DR. WOOD: If we could get all the committee members to come back to the table, please, so we can pick up with our next item, which is to finish things from Denver. And the next subcommittee is the communications and oversight subcommittee, and that is Dr.Rovner.
DR. OLSEN: First of all, we want to request the Honorable Mr. Martin to get the sergeant at arms for us. That's a joke we had at lunch.
The first thing, the communications and oversight committee would like to acknowledge the excellent staff assistance that we've received from Peggy Sparr until the Chair stole her away from us, but we have replaced her with Emily Loriso, and Emily is right here. So we welcome her as our person.
Now, that's kind of an introduction that the transition between the staff people is. You've actually gotten a second page or second report from the subcommittee. However, that only really applies to some of the activities tomorrow. So what we're talking about today really is in fact in Part C of your notebook.
DR. WOOD: The Section under 5C.
DR. OLSEN: 5C, right. And with the three or four reports I have to shuffle, it's hard to hold the button down at the same time.
But getting to the items that were referred from Denver, the first one is hopefully somewhat easy because the subcommittee has voted to withdraw it. And it has to do with the-- this is A1 on your papers. It has to do with the lock-in of snow birds, so to speak.
And as the subcommittee discussed this subsequent to the Denver meeting, we determined that if the change was made in this area, we would really be asking-- it would be an unequitable change. We would be asking the Medicare program to in fact favor people who maybe had the wherewithal to have two homes, etcetera. And we felt as a subcommittee that that was not appropriate; and, therefore, we have pulled the item off the agenda. And I'll move on.
The next--
DR. WOOD: Actually, could I ask if there are any of the committee members who had specific questions for Dr.Olsen about the recommendation? Suzanne?
MS. PATTEE: Dr.Olsen, that doesn't seem to resolve the fact that the snow birds still have a problem. Do you have suggestions on that?
DR. OLSEN: Well, the suggestions that not only I know are offered in some large organizations that have snow birds, but I'm in fact one myself, is that you should choose regular Medicare.
DR. WOOD: Other questions?
DR. OLSEN: By the way, I do also understand that Heidi -- is Heidi here -- that a number of the M+C plans do have options you can purchase for additional money that cover you in your secondary location. But it came down to an issue of equity probably favoring the economic advantaged maybe over the rest of the Medicare population if we recommended this change.
DR. WOOD: One of the concerns I think we heard in Denver was how to avoid the problem of people not understanding that they might be locked out by actions that they made. And I know we were struggling with that. Are we comfortable that we have addressed that particular problem?
MS. PATTEE: Perhaps we should ask if this is addressing the lock-in extension for three years?
DR. WOOD: Well, actually, the answer is it has been suspended for three years.
DR. OLSEN: Yeah, the problem has been deferred for three years.
DR. WOOD: Heidi?
MS. MARGULIS: Thank you, Mr. Chairman. That's what I was going to say. But also I think that it was my understanding that CMS was going to look into special enrollment periods, special election periods to cover this as well, so I know from both sides there were arrangements made because clearly it is a problem.
DR. WOOD: Right, that was the other question that came up, was whether the special election authority actually solved the problem to start with, and we just had to use it to our full extent possible. Okay. Erik, you may proceed.
DR. OLSEN: The next subject is on the deferred agenda. I'm going to refer to my eminent partner, Dr.Dennis, to cover the EMTALA situation.
DR. WOOD: Now we're back to you.
MR. DENNIS: Yes, yes. Thank you very much. There was some language issues at the Denver meeting related to the recommendation of it, too, and we wanted some clarification for it. What is different here that is being projected was just an editorial change. But I'll just read you what it currently states. "Define limits of EMTALA by clarifying that EMTALA requirements end when a qualified medical person has made a decision: (a) no emergency exists; (b) that an emergency exists and the patient is stabilized; (c) that an emergency exists which requires transfer to another facility where the EMTALA obligation rests with the transferring hospital until arriving at the receiving hospital; or," and this language here that an emergency exists is not here, which was editorially left out in error, so that should say, "That an emergency exists, that an unstable patient who is admitted to the hospital that has been stabilized."
So what this applies to is a person who is admitted because of an emergency, but the EMTALA obligation continues after admission until the emergency no longer exists. That's the clarification for this. It also clarifies who the responsible parties are in relationship to the EMTALA obligation. And this is essentially what we thought was a reasonable wording for that.
DR. WOOD: Okay. We're in the middle of obviously a comment period. And so I'm going to, before we ask for a second to the motion actually ask Leslie if she wants to comment? She's studying. While she's studying, then I'll ask for a second to the motion. Is there a second to the motion?
HON. MARTIN: I want a clarification, if I might, to the language that was left out unintentionally. Does that go prior to the -- after "the" or after "that"? I think it should go after "that."
MS. MARGULIS: That where.
HON. MARTIN: That where? All right. Is it "where" or "when"? Because you said "where." Is it up there?
MS. RYAN: That an emergency exists.
HON. MARTIN: Okay. It has already been put in there. My apologies. I'm sorry, Mr.Chairman. Because it wasn't here.
MS. NORWALK: I think as it's written that it's a reasonable request to ask for clarification. I would suggest that if you want us to do that it be given to us in writing before July 8th.
DR. WOOD: Miss Ryan.
MS. RYAN: I just have one question, and that was how the wording differs in which it says is admitted to the hospital and has been stabilized or was it that prior language has been stabilized that was still defined and therefore the CMS oversight of the clinical care of the patient was elongated for a period of time.
MR. DENNIS: What the issue was that it wasn't clear when EMTALA obligation ended for a patient who was either hospitalized or even the other patient it wasn't that clear. What this does is clarify when the EMTALA obligation applies and when it ends. And so that's essentially all-- and the other question was does it apply to a hospitalized patient who did not come into the hospital through a transfer or as an emergency? And this makes it very clear that it doesn't.
MS. RYAN: And so stabilized is sufficiently definable so that that ends the period, is that correct?
MR. DENNIS: That's true.
MS. NORWALK: I just note that the issue with the word "stabilized," I've been addressing questions about it for the past couple of months or at least since the regs came out is a long-standing one. The definition of stable is different in an EMTALA context than it is in a medical context, and it causes significant confusion across both hospitals and providers, so it's just making sure that both communities understand what the requirements are, given the stabilization.
DR. WOOD: Okay. Everybody's questions answered? Leslie, any other-- Mr. Cummings?
MR. DEVEREUX CUMMINGS: Question for Dr.Dennis. I draw your attention to B, Gary. It is still not quite clear in my mind, even as I look at the language at G, which is helpful, but going back toward between B and D, and specifically with respect to B, should that say and the patient is admitted or stabilized or both?
MR. DENNIS: No. It didn't say either. The obligation ends if the patient is in the emergency room and the patient is stabilized. That's when it ends.
DR. WOOD: Gary, if I can clarify, it seems to be what you have here is this background that the patient under B, that the patient is in the emergency room, the emergency exists and is sufficiently stabilized that probably the patient can go home.
MR. DENNIS: No.
DR. WOOD: But or -- well, no, you still have C and D that are options.
MR. DENNIS: Right.
DR. WOOD: Right. So C and D are not inclusive of B?
MR. DENNIS: That's correct.
DR. WOOD: And that's where I think the good part about the language. Leslie is nodding her head, so my counselor says that. Bruce, does that make sense?
MR. DEVEREUX CUMMINGS: It does make sense, although I'm still trying to contemplate where you have a patient who an emergency has been established and they are admitted, but they may or may not be stable at the point of that admission. So does the EMTALA obligation end based on the admission, based on the stabilization?
MR. DENNIS: Stabilization. What D says is that once the patient has been admitted, the EMTALA obligation exists until the patient has been stabilized. And, of course, you know, so all the conditions are covered now. It makes it very clear when the EMTALA obligation begins and ends, and that was the confusion before.
MR. DEVEREUX CUMMINGS: Thank you.
MS. NORWALK: And I think a lot of that just stems from you think intuitively how can an emergency exist and how can it be stable if there is an emergency? It's because under EMTALA stabilized means that there is not a material likelihood-- there is not -- the statutory language, there is not a material likelihood-- there is not a likelihood of material deterioration that would occur during a transfer, as opposed to the patient is stable and in fair condition or whatever.
DR. WOOD: Okay. Is there a second to this?
VOICE: Second.
DR. WOOD: Any other discussion? All those in favor.
(Ayes.)
DR. WOOD: Any opposed?
(None.)
DR. WOOD: It is adopted. Gary, you were proceeding with EMTALA, I presume?
MR. DENNIS: Yes, yes.
DR. WOOD: Go ahead.
MR. DENNIS: The next item was Item10/11, and there were issues as relates to the probe being incorporated more and that the due process incorporated in this. So the language, if you can read it, is the same language we agreed to. But we added something to it, and that was that we foster appropriate consultation with and involvement by PRO's, peer review organizations, appropriate due process for hospitals and health care professionals before CMS can issue a public notice of termination and proceed with the termination letter.
So that that whole due process would occur. It would occur early. And before any notices were sent out, the due process would have been carried out. And so those were the concerns.
Now, the specific requirements we also reviewed in terms of what that process is. But we didn't come up with any extensive recommendations in that change, other than this; and that's something that a future committee could look at more intensively. But we thought this addressed the issues that we were concerned about. And I support it.
DR. WOOD: Is there a second to this motion?
VOICE: Second.
DR. WOOD: Other questions, comments? Mr.Cummings?
MR. DEVEREUX CUMMINGS: I wonder if the committee would accept a friendly amendment for the insertion of a word "hospitals" when you were listing the various parties who would be part of this?
