We know some providers continue to have
concerns about the home health interim payment system. Last year, Congress made
important changes to the interim system to address some of these concerns.
However, given the magnitude of the changes in home health payment, it is
understandable that other concerns remain. We are committed to working with
providers and Congress to ensure fairness and protect access to appropriate home
care services covered by Medicare as we proceed toward prospective payment . We
are monitoring the impact of these changes on beneficiary access to care and,
thus far, do not have evidence on whether access to care has been compromised.
Hospital Outpatient Departments The Balanced Budget Act empowers us to move away
from charge- based hospital outpatient coinsurance, which has long been a
priority for the Clinton Administration. The increased costs the current system
imposes on beneficiaries are unfair. Regrettably, implementation of the
prospective payment system as originally scheduled would have required numerous
complex systems changes that could substantially jeopardize our Year 2000
efforts. Therefore, we have postponed implementation and are working to
implement this system as quickly as the Year 2000 challenge allows. In the
meantime, we are willing to work with the Congress to see if an alternative
solution can be developed that might more quickly move us toward our shared goal
of reducing beneficiaries' out-of-pocket costs for these services. We issued a
Notice of Proposed Rule Making in September 1998 outlining plans for the new
system so that hospitals and others can begin providing comments and
suggestions. We are making data files available to the industry, and we have
extended the comment period until June 30, 1999 so the industry and other
interested parties will have sufficient time and information to comment. We have
also implemented a BBA provision that eliminates an anomaly in the law, known as
the formula-driven overpayment, which caused taxpayers to pay too much for
certain surgical, radiological, and other hospital outpatient services. We
implemented this change just two months after the BBA was enacted.
Rehabilitation Hospitals We are in the process of developing a prospective
payment system for rehabilitation hospitals as required under the BBA. We have
contracted with Muse and Associates, Dr. Brant Fries at the University of
Michigan, and Dr. John Morris at Hebrew University to conduct research and aid
in development of a case mix classification system for rehabilitation hospitals.
This new system is scheduled for implementation over a two year period beginning
October 1, 2000. We are currently analyzing the positive and negative aspects of
both a per-episode and a per- diem payment system based on a comprehensive
assessment of each patient's condition and resource requirements. We have not
ruled out either approach at this time. Our primary concern is to ensure that
the system we adopt allows our beneficiaries to get the care they need and
treats providers fairly. We appreciate the technical suggestions we have
received from the industry in this regard, as well as the evaluation and advice
provided by the Medicare Payment Advisory Commission and the General Accounting
Office, and we will continue to work closely with them and Congress as this
system is developed and implemented. MEDICARE+CHOICE Medicare+Choice allows
private plans to offer beneficiaries a wide range of options, similar to those
available in the private sector. Medicare+Choice and other changes enacted in
the BBA require a massive and important new beneficiary education campaign.
Medicare+Choice includes important new protections for patients and providers,
as well as quality assessment and improvement requirements. And it initiates a
fairer and more accurate payment system. We are very committed to successful
implementation of Medicare+Choice. We believe that managed care and other
private plans are important voluntary options next to original Medicare.