DR. WOOD: This would be in the second sentence and would say, "This should be developed and implemented with the scientific and technical advisory board of emergency physicians, first responders, etcetera."
MR. DENNIS: That's fine.
DR. WOOD: Inserting hospitals.
MR. DENNIS: That's fine.
DR. WOOD: So that's been accepted. Is there a second to the amended motion?
VOICE: Second.
DR. WOOD: Okay. All those in favor, aye?
(Ayes.)
DR. WOOD: Any opposed?
(None.)
DR. WOOD: It is adopted as amended.
MR. DENNIS: The next item is Item 12. Item 12 dealt with the clarification of prudent layperson, which actually was included in the language, etcetera. But what this does is define it. There is language that defines it, and in Medicare+Choice language we simply extracted that so that you could see what currently is defined as prudent layperson. And this is exactly the way it's defined by CMS.
The term "prudent" has a commonly understood meaning, and we would refer the reader to the general dictionary definition to this term. This is their language. A lay person, quote, unquote, refers to an individual with an average knowledge of health and medicine as the definition of, quote, emergency medical condition, unquote, states. And that's simply the definition. And I so move.
VOICE: Second.
DR. WOOD: Okay. There is a motion and a second. Are there questions? Suzanne?
MS. PATTEE: Dr.Dennis, I just wanted to clarify that the definition of layperson was a CMS definition or dictionary definition?
MR. DENNIS: That's correct.
DR. WOOD: That's a CMS definition, as Leslie is whispering to me, is currently a Medicare+Choice regulation. So it's a definition that exists elsewhere. Although it's not in this context, it has been incorporated in regulation and rule elsewhere. Okay. So we have-- you want something else on this item, Gary?
MR. DENNIS: No.
DR. WOOD: So we have a motion and a second. Any other questions, comments? All those in favor, aye?
(Ayes.)
DR. WOOD: Any opposed?
(None.)
DR. WOOD: It is adopted. Leslie has one other item as long as we're on EMTALA.
DR. NIELSEN: He has a question.
DR. WOOD: Jeff, go ahead.
MR. BLOOM: Sorry to be the fly in the ointment here, but let's say you didn't have an average knowledge of health, but someone is having severe chest pains and they think they're having a heart attack, would that be covered under the prudent layperson thing?
MS. NORWALK: It's not an individual heart attack. It goes to the hospital's obligation, so if an average person would know that you're having a heart attack, then EMTALA obligations --
MR. BLOOM: So you don't really have to have a background in health? It's common sense?
MS. NORWALK: It's your average, yes.
MR. BLOOM: All right. Thank you.
MR. DENNIS: There is one other item on EMTALA. It's 3. It's not on a subsequent page. It's on the consent agenda, No. 8. Do you want us to discuss that tomorrow? Okay.
DR. WOOD: This is the carry-over from Denver.
DR. OLSEN: Yes, Mr. Chairman, we do have items tomorrow. And you'll have that item tomorrow, Gary. I would also point out to you so I would remind you that you've probably gotten three versions of communications. You've got one on the Internet. You've got one in your book, but you've got one distributed today. And there were no changes relative to what we discussed today, but there will be on the consent agenda tomorrow, and this has to do with the transition we've had.
So tomorrow you will really want to have the new version to refer to, or I guess it's tomorrow, when we discuss that. So having-- and also I will make an announcement. There is a piece of the background that I want to read in tomorrow, so we'll do that. Anyway, the next item--
DR. WOOD: Can I hold you just one minute? I would like to recognize Leslie. She's got one other announcement about the EMTALA, and then I'll come up to pick up with the beneficiary pieces.
HON. MARTIN: Mr. Chairman, have we acted on 12?
DR. WOOD: We did.
MS. NORWALK: The only comment I have, as I alluded to earlier, the bioterrorism bill that was passed by Congress May 24th has a provision in it which states that the Secretary may waive under various emergency conditions EMTALA sanctions for a transfer of an individual who has not been stabilized in violation of EMTALA if the transfer arises out of the circumstances of the emergency.
So it's actually not as broad as I originally thought. It's always good to read the language. And I expect that the President will sign the bioterrorism bill and will give us some flexibility, although not ultimate flexibility with sanctions when there is an emergency, quote, unquote.
DR. WOOD: All right, Dr.Olsen, you may proceed.
DR. OLSEN: Thank you, Mr. Chairman. Because I'll turn to beneficiary education, it looks like we have four or five items for discussion, I'll turn that over to Patty Shafer. Patty?
MS. OSBORNE SHAFER: Thank you, Mr.Chairman and Dr.Olsen. On the beneficiary education on the remaining items, I had taken into consideration some of the comments I had heard from some people to help clarify, and we did some clarifying within our subgroups. I hope that it meets some of the issues.
On the first one, it was changed to state expanding contractual relationships to community-based organizations. For example, organizations that REACH commonly works with, addition in SHIP programs for translation services, information education and outreach to individuals with limited English proficiencies, persons with disabilities and beneficiaries in rural areas.
And when what we added was considering the RFP process, this is a means of establishing these relationships. As we had further discussions with CMS, they already have capabilities of partnering with a variety of community-based linkages. The REACH organizations are examples of different ethnic groups; Asian American coalitions, churches, libraries, different kinds of American Red Cross chapters. A variety of things that partnership now can be made, which is different from the contractual relationships with the SHIP organization.
But what we've heard through some of the hearings and particularly going back to the Miami hearing, that in some communities that there is some very culturally-based organizations that are much more appropriate in providing a lot of these services. But there isn't a means of really having contractual relationships. So this item will ask CMS to expand that.
DR. WOOD: We have a motion. Is there a second?
VOICE: Second.
DR. WOOD: Are there other questions or comments for MissShafer? All those in favor, aye?
(Ayes.)
DR. WOOD: Any opposed?
(None.)
DR. WOOD: It is adopted. Please proceed.
MS. OSBORNE SHAFER: The next one is improving the accuracy and effectiveness of beneficiary counseling and assistance programs, with consistent training programs, integrating them into regional and local outreach activities.
What we added to be a little bit more specific here was that training programs should be based more on national standards, but the implementation needs to be tailored more to community needs. So again you're focusing in on some of the consistency around the country.
DR. WOOD: So is there a second to this motion?
VOICE: Second.
DR. WOOD: Other questions or comments? All those in favor, aye?
(Ayes.)
DR. WOOD: Any opposed?
(None.)
DR. WOOD: It is done. Go ahead.
MS. OSBORNE SHAFER: The next one is encouraging and/or incentivising state Medicaid program to provide reimbursement between the agencies providing education and outreach activities.
This stemmed again some of the hearings -- I'm thinking of the Miami as well as the rural ones -- where providers have to pay for translation services and different kinds of education outreach services, yet what we learned was that state Medicaid plans now are able to reimburse for this. And again recognizing states rights, what we wanted to do was to encourage or incentivise them to provide the reimbursement for these services. And that would certainly help I think a lot of providers and institutions in the rural areas.
DR. WOOD: Okay. Is there a second to that motion?
VOICE: Second.
DR. WOOD: And questions? Mr. Bloom?
MR. BLOOM: Yes, if it's possible, could we hold this over until tomorrow? We have a recommendation from coordination and since this is a federal/state coordination issue, we have something very similar with beneficiary information. If it's okay with the committee, if you could double over tomorrow.
DR. WOOD: Okay. Michelle?
MS. EVINK: Thank you. Under this are education and outreach activities that are provided by providers always reimbursed? Because my question is are we only to going to reimburse community agencies that are providing these services? Or as providers are providing these services, shouldn't they also provide some compensation to them?
MS. OSBORNE SHAFER: May I? Good point on that. I think actually underneath the provider education component, there was a recommendation in there to allow reimbursement for such services to providers. But we were looking specifically at separating the issue because it provides the beneficiary education and translation services in a different way.
DR. WOOD: Dr.Dennis?
MR. DENNIS: Well, I was simply going to say that this specifically was addressing the needs of community organizations that testify, so that they would get -- reimbursement would go to them. As it is now, many of those, even though the reimbursement is not there, the physician providers are really being held accountable for those services and could be reimbursed for these currently. So that I don't think you need to have any language that states that they should be reimbursed, too, because they can be currently. But--
MS. EVINK: Not all providers.
MR. DENNIS: No, not all providers, but physician providers can. And if you think that's something that needs more comment, then it should be provided.
MS. OSBORNE SHAFER: Anyone on the subcommittee can help me out on this, but there are two pieces of it. One was that there is now state Medicaid do have the capability of doing it. And what we wanted to do was to encourage them to be able to do this to those community agencies so they can continue their work and the beneficiaries can get their needs met.
The next recommendation that was coming forth in the provider education was actually more of a new one because you're saying not just state Medicaid but, as our committee had discussed this, was to make medical translation services a reimbursable service from Medicare. That was what's on for tomorrow. So--
DR. WOOD: They're being separated. Are there other questions? Mr.Redding?
MR. REDDING: Mr. Chairman, I just wanted to comment. Dr.Nielsen earlier talked about what incentives might be available. And I think in response to that, I mentioned some administrative changes that would be a good. This is one, though, where in particular enhanced reimbursement to states would be an incentive that CMS has used before to get, you know, outreach done and education done and that sort of thing. So it's one that they're familiar with in terms of enhancement. This would be one where that would be particularly suitable.
DR. WOOD: Other questions or comments? All those in favor, aye?
(Ayes.)
DR. WOOD: Any opposed?
MS. EVINK: I thought we were deferring it until after the--
DR. WOOD: I'm sorry.
MS. OSBORNE SHAFER: So the recommendation will be held for tomorrow?
DR. WOOD: We will hold it for tomorrow.
MS. OSBORNE SHAFER: It would be just nice if we could have just voted on that.
DR. WOOD: We'll make sure we get it back.
MS. OSBORNE SHAFER: Thank you. Okay. On No. 6, on an ongoing basis simplify beneficiary forms, using plain language, using peer focus groups to rigorously re-test the clarity of communication.
We added a sentence. Test recommendations to target literacy at the fourth grade level.
Currently CMS is-- Peggy, correct me-- sixth grade level is where they strive to target. Yet in some of their background research-- and I always block the name of this book.
MS. SPARR: Health Care Review.
MS. OSBORNE SHAFER: Health Care Review. In their studies, some of the studies are recommending that they should be targeting towards the fourth grade level. At least what I have read through that. And so my recommendation from the last meeting people have asked me to put in a specific grade level, and I would just suggest I would want them to target-- to test whether or not the fourth grade level was appropriate or at least to encourage continuing at the sixth grade level.
DR. WOOD: Are there other questions about this one? Is there a second to the motion?
VOICE: Second.
DR. WOOD: Okay. Other discussion? All those in favor, aye?
(Ayes.)
DR. WOOD: Any opposed?
(None.)
DR. WOOD: It is done. Proceed, Patty.
MS. OSBORNE SHAFER: Simplify the Medicare application using plain language and encourage states to develop their own simplified, universal application for Medicaid and other services.
And as I read the coordination subcommittee, I also think that there is probably -- this is similar language to the coordination one. And I don't know if we want to hold it until then or just move on.
MR. BLOOM: Yes, we actually have a proposal that's much more comprehensive than this Medicare/Medicaid in a comprehensive application, so we would like to hold it until tomorrow if possible.
DR. WOOD: Okay. We will hold this one. That takes you to No. 13 I think, Patty.
MS. OSBORNE SHAFER: Okay. And this is evaluating education, communication strategies with established measures of effectiveness and quality. Trying to focus more on quality of outcomes and not just on the process measures.
DR. WOOD: Is there a second to this one?
VOICE: Second.
DR. WOOD: Discussion? Comment? When we say established measures of effectiveness and quality, do we have any idea what specifically we're talking about here?
MS. OSBORNE SHAFER: What difference do these make, you know, when we have different kind of education or communication strategy looking at the overall outcome. We should be having the outcome, I guess. This has had a few different changes, so I can't --
DR. WOOD: My only question about it was to be precise about what outcome we were looking for.
MS. OSBORNE SHAFER: Right.
DR. WOOD: It's nice to say something like this, but I don't know that it actually gives CMS very discrete, actionable help.
MS. NORWALK: That's true.
DR. WOOD: What would you like, Leslie?
HON. MARTIN: Mr. Chairman, I'm just -- I'm just concerned a little bit about what we're going into here. I mean you were talking a few minutes ago asking to look to see whether or not fourth grade reading level is sufficient for trying to make sure that we're communicating on a level which the general public can understand.
It's sad to say that we're back talking about the question of whether or not-- we aren't, but in the public debate talking about whether or not folks even reading by the time they leave the third grade or not. I'm wondering what fourth grade reading level we're talking about and how far we bring this down before we're satisfied whether or not those folks, you know, what kind of decision-making capacity and understanding even exists if you're trying to bring it down to that level of understanding. So I mean I just don't think we're doing the public any good whatsoever by talking in these terms.
DR. WOOD: Okay. Any other comments? We're on 13. And again the question from my perspective is is this prescriptive enough or help CMS enough in terms of enough what they are concentrating on. So Leslie is going to comment.
MS. NORWALK: I mean I suppose there are a couple things you could compare it to. In the Medicare+Choice context you could look at whether or not-- we typically look at whether or not a Medicare+Choice organization is doing an adequate job of marketing and providing information to enrollees by looking at their rapid disenrollment rate, which is the rate at which enrollees leave within a month of having signed up, et cetera.
In addition, we look at our call volume and the type of questions that we get at 1-800 Medicare to see whether or not the information we have out in the public is adequate and what might need to be changed, so those are the sorts of things that we currently look to to change and help instruct us what other things need to be done.
DR. WOOD: Dr.Dennis?
MR. DENNIS: I have nothing more to add.
DR. WOOD: Miss Nielsen.
DR. NIELSEN: I want to ask about, Leslie, do you want us to specify that; or can you just interpolate that?
MS. NORWALK: We're always delighted to have examples. I mean obviously if you want to provide examples, I'm not going to preclude that; but we do currently do those sorts of things now. So if you've got brilliant ideas, I'm delighted to listen.
DR. WOOD: Go ahead, Patty.
MS. OSBORNE SHAFER: You know, I would suggest that I'm going to pull this for today and talk to my subcommittee. I think the problem is when you get down to saying look at the suggested number of call volumes, we end up counting numbers of phone calls and not necessarily what's the effect on the beneficiary. And so I guess it was left broader in part to stimulate to say you got to get at the issue of importance for beneficiaries, yet I'm hearing the need to also be a little bit more specific on that.
DR. WOOD: Now, in the context of, say, Medicare+Choice, there is an expectation that some level of beneficiary patient satisfaction be measured, which would include measurements of the satisfaction with the plan administration. Is that right, Heidi?
MS. MARGULIS: I'm sorry?
DR. WOOD: In Medicare+Choice, you do have to do a periodic measure of satisfaction of your enrollees with administrative actions on the plan, that is, how well is the plan providing information to me that can help me access my services, make appropriate choices, etcetera, right?
MS. MARGULIS: Yes, sir. We do have -- I believe Leslie was describing before what was in place secondarily through caps. It's possible.
DR. WOOD: So then my follow-up question was then if we have this again in the context of an existing place, I think it's already the stated goal of AHRQ and perhaps somewhere else in the CMS the idea that we ultimately in terms of service would convert to a similar sort of measure one way or the other, is that right?
MS. NORWALK: I'm not sure if you could do it I think for service context. But just to clarify an earlier point, which is taking that it's more than just looking at the call volume that we get under 1-800 Medicare, but actually looking at the questions that come in to help us focus what our marketing materials say and do and giving us some sense of what's right or wrong. And what we really need to do is a good job of putting out the 1-800 Medicare numbers that people are encouraged to call when they have questions. And whatever those questions are, just paying attention.
DR. WOOD: Okay. We'll pull this one, anyway; and we'll have some more discussion. That goes to 14.
MS. OSBORNE SHAFER: All right. 14 was raised at the last hearing, and we re-worded this after some advice from CMS. It was regarding the power of attorney for Medicare beneficiaries. And we wanted to implement education and training of intermediaries and carrier call centers regarding rules for disclosing beneficiary-specific information to others and publishing these guidelines in plain language for the general public.
What we found that while--
HON. MARTIN: No, no.
MS. OSBORNE SHAFER: The confusion that arose before shouldn't have happened and that in reality they can talk to the powers of attorneys, and there is quite detailed guidelines for how you can communicate with a variety of people about beneficiary information. And the training needed.
DR. WOOD: The point here actually is that it already exists. It's just that people weren't quite aware of what the transmittal happens to be. Peggy is telling me here it's a new policy. When was it new, Peggy?
MS. SPARR: Toward the latter part of last year.
DR. WOOD: Toward the latter part of last year. Okay. So there is obviously some opportunities for us in terms of implementation. Is there a second to this?
VOICE: Second.
DR. WOOD: There is a second. Any other comment or comment? All those in favor, aye?
(Ayes.)
DR. WOOD: Any opposed?
(None.)
DR. WOOD: Okay.
MS. OSBORNE SHAFER: And the last one, No. 15, the committee has withdrawn this. Actually it came up at the last hearing, but after exploring it in more detail felt that it wasn't needed; and I think I'm going to have to turn to Erik or Peggy on this.
DR. OLSEN: Erik will start and turn to Peggy, but the limit of my knowledge is that the present policy is very fair. It's three days' hospitalization before you can get into a skilled nursing facility. And the question comes up if you become eligible during these three days and the rules apply in a non-discriminatory way, if you are in the hospital for two days prior to turning 65-- excuse me-- the first day of the month you turn 65, you do not qualify because you wouldn't have if you had been on Medicare.
So it's really it's as if you had been on Medicare all that time, the same rules apply. To go one way or another would be discriminatory to people. So in the view of the committee -- Peggy, bail me out -- but in the view of the committee this was very fair and already working in the way it should. Peggy?
MS. SPARR: The current policy basically allows if you are discharged from your hospital stay in the month when you turn 65, your entitlement date, anytime during that month, you are entitled to Medicare coverage for your stay.
We talked with different staff in CMS to find out, you know, is there any exceptions to the rule. And they said that one option that could be considered -- but the question is at what point do you cut it off -- you could keep, you could say the month before. If your discharge happened in any day in the month before you turn 65, and at some point it could be two months before or three months before. And at some point they've made the cut-off the way it is. If the committee believes that's an unfair or arbitrary and capricious way, they could make a recommendation to the contrary.
DR. WOOD: Okay. We have a motion for that withdrawal, or the sub is withdrawing that. Are these questions answered in a satisfactory fashion to the members of the subcommittee? Or I should say to the members of the committee, are you happy with the subcommittee's recommendation? Any objection to withdrawing? Okay. We'll withdraw it.
Mr.Rovner, we have no carry-over items from Denver, I believe, correct?
MR. ROVNER: On behalf of the coordination subcommittee, that is correct. There are no carry-over items from our subcommittee for here. I do have some items I would like to take care of, and then I would yield our time back to the chair to do with what you think is appropriate.
DR. WOOD: Proceed.