Medicare managed care enrollment has nearly tripled under the Clinton
Administration, from 2.3 million when the President took office to 6.8 million
now. We now meet regularly with beneficiary and industry representatives to
discuss ways to improve Medicare+Choice, and have begun making refinements based
on these comments and discussions. We have converted the vast majority of former
Medicare HMOs to the Medicare+Choice program and published all BBA-mandated
Medicare+Choice regulations. Last month we published initial refinements to
these regulations which improve beneficiary protections and access to
information while reducing plans' administrative workload. We launched a
national education campaign and participated in more than 1,000 events around
the country to help beneficiaries understand Medicare+Choice and other important
changes to Medicare. And we are establishing a federal advisory committee to
help us better inform beneficiaries. Beneficiary Education As mentioned above,
we have launched the National Medicare Education Program to make sure
beneficiaries receive accurate and unbiased information about benefits, rights,
and options. The campaign includes; - mailing a Medicare and You handbook to
explain new benefits and health plan options; - a toll-free "1-800-Medicare"
call center with live operators to answer questions and provide additional print
information on request; - a consumer-friendly Internet site, www.Medicare.gov,
which includes comparisons of benefits, costs, quality, and satisfaction ratings
for plans available in each zip code; - an alliance with more than 100 national
aging, consumer, provider, employer, union, and other organizations who help
disseminate Medicare+Choice information to their constituencies; - enhanced
beneficiary counseling from State Health Insurance Assistance Programs; - a
national media publicity campaign; - more than a thousand individual state and
local outreach events around the country in senior centers and town halls, on
radio call-in shows and other venues, and in languages ranging from Vietnamese
to Creole; and, - a comprehensive assessment of these efforts. In 1998, we
tested the whole system in five states -- Arizona, Florida, Ohio, Oregon and
Washington. Unfortunately, the decisions by some plans to withdraw from the
program or reduce their service area significantly complicated our task. We
learned a great deal in this "dry run," and focus groups indicated that a
majority of beneficiaries found the information in the Medicare & You
handbook to be informative and useful. We are also conducting cases studies to
evaluate the education campaign in five communities in the five pilot States and
one community outside the pilot States. Preliminary results from our assessment
efforts are already suggesting ways to make Medicare & You easier to use,
and links we can add to help users find key information faster on our website.
These and other findings will help us to refine efforts for a full-scale,
national campaign before the November 1999 open enrollment period. As mentioned
above, we are establishing the Citizens Advisory Panel on Medicare Education, in
accordance with the Federal Advisory Committee Act, as a formal mechanism to
obtain public input for improving our education efforts. The Panel will meet
quarterly to help: - enhance our effectiveness in informing beneficiaries; -
expand outreach to vulnerable and underserved communities; and - assemble an
information base of "best practices" for helping beneficiaries evaluate plan
options and strengthening a community infrastructure for information and
counseling. Panel members will include representatives from the general public,
older Americans, specific diseases and disabilities, minority communities, plans
and insurers, providers, and other groups. We are also working to standardize
plan marketing materials that summarize benefits so beneficiaries can make
apples-to-apples comparisons. Our goal is to complete this work before the first
annual coordinated open enrollment period in November 1999. Reaching Out to
Plans We have taken several steps to encourage health plan participation in
Medicare+Choice. In addition to converting the vast majority of Medicare HMOs to
the new program, we have added 12 new plans and expanded service areas for
another 11 plans since last November, including the first provider sponsored
organization with a Federal waiver from State licensure requirements. We are
reviewing 24 new plan applications and 18 service area expansion applications.
Last summer we held outreach sessions attended by more than 1,500 plan
representatives, and we continue to strengthen lines of communication with
plans. We have named a senior official within HCFA, Tom Gustafson, whom plans
can call directly if they have trouble resolving issues through normal HCFA
channels. As mentioned above, last month we published initial refinements to the
Medicare+Choice regulation. The new rule: - clarifies that beneficiaries
enrolled in an M+C plan that withdraws or is terminated from Medicare are
entitled to enroll in other remaining locally available M+C plans; - specifies
that changes in plan rules must be made by October 15 to ensure beneficiaries
can make informed choices during the November annual open enrollment period; -
waives the requirement for an initial health assessment within 90 days of
enrollment for enrollees who stay in the same plan when they age into Medicare
and for enrollees who switch plans but remain under the care of the same primary
care provider; - allows plans to choose the form of the initial health
assessment; - allows coordination of care to be performed by a range of
qualified professionals; - limits the applicability of provider participation
requirements to physicians; and - aligns requirements for terminating
specialists with the process for other providers. We intend to publish a
comprehensive final rule with further refinements this fall. To further
facilitate plans participation, the President's budget includes a proposal to
give plans two additional months to file the information used to approve benefit
and premium structures. This "Adjusted Community Rate" data would not be due
until July 1, rather than May 1. July 1 is the latest we can accept, process,
and approve premium and benefit package data, have the data validated, and still
mail beneficiaries plan information in time for the November open enrollment
period. Given legislative schedules and the need to act immediately, we informed
plans that the required filing date this year will be July 1. We look forward to
working with you to enact legislation necessary to support this change that is
so important to Medicare+Choice success. Payment Reform The BBA requires
Medicare to "risk adjust" Medicare+Choice payments starting January 1, 2000.