MR. ROVNER: We did have a productive meeting. Actually, I didn't. I should say that my esteemed subcommittee member, Lisa Gigliotti, had met with the esteemed chair of the flexibility subcommittee over lunch and have worked out the issues that we said we would.
And on that score, I would like to call or defer to or yield to MissMargulis, who will I believe re-introduce Items 2R and F off the flexibility agenda, carry-over agenda. And then I would defer to Mr.Redding, who will re-introduce Item 3D off of the flexibility agenda.
DR. WOOD: So go back to your flexibility agenda, everybody. We will pick up from where we were.
MS. MARGULIS: Mr. Chairman, the first item will be Item 4. We'll change the name of the subcommittee to the double joint.
DR. WOOD: So we have Items R and S. But this is Item R. It is on Page 3. So, Heidi, do you want Gary to take it?
MS. MARGULIS: On Item R, I will take this one.
DR. WOOD: Go ahead.
MS. MARGULIS: In discussions with MissGigliotti, this is what we are recommending; that the title of the recommendation be modified to read M+C budget neutrality recommendation, for the simple reason that within the coordination subcommittee there is a recommendation with regard to budget neutrality in terms of savings with regard to states and their Medicaid programs. And this is a different item completely.
And let's see. Let me read the additional recommended changes. CMS should-- and I would like to add inserting the word "consider" for "make." And change "make" to "making." Changes necessary to implement the, insert M+C, enrollee. We've got it up there. Oh, wow. We're real good, some of us more than others. On our budget neutral basis without increasing or decreasing total funding for the M+C program as intended by Congress.
DR. WOOD: Everybody see that?
MS. MARGULIS: We're trying to be as clear and as simple as possible, which is very hard in this business.
VOICE: (Inaudible.)
MS. MARGULIS: Let the record show that once I was polite.
DR. WOOD: We have a motion then. Is there a second?
VOICE: Second.
DR. WOOD: Is there discussion? Mr.Fay?
MR. FAY: Ms. Margulis, could you clarify what is behind the issue? Is it that CMS in some of its thinking is proposing a risk adjustment that is not budget neutral, that would be subtractive or additive to the total M+C dollars?
MS. MARGULIS: Let me try to make this as clear as I can. During the previous administration, the health risk adjustment mechanism was not implemented in a way that met the intent of Congress, which was that the risk adjustment be done within the M+C program, and that the moneys that were allocated for that remained within the risk-- remained within the M+C program and not re-allocated across the entire Medicare program. Such that if M+C Plan A had enrollees who were sicker than those in M+C PlanB, that the money was taken from B to give to A.
That is not how it is being implemented today, and so the reason my colleague down the table that I said consider making the changes, we would welcome CMS doing whatever they needed to do to clarify the intent or they were clear on the intent to have it remain as it was intended within the M+C program. It's complicated, I think. And I look to my colleagues across the table.
DR. WOOD: Leslie, you want to comment? Okay. Erik?
DR. OLSEN: Maybe I'm confused. I thought-- to me the whole idea is to pay based upon the health of the population, and by keeping that pot for sure the same without knowing ahead of time what is in the pot, it is my understanding that the healthier were in that pot, the M+C pot, so to speak. And, therefore, you would be raising the relative amount and paying more, getting -- the M+C plan would be getting paid more for the high risk patients, and that's what I read this as saying.
DR. WOOD: Go ahead, Heidi.
MS. MARGULIS: I'm not sure I totally follow. All that I will say is that the payment to us is based principally on -- the payment methodology is based on fee-for-service costs. And then this adjusts it according to the health of the individual folks who join the plan. So I got lost halfway through what you were saying. I'm sorry.
The program is not going to be paid any more than it would have been without risk adjustment. It is budget neutral. That was the intent. In other words, plans who have healthier enrollees will be paid less than those plans who have sicker or more chronically ill or disabled beneficiaries.
DR. OLSEN: Yes, but-- and this does get to what I did in my career. If the pot already is bigger and it's determined that these are the healthier people that are enrolling in the HMO's, let's say, you would have a bigger pot and, just by this resolution, would create a bigger pot for the M+C plans. That's my problem.
MS. MARGULIS: Okay. The money has already been allocated today. That money is not going to change. It's just going to change among the plans based on health status. Today what's happening is actually M+C plans are being paid less because that money is going back to the larger pool.
HON. MARTIN: Mr. Chairman, question for Heidi.
DR. WOOD: Go ahead, Steve.
HON. MARTIN: Given your explanation just then, it seems to me as if CMS should make the changes necessary. Then why should we say that they should consider making them? Given your explanation, it seems like they shouldn't make the changes.
DR. WOOD: Go ahead.
MS. MARGULIS: I have no problem one way or the other, but in the end it's their decision.
DR. WOOD: Suzanne?
HON. MARTIN: Follow up, Mr. Chairman. We're trying to give guidance and the words saying "you should do this" is already us giving them guidance, what they think they ought to do. And they will consider that. They will consider our guidance.
And for us to turn around and say that we should consider it really negates the whole purpose for even having offered this advice to begin with. It just kind of -- it just waters it down to meaningless. So I would like since your explanation that says-- your explanation tells me that they should do it, then I would like to move, if I might, that we adopt the unedited version and just ask them to tell them that we think they should do it.
DR. WOOD: Let me go to Suzanne now.
MS. PATTEE: Thank you, Chairman. I want to follow up with Dr.Olsen's point because the way I'm hearing it, it sounds like-- and I don't want to obviously go against congressional intent, but it sounds like the sicker patients are most likely within the Medicare program overall, and so that even though you want to do an adjustment, the M+C plans would keep the same amount of money, perhaps Medicare and the rest of the plan needs that money because it has the sicker patients. So I guess I don't want to impede patient care with either of these recommendations.
DR. WOOD: Heidi?
MS. MARGULIS: I don't believe that it would be because we are paying M+C plans more accurately under the proposed risk adjusted formula than we would be had it not been in place. And I would take some offense or be at some disagreement with the fact that M+C plans do not take care of sick patients or more chronically ill patients.
DR. WOOD: Len Schaeffer.
MR. SCHAEFFER: This used to be a very important issue. I thought that some of the rules had been changed. But in the beginning what we saw was that the less chronically ill people opted to go into Medicare+Choice. And they were being paid based on what you would normally pay for the average person going in. And, therefore, what happened was there were windfall profits to Medicare, within Medicare Risk, I guess it was called back then. Medicare Risk plans.
And you could argue that less money was available to treat people who weren't in those plans. Over time, though, I think that has kind of normalized. And what is the rule now? How is money allocated to Medicare+Choice? Is it a straight percentage of the AAPCC or what?
MS. NORWALK: Of course, it's complicated. It's the greater of three ML's. There is a floor amount that's statutorily defined every year. There is the 2 percent increase over last year's payment, which the base rate is 1997 AAPCC rates or 95 percent of them. The third one is a blended rate, which is almost never paid. I think maybe it has been paid one year to two plans, so that's not really --
MR. SCHAEFFER: But does it -- I mean Erik makes a good point, at least from way back when. Is that still-- Erik and I have been both on this a while. But is that still relevant given these changes? Basically what you're saying is the entire basis for Medicare Risk is flawed. 95 percent of AAPCC only works if you get an average, you know, allocation. But over time because the thing was around so long, it's like normal HMO's. It does normalize.
MS. NORWALK: I would say in terms of the delink from the AAPCC rates is that Medicare providers generally have had increased payments like upwards of 11 percent, whereas opposed to the floor, as opposed to, you know, the floor of the 2 percent increase over time over the past number of years.
So I think generally the trend is that Medicare fee-for-service payments have been increasing at a greater rate than the Medicare+Choice payment system has. That's one issue.
In terms of your original question, I haven't seen anything that addresses the, quote, unquote, cherry picking of health plans recently to know whether or not that's changed. I just haven't looked at it. Heidi might know more about that.
MR. SCHAEFFER: I don't want to be accused of accusing health plans of charity. Just the way that people self-select through HMO's. It has nothing to do with cherry picking, although we are, by the way, we are in the home, the origin, the original site of cherry picking in Medicare HMO's.
We should take a minute. There is a venue here-- I think it's in Minneapolis, maybe it's in St.Paul, called the Promenade, the Promenade. It's a place that used to have big parties. You could rent it out. And one of the original HMO's that went into Medicare+Choice used to hold a party there once a month called the Senior Prom. And they invited people who were over 65. It started at 9:00 o'clock, and they enrolled everybody who was still standing at midnight. They should have a brass plaque or something.
DR. WOOD: It's sounding to me like we should actually plan something for the committee about 9:00 o'clock tonight.
VOICE: See who is left standing at 9:00 o'clock tonight.
DR. WOOD: Really, your stress test, I do have to compliment you on the hard work you do, but I really want to see who is standing at 9:00 o'clock. Let me go back to Heidi, and then I'll come back to Dr.Olsen.
MS. MARGULIS: Okay. The payment, as Leslie said, has been delinked. It's no longer based on a percentage of fee-for-service, so it has been delinked. While there are recommendations going forward legislatively that could change that, it currently is delinked.
And there is a current study out, and I believe it was by Blue Cross that I saw last, but it has been justified in other realms as well that the majority of people who join M+C plans are generally lower income people and minority people and who cannot afford Medigap premiums, in addition to fee-for-service. So I will let the committee think about that in terms of the relatively health status of those folks.
DR. WOOD: Dr.Olsen?
MR. OLSEN: I guess my basic concern is that we provide the maximum funds that are available for the average enrollee. Now, if I was right, it's maybe the fee-for-service, but maybe it's the M+C, so I wouldn't want to see budget neutrality within the program because we need to provide the money equitably to the enrollees. So I guess on that basis whoever is right, I would still not be able to support this recommendation.
DR. WOOD: Now, earlier actually in part of the discussion, Mr.Martin was asking if we wanted to leave the language as it was at the beginning. So from that perspective if we go back to the original, which would be CMS should make the changes necessary--
HON. MARTIN: My point is simply as to whether or not it should have meat on its bones or not.
DR. WOOD: Right.
HON. MARTIN: If you want to have substance, then leave it like it was.
DR. WOOD: So we'll leave it like it was is the motion. Is there a sec -- I'm assuming then that you would support that as a second, Mr.Martin?
HON. MARTIN: Yes.
DR. WOOD: Any further discussion? All those in favor, aye?
(Ayes.)
DR. WOOD: Those opposed?
(Hands raised.)
DR. WOOD: Dr.Olsen, Miss Martin, Mr.Fay, MissRyan, MissPattee. Okay.
MS. EVINK: Was that the amendment or-- I'm sorry.
DR. WOOD: To record the dissents again, I have Ryan, Fay, MissMartin, MissPattee, Dr.Olsen. Did I get everybody? Okay. Good. Heidi, yes?
MS. MARGULIS: Are we voting on the entire recommendation, or that was a vote on the amendment? Or as amended?
DR. WOOD: Yeah, that was with the amendment. The M+C enrollee health as amended.
MS. MARGULIS: So we're on Item S?
DR. WOOD: We're on Item S.
MS. MARGULIS: All right. "Medicare and You" handbook, who answers which questions. For the next publication of "Medicare and You" reduce the number of pages of referring telephone numbers in the "Medicare and You" handbook focusing on 1-800 Medicare so as to avoid overwhelming readers. Further, if not currently doing so, ensure that all the transferred callers from 1-800 Medicare are connected with a live person at the connected number.
There is a recommendation, a very good recommendation, within the coordination subcommittee that encompasses a 1-800 Medicaid number to reflect the 1-800 Medicare number, and we thought that it would be appropriate for us to flesh out this recommendation here prior to taking that one.
Secondarily, as background for this, I know there are a number-- there are some people who think that the numbers or believe that the numbers that are in the "Medicare and You" handbook are helpful for people who want to directly call those numbers. At least it was the sense of the our subcommittee that by calling 1-800 Medicare that those numbers could be given out at that point and a live connection made with those agencies so that there would be one standardized number on the 1-800 Medicare card, and that people didn't have to flip through pages in the handbook to find what they wanted. Very important that people be connected live so that we would reach an ultimate customer service standard here.
DR. WOOD: Is there a second to this motion?
DR. NIELSEN: Second.
DR. WOOD: Other questions or discussion? Mr.Finan?
MR. FINAN: Heidi, you discussed the number of options that the caller would receive when they call in, considering directing all calls to one number or how long it would take them to work through the menu. I've had the experience of trying to reach either an agency or an organization and spending, clocked fifteen minutes trying to work through the menus and bouncing around inside the system. So-- and I don't know how to incorporate that into language, but I just wanted to know whether this was discussed or not.
MS. MARGULIS: Actually, I would also yield to Dr.Olsen because I believe this-- sorry, Dr.Olsen. This issue was also discussed within the communication subcommittee. The answer is in our subcommittee, no. But I would defer to Dr.Olsen for discussion within his.
DR. OLSEN: Correct me if I'm wrong, Patty, but I don't think we got-- did we get into that entire discussion? I'll refer to you. I will add, though, that in this entire discussion I would remind you something that I'm I think-- well, it is happening because I've seen a mock-up. They're going to start putting the number on the card, and I don't know if that's happened yet, but so it's going to be bigger and broader than ever.
MS. OSBORNE SHAFER: We didn't make a specific recommendation because I knew you were doing it, Heidi. We had talked about this early on to simplify it. And I would concur with this. My only point on this is that beneficiaries should be able somewhere to find out what those alternative numbers are. They need to do their own homework.
So I would hope that by trying to simplify it, you don't take information away from beneficiaries, whether it's links on the web site that are there. I mean we shouldn't be-- make it simple, but find some access for it. Yeah, let's see. Could we add a statement so that the-- the alternative numbers or additional numbers are made available at least on the Medicare.com web site.
DR. WOOD: Dr.Crosby?
DR. CROSBY: I wonder if that's adequate for those beneficiaries who don't have Internet access, and are we taking away from their knowledge base if we reduce the pages and eliminate their access to print versions of those numbers? And they then, as Mr.Finan suggested, have to go through fifteen minutes of ACD?
DR. WOOD: That's part of the concern that we had. When we were looking at all the pages of the "Medicare Plus You" handbook, how can we get it at least a little simpler? So there is probably some happy medium in here somewhere. Jeff?
MR. BLOOM: The one number that I do think needs to be a part of it, and because it's a vital part particularly if it's a case where there is a disenrollment situation is the SHIPs counselors' numbers, which frequently when you call the 1-800 Medicare number they actually don't know the number of the SHIPs counselors as well.
So that's something else for CMS to check on, but I really think that the SHIPs counselors need to be listed in the book, so people have that reference to call. It's not that many numbers, and each state has a SHIPs counseling office.
And that's another way of getting information because again pointing out that not everyone has access to the Internet, particularly the over-65 population may be less familiar with the computerized generation that we live in now, but we've all been very impressed with the SHIPs and the jobs that they do. And I think it would be important to make sure that their numbers are included.
MS. MARGULIS: Perhaps, Mr. Chairman, what we could do is reduce the number of pages of referring telephone numbers in "Medicare Plus You" handbook, maintaining key counseling numbers.
DR. WOOD: Well, actually, I think from the perspective of what we have here, this is a fairly straightforward approach. Perhaps the only thing we're missing is to say something like work with beneficiaries to determine what is the best structure of telephone numbers or advice for where you can find answers to your questions about Medicare. Maybe that's really what we're trying to say here. Lisa?
MS. GIGLIOTTI: I support that. We have a good SHIPs advocate here, but there might be other advocates who really believe that their counselors also should be represented in a booklet because that's the best form for their constituents.
DR. WOOD: I mean our overall intent when we looked at "Medicare Plus You" was it has got these pages and pages and pages. And it says if it's this question, call this person. If you're here, call this person, et cetera, et cetera, etcetera.
What we were really trying to do was to simplify the number of options so you could get the answer to your question and achieve a higher level of service, so maybe we haven't quite said it the right way.
So maybe if we said it as in for the next publication of "Medicare and You," the number of pages of referring telephone numbers should be reduced with a focus on 1-800 Medicare, period. Further, CMS should use a beneficiary focus group to determine the best content and organization of this section of the "Medicare and You" handbook, period. Or you could say if not already being done, because I guess the question is when Michael Mullin was here, I don't know that we specifically asked her. Did we? What did she say? What did Michael say?
MS. SPARR: There is already a lot of extensive beneficiary focus testing of almost every section of the handbook, so whether they do this particular piece as a separate focus group, we don't know; but they do almost every other section.
DR. WOOD: Okay. Jeff?
MR. BLOOM: Just for the committee's information -- and I do have a copy of it -- I have been told by many SHIPs counselors and many other beneficiaries that the 1995 handbook is actually the book that all of them use in their offices, and it's been the most informative handbook that CMS has put out and actually has more information, as opposed to less information.
So that's something to think about, that people really do have a need for more information than less information. I'll be happy to share a copy of it with you if you like.
DR. WOOD: Yeah, I think the concern we had actually was we were looking at it. There were just so many options available to a person, it quickly became confusing; and so how could we improve it to the point where people could get their questions answered as quickly as possible and get the answer they needed?
MR. BLOOM: This actually tells you things like how to read your Medicare summary of benefits form and different things like that. It's not so much like the current handbook, but it's much more of a walk-through thing of the whole process, so it's a pretty decent book, and I have a copy with me.
DR. WOOD: Now, for -- Heidi, go ahead.
MS. MARGULIS: I'm sorry. Mr.Chairman, finish your thought because something was just struck that I'm not sure was intended to be struck.
MS. GIGLIOTTI: That's one of the most important ones.
DR. WOOD: Oh, right. You don't want to strike the live customer service.
MS. MARGULIS: Correct.
MS. GIGLIOTTI: If anyone does call, we want them --
DR. WOOD: We want a human touch.
MS. MARGULIS: We would like them warmly connected.
VOICE: And I might suggest in three minutes or less.
MS. MARGULIS: We sort of have a 20-second rule I would --
MR. MARTIN: Mr. Chairmen, then that needs to be a separate sentence because we've restructured the one before that.
DR. WOOD: Okay, Steve. Why don't you watch and make sure she gets it the way you want.
MR. MARTIN: This is important, not only the live person; but I have a feeling if we simply went to one, single number, all you're doing is shifting the inconvenience from the inconvenience of having to look up the number to the inconvenience of having to stay on line.
DR. WOOD: That's what we're trying to figure out, so the point here actually is that what we're going to try to do is to reduce the number of pages and continue to work in ways that we can find what works the best for users. So with that, is there a second to where we are with this? Everybody look at the language. Make sure you're happy with it.
MS. MARGULIS: Mr. Chairman, I think we have a little amendment for the end of the live person so that it's being done expeditiously or within a short period of time or somewhat--
DR. NIELSEN: In a timely manner.
VOICE: How about a knowledgeable, live person at the connection end?
DR. WOOD: We're going to give CMS credit here.
MS. MARGULIS: Or expeditiously connected.
HON. MARTIN: Or connected expeditiously, either one. That word needs to be moved up in the sentence.