That means we must base payment to plans on the health status of individual plan
enrollees. Data on individual beneficiary use of health care services in a given
year will be used to adjust payment for each beneficiary in a Medicare+Choice
plan the following year. Risk adjustment represents a vast improvement over
current payment methodology. It helps assure more appropriate payments and
curtails the disincentive in the current payment system for plans to enroll
sicker beneficiaries. Risk adjustment will help beneficiaries feel more
confident in their Medicare+Choice options. It assures beneficiaries that
Medicare pays plans the right amount to provide all necessary care because
payments take each enrollee's health status into account. That will help people
with serious illnesses, such as cancer or cardiovascular disease, who can
benefit most from the coordination of care health plans can provide. Risk
adjustment will help taxpayers by addressing the main reason Medicare has lost
rather than saved money on managed care. Many studies show that health plans
enroll beneficiaries who, on average, are much healthier and less costly than
those who remain in traditional Medicare. Risk adjustment will also help level
the playing field among Medicare+Choice plans. It tempers the risk of
significant financial loss when plans enroll beneficiaries who have expensive
care needs. And it focuses competition more on managing care than on avoiding
risk. It also will help plans by alleviating concerns among beneficiaries that
plans have financial incentives to deny care. The law requires us to proceed
with risk adjustment starting January 1, 2000, and does not specifically call
for a transition. However, we believe we must implement these changes in an
incremental and prudent fashion, and are, therefore phasing in risk adjustment
over five years to prevent disruptions to beneficiaries or the Medicare+Choice
program. It is essential to stress that risk adjustment will not and cannot be
budget neutral. Risk adjustment was required in the BBA because of substantial
evidence that Medicare has historically overpaid plans because managed care
enrollees tend to be healthier than beneficiaries who remain in fee-for-service
Medicare. If risk adjustment were budget neutral, Medicare and the taxpayers who
fund it would continue to lose billions of dollars each year on Medicare+Choice.
Budget neutral risk adjustment would cost taxpayers an estimated $200 million in
the first year of the phase-in, and $11.2 billion over five years if health
plans maintained their current, more healthy mix of beneficiaries. Actual
savings to taxpayers will depend on the extent to which less healthy
beneficiaries enroll in plans. Total payment may be higher for some plans than
it would be under the current system if their enrollment becomes more
representative of the entire Medicare population. Overall, we project plan
payment to change on average by less than I percent the first year. The phase-in
substantially buffers the impact. The federal government is forgoing an
estimated $1.4 billion in savings in the first year and as much as $4.5 billion
over the full five years because of the phase in. Impact on plans will be
further buffered by an annual payment update for 2000 of 5 percent, and by
blended payment rates that we estimate will be paid to 63 percent of counties in
2000 and in many cases will be greater than 5 percent. Competitive Pricing
Demonstration We will soon begin a test of competitive pricing for managed care,
as called for in the BBA. This test will provide objective data and actual
experience that is needed to evaluate Medicare reform proposals that assume
savings from competition among plans. Managed care plans will compete to offer
benefits at the most reasonable cost. A bidding process, similar to what most
employers and unions use to decide how much to pay plans, will be used to set
Medicare+Choice rates. To ensure broad community involvement, a Medicare
Competitive Pricing Advisory Committee, chaired by General Motors Health Care
Initiative Executive Director James Cubbin, has made I recommendations regarding
key design features. It also has selected the markets of Phoenix, Arizona and
Kansas City, Kansas and Missouri, as initial demonstration sites. We are
establishing local advisory committees in these communities, and they will hold
public meetings to ensure that local beneficiaries have a voice in how the test
program will operate. Ensuring Quality The BBA raises the quality bar by
requiring most plans to monitor and improve quality so beneficiaries can compare
plans based on quality and we can use Medicare's substantial market leverage to
be a prudent purchaser. We are working to incorporate quality assessment and