MS. WALDEN: Dr.Woods, I need a point of clarification. When we talk about connecting, are we talking about a live voice giving a phone number to the beneficiary that they make another phone call? Are we talking about actually Medicare having the transfer kind of capability to potentially all SHIPs and all entities that could answer these questions?
MS. MARGULIS: Correct.
DR. WOOD: Yeah, you're talking about a service agent. And then you've got to figure out how much it's going to cost. Now, one of the-- well, I mean one of the circumstances all of us have to remember is that as we go through this large series of recommendations, CMS staff has to look at them again.
We talked about it this morning. You've got to figure which ones you can do easily or just a simple regulation, regulation change. Then you've got to figure which ones are going to take a big resource in terms of people, are going to take a big resource in terms of expense.
And then we have to try to help prioritize those so the CMS staff can decide how they're going to deploy their resources. I also think we have to-- I'm not sure that we wanted to take out the include funding in the next budget cycle.
MS. MARGULIS: Yes, Mr. Chairman. It was assumed that if indeed the second piece of that were affected that in essence the agency would do that.
DR. WOOD: Okay. So we have this one?
HON. MARTIN: Well, I just want to raise one question. The language, beneficiary groups, was just changed for consumer testing groups. Is that an appropriate change?
DR. WOOD: What's the staff think?
HON. MARTIN: It did say beneficiary group.
DR. WOOD: It might be more consistent to say beneficiary, actually, because those are the people we're after.
MR. BLOOM: It was Peggy's suggestion.
DR. WOOD: Which one was Peggy's suggestion? Consumer testing?
MR. BLOOM: Yes.
DR. WOOD: Okay. What do you think, Peggy?
MS. SPARR: Consumer testing.
DR. WOOD: It's better?
MS. SPARR: Oh, yes. Focus groups is only one type of consumer testing. There are many that might be more applicable to this.
DR. WOOD: Okay. Did everybody hear Peggy's comment?
HON. MARTIN: Well, the difference was not between -- excuse me, Mr. Chairman. The difference that I was raising was not between focus group and consumer testing, but between beneficiary groups versus consumer testing groups. That's what was changed. Beneficiary was stricken and replaced by consumer testing.
MR. WOOD: Peggy, go ahead.
MS. SPARR: Consumer testing, as I understand it, is the terminology that we use for social marketing. And consumer testing in CMS's terms is focus tests and other types of different types of technology.
DR. WOOD: Okay. All those in favor, aye?
(Ayes.)
DR. WOOD: Any opposed?
(None.)
DR. WOOD: Okay. Heidi?
MS. MARGULIS: That concludes those recommendations. I would also like to inform the chair that I do have a recommendation for consideration on the provider solvency issue from before, and the re-worded provision on the interface between the PVP and the summary of benefits at a time that's suitable to the chair. I did my homework.
DR. WOOD: Relatively soon we're expecting Secretary Thompson. And so we can begin to do those, although we might be interrupted a bit. So, Heidi, if you would prefer to do the solvency one.
MR. ROVNER: Mr. Chair, if I may, I would prefer to yield to Mr. Redding to take care of the carry-over item; and then I would suggest we go back to Heidi.
DR. WOOD: I would take that as a suggestion. Mr.Redding, it is your floor.
MR. REDDING: Thank you, Mr. Chairman. Back to Item 3D, Page 4, we had previously talked about maybe incorporating this into a broader coordinating committee, coordination, rather, committee, subcommittee rather, item upon further review as they say, the decision was made to have this item stand alone, with the wording "except" instead of "develop" in there, so that's my motion.
VOICE: Second.
DR. WOOD: Second. Any other discussion? All those in favor, aye?
(Ayes.)
DR. WOOD: Those opposed, nay?
(None.)
DR. WOOD: It is adopted. Let us change our-- we'll get back to our schedule. Secretary Thompson is here to join us. I will stop for the moment. I will do a little bit of the reporting here for you. Secretary Thompson, on behalf of the members of the Secretary's advisory committee on regulatory reform, we appreciate your coming today. Thank you very much. In the time that we have, I will give you a short summary of what we have accomplished to date and a preview of our remaining work.
In the five short months since we first met in Washington and you asked us to find immediate and effective solutions to some of the most vexing regulatory problems, we've been working diligently to achieve your expectations. I hope that what we have to share with you today will satisfy your charge to us.
It is my personal privilege to work for you as chair of this group, and I must thank you at the outset for your confidence, as well as for the resources that you have provided. Our success to date is a direct reflection of the most valuable resource, and that is the ladies and gentlemen of this committee. In addition, the hard working staff that have come to us from various parts of HHS who have been posted to this committee while in some circumstances doing their other jobs have been extremely helpful.
I consider this group unique among committees on which I have served. We have not simply come together at scheduled meeting times to discuss problems, make a few suggestions and then to go back to our usual jobs between meetings without so much of a thought about what our next meeting might be or what our last meeting accomplished.
Instead, it has been five months of very steady work, whether we are here as a group or working in our subcommittees. We decided early on that in order for us to accomplish our work, we would need to break this large committee into subcommittees, each of them with broad representation from the whole committee.
As we thought about that approach, we considered that it would not be very helpful for us to take a typical industry approach, and that is to divide ourselves into representatives from hospitals and home health care agencies and the like, but rather to think about how it was that Medicare beneficiaries in fact accessed care and administrative support from the Medicare system. An overarching principle for us has been to keep the needs of the beneficiary in the center of our efforts.
Each subcommittee has been responsible for evaluating its area of responsibility and to identify major areas of need. We have prioritized our work according to a set of principles that we adopted at our first meeting. And the executive committee in order to keep this task headed in the right direction has met regularly, on a weekly basis almost; and with that we have kept our agendas organized in a way that we hope has been most productive.
We have a considerable wealth of expertise and talent around this table, and I am personally not very bashful about sharing with you their contributions and recognizing the hard work that they have in fact accomplished.
In the course of our work we have conducted a series of regional hearings, of which this is one, around the country. And our usual format what we would do is to identify two or three significant issue areas. And with those themes we would then invite HHS staff with particular expertise in an area to review with us the statutory basis of the program or the statutory basis of a group of regulations and the process by which a regulation was developed.
We then sought to bring together panels of doctors and nurses, administrators, patients, people who were caring for their older parents or relatives and others to tell us how things were actually working for them, as well as to give us some suggestions about improvements in process or regulation.
We saw demonstrations of assessments of elderly patients at homes for generation of OASIS data. We visited hospital emergency departments. We visited nursing homes. We accompanied home health nurses on their visits. We went to small rural clinics; and we went to hospital, teaching hospital information management departments.
And at every one of our hearings we have in fact been privileged to listen to comments from the public. In some situations people would drive all day or overnight in fact to be able to come and share their stories with us. Combined with the comments received in the mail and electronically, our subcommittees have incorporated the ideas that we have received into their recommendations for solutions to regulatory problems.
All of this work, now producing more than one hundred specific recommendations, could not have been accomplished without the hard work of the dedicated staff. Kristy Schmidt had been our lead staff person for most of this effort, and all of us on the committee are grateful for her efforts and regret that her retirement has kept her from being here today and with us as we finish our work.
Peggy Sparr has immediately stepped into a new role on a short notice, and she will help us finish. And with the fine work the Paul Hughes, Bela Sastry and Erin Palmer and Emily in particular, our newest helper, our subcommittees are in good stead.
I would tell you, too, that we have especially benefited from the presence of Leslie Norwalk, and I thank Mr.Scully for letting us have her. She has carefully listened to all that we have said.
SEC. THOMPSON: Thank me. Don't thank Scully.
DR. WOOD: We've been especially-- she has listened carefully to what we have said. She has listened to the testimony of the panelists. She has heard comments, and she has worked to help us to provide analysis of our issue areas and facilitate the incorporation of our suggestions into action plans.
In our work we have seen how the current complexity of regulations creates problems for beneficiaries and providers. In some situations it is apparent that the complexity of regulations have meant that carrier medical directors have made decisions that keep beneficiaries from receiving needed services.
It is difficult for beneficiaries increasingly to find information about Medicare. In fact, when you came in, we were discussing ways that might make that even easier. There is no single telephone number or web site address on the beneficiary's card which will provide ready reference about where to get help.
We have seen demonstrations of data collection procedures that require an hour or hour and a half of beneficiary time. Not the best thing if you're sick and you're really wanting a visiting nurse to help take care of you, rather than tending to paperwork. And we have identified solutions for improved services to beneficiaries, solutions for reduction of obsolete or duplicative reports and some other solutions.
We have seen problems encountered in emergency rooms around the country caused by EMTALA regulations. We have seen firsthand that small rural clinics find it difficult to get access to resources that would help them in caring for their own patients. These are valuable resources that could better help them in their job, if only they were readily available or there were people who could help these rural clinics find those resources. We are working on other issues, implementation issues, the interface between FDA and CMS. And, in fact, a large part of the meeting here in Minneapolis is that FDA/CMS interface and the relationships between Medicaid and Medicare.
Already you and your staff have announced reductions in regulatory burden in these areas, and we appreciate the attention that you and your staff have given to the recommendations that we have made as we have gone along.
For the summer we intend to finalize recommendations from the areas that we are considering here in the Minneapolis meeting. We will work to prioritize all of our recommendations and to transform the results of our data gathering into knowledge that can be used as a basis for long-lasting improvements in the work of translating program design into working regulations. In effect, making the regulatory process more efficient, more effective and more responsive to the needs of beneficiaries and providers so that we will no longer hear stories that beneficiaries are denied needed services because of the complexity of the operation of these vital services.
My colleagues on the committee, ladies and gentlemen, and ladies and gentlemen of the audience, it is my particular privilege to welcome today the Secretary of the Department of Health and Human Services, the Honorable Tommy Thompson.
SEC. THOMPSON: Dr.Doug, thank you very much. I thank all of you very, very much. When I was a governor for fifteen years, what really irritated me sometimes was when citizens would come together, work hard and turn out a very good work product; and I couldn't get the legislature to go along with it. And I also was very upset when people like yourselves would donate your time and your energy and accomplish great things and then have that work product be placed on the bookshelf and never be taken up.
I want to assure you that the reports, the recommendations and the advice which you're giving the department, that is not going to happen. What you're doing here today and what you have done and what you're going to continue to do is so vitally important to change the delivery of the health care system in America, I can't tell you how important your effort is. But you know so, and I would like to just start out by saying thank you. Thank you from the bottom of my heart for all of the hard work that all of you have done.
And, Dr.Doug, every great team needs a wonderful, most valuable player, the quarterback; and that is you. And even though you're from Minnesota, I would put you, I would say that you were going to receive the Brett Farb award because he's the better quarterback than what you have in Minnesota. He comes from Wisconsin. So I just would like to say thank you.
In fact, I spoke this morning in Toronto to the biotechnology conference. And one of the individuals that I met with is a member of this panel, and she couldn't be here today. She's up there representing her company at the biotech conference, and she wanted me to tell you that she is vitally interested in what comes out of here today and is very interested in making sure that her comments are taken into consideration as well. And I told her I would pass that on to you.
I would like to thank you, all of you, for your kind introduction, Doug, and for your report. You and your committee are absolutely doing excellent work. And the American people owe you their thanks for it. And I want to just tell you I really appreciate it.
I see we also have some of FDA's finest here. As I understand, they're going to be on the next panel. Dr.David Feigal, James Rothco. I thank those for their excellent work and thank them for being here. And I would like to thank all of the staff from HHS. I see so many members from HHS, I wonder who in the hell is working back in Washington. And you better be working while you're out here, and I know you are, and I appreciate all of your efforts and your interest in this subject. I also would like to introduce Kory Hoze, who is my regional director for this region. Kory Hoze is up here, and I thank him so very much.
And the individual who came in late eating his lunch, walking through looking important is Tom Scully. He's also present. Tom is and will be executing many of the committee's recommendations. This really galls me to say this, but I thank him for his hard work and bringing them to fruition. Please don't encourage him. He's already enough of a problem for me. I think the world of him, as he knows; and I'm very happy he's here.
Last January I charged this committee with the task of finding ways to make it easier to provide health care while still maintaining the high standards of accountability. We're committed to common sense government. We want regulations to serve people, rather than make people confirm to regulations. If we can clarify and simplify confusing regulations to make life easier for patients and consumers, then we'll all know that we're making real progress.
We've begun to make some of the improvements that you've recommended. And let me go over some of the highlights. As you remember I told you, don't wait. You got an idea, send it in right away, so we can get started on getting new proposed rules out there. You've done that. And we've already made a lot of progress. A lot more to be done, but I want to thank you for it.
No. 1, we streamlined the paperwork requirements in the MDS form for nurses and other clinical staff. Caring for Medicare beneficiaries in nursing homes. We believe we cut the time needed to complete the Medicare assessment form in half, while still completing the necessary data.
We also proposed to clarify requirements for hospitals, to screen and treat emergency room patients under the EMTALA law. And so many hospitals that I go and visit and they tell me about how onerous the rules and regulations under EMTALA and how they're so much in hopes that this committee and the department are able to come up with streamlined rules and regulations to improve it. I think we're doing a great job, and I want to thank you for that.
In May the Center for Medicare and Medicaid Services, CMS, proposed common sense improvements to ensure that patients with possible emergency conditions receive appropriate care as rapidly as possible. And we did it by simplifying the rules and regulations.
And, third, we allowed hospitals to gather Medicare secondary payer information used to make sure the correct insurer pays each health care claim just once every 90 days. Now every time you go in for a treatment, you have to fill out the same damn form. I had so many people say -- well, people came in and says, you know, I didn't even work in the coal mines, but you have to ask if they've got black lung. I didn't have black lung last week. I didn't have it last month. I didn't have it last year. I don't intend to have it for the next ten years, but I still have to be asked that question. And I think that that is something -- you know, those are the kind of idiotic things that drive up the cost. And we're changing that, and I want to thank you.
The Medicare secondary payer information now it's going to be once every 90 days. And this change allows hospitals to focus more time and resources on caring for patients, instead of repeatedly collecting this data. And all these changes mean less burden on the health care provider and more time spent on patients. And that's just the beginning, thanks to you.
Now, our reform initiative is going to have a big impact on Medicare. We must bring Medicare into the 21st century. And that's why the new Medicare cards that you have up here on your forms here today, as you can see here, we'll have both a 1-800 number and the Medicare web site printed on them. That's just common sense. Why didn't anybody ever do that before? I mean it just doesn't make any sense. It wasn't there. Thanks to you it's going to be there.
We want beneficiaries and their relatives to have quick and easy access to the most up-to-date information on Medicare. We're going to use technology, and we're going to use common sense to get that job done.
We're going to work on the other recommendations that the committee is making today. As soon as you get done making the recommendations, I want you to know they're picked up. They're taken to Washington. They're faxed to Washington, and we're able to start working on them.
We're going to streamline Medicare's paperwork requirements for home health nurses and therapists so they can focus more on providing quality care to their patients. That's why I'm directing the Centers for Medicare and Medicaid Services to eliminate elements-- listen to this, Scully -- to eliminate elements of Medicare's required home health patient assessment, which is called OASIS, that are duplicative or unneeded to promote quality care or to ensure accurate payment.
As a result, CMS estimates that they can reduce the time nurses and therapists spend on these assessments by more than 20 percent. That's what my notes said. But right now in our end it takes one hour to fill out that form, as I understand it. One hour. Twenty minutes you save, Tom, that's still forty minutes.
Now, we have enough brain power in CMS, ladies and gentlemen, and I'm giving you sort of a directive here and an encouragement. We should be able to fill that form out in ten minutes or fifteen minutes and save the fifty minutes that a nurse has to be able to have a patient. So, Tom Scully, if you're as all important and as intelligent as you tell me every day, I want you to get this down to ten minutes. You got that? All right.
We have lawyers in here that have heard that, so now we're going to do that. Okay? That's an order. That's a goal. You slip two minutes, that's fine, but I want it down. I don't want 20 percent. I want at least 40, 50, 60 percent shaved off of that form.
We're also going to put modern technology to work for the health care consumer. And later this year we're going to test the new web-based enrollment form for suppliers of durable medical equipment, prosthetics and other supplies. Suppliers will be able to complete the form on-line instead of on paper forms, allowing Medicare to review and act on those forms much more quickly. That means quicker and better treatment for Americans on Medicare, something every one of us around this table and in this room want.
Ladies and gentlemen, this was just the tip of the iceberg. I look forward to your final report later this year, and I'm here to assure you that it's not only going to be read, it's going to be acted upon. Quality care. Why I set this committee up was to get radical suggestions in order to improve the delivery of medical care in America, and that's what you're here to do. And I want to tell you so far your efforts have been stupendous. And we can do more, and we are going to do more, and I'm passionate about making it happen. And together we're going to get it done.
Before I thank you and end up letting you get back to work, I would like to introduce Bobby Jindal. Bobby is the boy genius of the Department of Health and Human Services at 29 years of age, and he has been with you on all of your hearings, and I want to thank him personally for the tremendous work he and John from his department and everybody at Aspian, all the wonderful employees from HHS for doing the great job that you have serving this wonderful group of individuals. I think we owe the department employees and Bobby our thanks.
(Applause.)
SEC. THOMPSON: Scully will get his applause when he gets that OASIS form down to ten minutes. But there are three things I wanted to leave with you today. I have been doing a lot of speaking, a lot of discussion about the high costs of health care in America, the high costs of insurance premiums, the problem with maintaining that insurance and a lot of companies that are now looking at the possibility of withdrawing from the market.
I also am looking at the fact that we have 39 million Americans that are uninsured, and I'm also looking at the demographics, look at the aging of Americans and find that unless we do something, we are going to have a health care delivery system that is not only stressed and stretched but has the prospects of actually collapsing.
And there are three areas that I think we can have a tremendous impact on holding down health care costs, improving the quality of care and really doing a service. The first large one is the regulatory reform. You're doing that. But I want you the rest of the time that you're together to be as radical, as innovative and as far reaching as you possibly can be.
The American Hospitalization Association says that 20 to 25 to 30 percent of their costs are because of unneeded rules and regulations. If that's the case, we have a tremendous opportunity in this committee and this commission and in partnership with the department to reduce that considerably, and I need your help to ferret out all of those rules and regulations and do the job necessary to make it happen. No matter how small or how large that rule that you find offensive, I want you to put it down.
And, as I understand from Dr.Doug, the Brett Farb of this commission, that you're not bashful at all; and I want you to continue on with that spirit the rest of the summer and give me that final report so that we can make the necessary changes.
The second point, I really believe that the next giant step forward is to do something about the tort system in America. About malpractice, about the tort system. And I want to see if we can't develop a system. I've got other people working on that to develop a no-fault type of system or a Workers' Compensation kind of system or a patient compensation kind of system to take a look at how we might be able to drive down the cost. Look at regulations, look at the malpractice system. You're starting to talk, ladies and gentlemen, about real money. Saving the system, making it better and using the dollars for improving the quality of health care in America.