improvement into original Medicare, as well. And we are committed to making
measurable quality improvements throughout the Medicare program as part of our
Government Performance and Review Act objectives for fiscal 2000. All
Medicare+Choice plans must report objective, standardized measurements of how
well they provide care and services. They have been using HEDIS, the Health Plan
Employer Data and Information Set, for reporting purposes since 1997. We also
are using CAHPS, the Consumer Assessment of Health Plans Study, to objectively
measure beneficiary satisfaction. We began requiring Medicare HMOs to conduct
CAHPS surveys last year. This fall, we will conduct a CAHPS survey of
beneficiaries who disenroll from plans, asking about the beneficiary's
experience and why they left their plan, to give beneficiaries the perspectives
of both those who left and those who stayed. And next year we will conduct a
fee-for-service survey to provide beneficiaries with data on all options. HEDIS
and CAHPS results are being formatted so beneficiaries can make direct,
apples-to-apples comparisons among their plan options, and are posted on our
Website at www.Medicare.gov. Beneficiaries may also request HEDIS and CAHPS
information through our 1-800-Medicare call center, and we will include this
information in the 2000 edition of Medicare & You. We recognize that it
takes time for plans to adapt to the quality improvement requirements, and that
a learning curve is involved. Therefore, we made several changes from our draft
proposal to help plans comply. For example, we are: - requiring plans to conduct
two performance improvement projects per year, which is comparable to standards
of private sector accrediting organizations; - giving plans three years to
achieve demonstrable quality improvements; and, - giving plans discretion as to
where they conduct site visits for provider credentialing. Appropriate
flexibility will be provided so plans with networks that are less structured
than traditional HMOs, such as PPOs, can meet these requirements. Our quality
improvement systems will be sensitive to different plan structures and their
different abilities to affect provider behavior. We are extremely impressed with
the quality improvement project outlines submitted by plans. Most are very
thorough and thoughtful. Many include detailed benchmarks and timetables. They
make clear that plans are very capable of achieving what Congress envisioned in
the BBA. Market Volatility As you know, some Medicare HMOs did not convert to
the Medicare+Choice program, and others reduced their service areas last year.
While we are concerned about the impact on beneficiaries who were left with no
other managed care options, it is important to put those business decisions in
context. Some of the plans that withdrew had market positions or internal
management issues that made it hard for them to compete. And they faced rising
prescription drug prices and other commercial pressures. Many of the disrupted
beneficiaries had several other plans to choose from, and all but 50,000 had at
least one other plan option. It is our understanding that the Federal Employees
Health Benefits Program experienced a similar rate of plan pullouts, often
affecting the very same counties. The vast majority of Medicare HMOs converted
to Medicare+Choice, and we have approved several new plan and service area
expansions. This suggests that plan withdrawal decisions have more to do with
internal plan and larger marketplace issues than with Medicare rates or
regulations. In fact, a certain amount of market volatility must be expected
when relying on the private sector. To buffer against such market volatility,
the President's budget includes proposals to protect beneficiaries from such
disruption by broadening access to supplemental Medigap, polices if
beneficiaries lose their plan option and allowing enrollees with end stage renal
disease to move to another plan. We also provided for earlier notification of
plan withdrawals in our recent refinement to Medicare+Choice regulations.
CONCLUSION We are making substantial progress in implementing the many Medicare
changes in the BBA. They expand options and improve services to our
beneficiaries, create better payment systems, and extend the life of the
Medicare Trust Fund. Clearly, more work remains. We are committed to continuing
to work to ensure that we are fair and prudent as we implement payment systems,
and above all do not compromise beneficiary access to care. I am grateful for
the advice and assistance this Committee and the Medicare Payment Advisory
Commission have provided. I thank you again for holding this hearing, and I am
happy to answer your questions.
LOAD-DATE: March 26,
1999