And the third major area is I would like very much to encourage the Congress to use either the fraud and abuse money that we take in through the department and set up a giant technology fund or find another way to set up a technology fund like the old Hill Burton law that was set up to build clinics and hospitals but to use the capital from that compensation fund, whether it be from fraud and abuse, to start driving a compensation fund that's going to allow for hospitals and clinics to apply for new moneys for technology.
I want to drive the system so that we have a technology system like Mayo has and like some of the other great hospitals and be able to improve it so we get to a paperless system and so one that is going to be one that can be used whether it be in California, in Minnesota or in Washington, D.C., a system that could be used to improve the efficiencies, reduce patient errors and be able to reduce the cost of health care, the health care system.
And if we are able to do our job in those three areas this year and be able to get some support from Congress, ladies and gentlemen, we can absolutely hold down the cost of insurance premiums. We can absolutely improve the quality of health care in America and make it affordable and be able to get more uninsured covered by insurance and allow for companies to expand their insurance.
Those are my goals, and I need your help to accomplish them. And you're doing the big one right now with your work on regulations and rules. And I thank you so very much for that, and I wish you nothing but the best. I appreciate your devotion to the American health care consumer, and I look forward to working with you as we make these good ideas a practical reality.
So with that, Dr.Wood, I thank you so very much for giving me this opportunity. I would be more than happy to take three or four questions if there are some. If not, I'll be more than happy to leave and let you get back to your work because I've got some other places I've got to go to, but those are my ideas and my suggestions.
And I really wanted to come out here to tell you three things. One, your work is very much appreciated. Two, it is going to be taken into consideration; and it's going to be adopted so your work is not going to be lost at all. It's going to be put to good use. It's going to help to really improve it. And, three, what you're doing here has a great bearing on health costs and improvement of the health delivery system in America. And so with that, Dr.Wood, thank you so very much.
DR. WOOD: Thank you very much, Secretary Thompson. We do have actually some time built into the agenda. I can't give you too much, though, because I've got to keep this crowd on a pretty hard task. We already this morning talked about who is going to be standing at 9:00 o'clock tonight for a demonstration project.
We appreciate very much already the passion that you share for our work, and the response that you and your staff have given us in reacting to even our early suggestions is a pretty remarkable example of what that commitment happens to be, so there is no doubt in our mind of your commitment.
We're especially encouraged to hear of your challenge to us for the next phase, and that is to come up with truly radical ideas. And I can tell you that around the committee some of us have been having this discussion, and we intend not to disappoint you in that fashion.
So with that in mind, then let me ask the members of the committee if there are any specific questions that you might have for Secretary Thompson for about the next several minutes or so? Any of you? Lisa? Miss Gigliotti?
MS. GIGLIOTTI: Suggestion on your Point No. 3 regarding urging Congress, many states have best practices working with either providers or their hospitals to, you know, increase whatever kind of information technology there is out there. Billing for safety, patient safety errors. I believe it would be useful to research those in states and show Congress we're not just talking about pie in the ski. These are examples. This is what works. You know, use this as a model, etcetera.
SEC. THOMPSON: Ever since 9-11, everybody that has got an invention or new technology has been in our office.
MS. GIGLIOTTI: Okay.
SEC. THOMPSON: And some of the technology out there is just absolutely mind boggling. It's exciting. And what we can do for privacy and what we can do for expediting the system, what we can do for preventing doctor errors, you know, it's just amazing. And why we don't do it is because we don't have the capital.
And what we've got to do is find ways to get capital into the system so that hospitals and clinics -- you know, there are some grocery stores that have more-- and you've heard me say this-- more technologically advanced than some hospitals and clinics. And that to me is not acceptable. And, what we have to do is -- I know this is a little bit far afield from what you're doing, but those are the three driving forces that we can have such a tremendous impact on improving the quality of health care.
But I, of course, coming from the states know that there is a great deal of wisdom in those venues; but I also know that we have a lot of those individual entrepreneurs coming into Washington to Homeland Security and to the Department of Health and Human Services. And we've had the benefit of seeing some of their wonderful inventions.
MR. TOBY: Mr. Chairman, may I ask a question?
DR. WOOD: Mr. Toby, you may proceed.
MR. TOBY: Thank you. Mr. Secretary, I would like to wish you great luck with regard to the uninsured. Yesterday in Aberdeen, South Dakota, after church I was at a session. A young woman came up me who learned I was in health care. She was about 39 years old with two children. Her husband worked seasonally, and she expressed to me the fact that she has no insurance and if anyone got sick she didn't know in what the world she would do. How could she live in a country like this that doesn't care enough about people like her, fifty million or so?
And just last year I taught in Spain at a University where they have total health insurance. And all they talked to me about was the fact that America is such a great country, but how can it have for forty or fifty million people uninsured? So we should have a government health system that's as good as its people, so I thank you very much.
SEC. THOMPSON: Thank you.
DR. WOOD: Dr.Dennis.
MR. DENNIS: First of all, I would like to thank you for those remarks; and, of course, we've been doing this work. But we do it because we love our country, and we consider this a privilege.
SEC. THOMPSON: Thank you.
DR. DENNIS: What I would like to say, though, is that your second issue related to something regarding the tort system. As a physician and as a neurosurgeon, I consider that very, very important. And, of course, all of us do here as well. Could you give us a little more information about what you plan to do there?
SEC. THOMPSON: I could, but I'm not going to. I want to whet your appetite. I also want to roll it out in its proper forum. It's going to be a hell of a fight, and it's going to have to get through the United States Senate, and it's going to be very difficult. But I want to make darn sure, you know, that we proceed.
Those are the three driving forces. If we can get regulations, if we get malpractice, and if we can get technology, we can do a tremendous amount to change the delivery of health care in America. And I don't want to start talking to you because there are reporters in this room, and it will be in the paper tomorrow, and they'll already beat me up on what I've already told you. And I want a chance to, you know, the opportunity to win on malpractice. It is going to be a very uphill battle, and I don't want to give away any advantages I might have at this point in time. I hope you understand.
DR. WOOD: Miss Ryan.
MS. RYAN: In so many of our deliberations we've been so focused on Medicare and Medicaid, but we've had testimony in a number of the regional hearings about the regulatory constraints around the medical savings accounts. And is there still a commitment on the part of administration to be moving toward infusion of private sector dollars as well through that vehicle?
SEC. THOMPSON: Yes, there is, very much so. And Bobby Jindal is working on that as we speak. And Bobby has done-- Bonnie Jindal, I think you've had a chance to meet Bobby. You should talk to him specifically about his ideas because he's been working on it non-stop on how to improve Medicare and Medicaid; and part of it is medical savings accounts, Medicare+Choice, all these things. Bobby is our thinker on it, and he's got great ideas. Okay.
DR. WOOD: Mr.Fay?
MR. FAY: Thank you for being here, Mr.Secretary. We heard excellent presentations today from representatives of the FDA discussing adverse event reporting as well as the service initiative. And we know as a hospital and health care industry that we can accomplish some of the same good things under the proposed patient safety legislation that's been introduced by Senator Frisk, so I want to let you know that we are really committed to doing what we can to improve the quality.
SEC. THOMPSON: Thank you very much. I can see Dr.Wood wants to get back to work, and I love somebody like that, so good luck to you and thank you very much for giving me this opportunity. I really appreciate it.
(Applause.)
DR. WOOD: We do need to set up for our next panel, and so I'll take about a five- to ten-minute break to allow our staff to get ready for Dr.Tunis and Dr.Feigal to begin their presentation as quickly as possible. And I want to express my thanks to the Secretary and his staff for their tremendous help today. You can see why we're energized as a group.
(Short break taken.)
DR. WOOD: If I could ask committee members to come back to the table. We have a panel we want to do this afternoon on medical device policy. But before we start that, I would like to take the privilege to recognize Mr.Scully for a couple of minutes for comments that he would like to make about OASIS and perhaps to at least respond to some of the Secretary's challenges in any way he sees fit.
MR. SCULLY: The best way to respond to his challenge is probably to find a new job, but John left, I left, Leonard Schaeffer went. I don't know. Those are the guys I know, and I'm not sure if I would get a recommendation from my employer anymore.
But, anyway, just so you know, we respond quickly to the boss's request on OASIS. The Secretary left to go to Toronto yesterday, and we were still working on OASIS, and I came in an hour after him, and he's going to put out a press release this afternoon announcing some pretty substantial changes in OASIS. We're going to do more, but largely from the committee's direction, much less with the MDS reductions.
We have spent a lot of time trying to reduce the OASIS, which is the home health insurance form. Actually, about three weeks ago I actually had a whole bunch of people come in and give me the test, which took about an hour and half, is depressing enough as it was. And then last week I had the extremely talented professor from the University of Colorado who invented OASIS come in and go through with me with this staff, and he almost had heart failure when I told him when I started the goal was to reduce it by 50 percent. And now the Secretary is telling me more.
But, anyway, we didn't quite get to the 50 percent. But we are announcing today -- and this is probably going to take until December 1st to fully implement, and we're going to keep working on it -- we are announcing today that we are reducing OASIS in a number of ways.
First, for those of you who are familiar with OASIS, there are ten different times that you theoretically have to do the OASIS questionnaire for a home health patient. We're eliminating two of those ten. When you first come on as a patient in OASIS, it's difficult to do a significant reduction either when you come on in your first home health visit or when you're finished, whether it's the 1st day or 70th day.
We are going to reduce both of those, the entrance and exit questionnaires, by about 25 percent. Overall, what we're doing today, what we're announcing today is going to reduce the OASIS burden on average for all home health agencies by about 27 percent. So it's the timing. 28 percent of the questions, 20 of 75.
The one that drives the home health aides is the craziest -- and I had this confirmed by visiting nurses from Colorado a minute ago -- is after your first 60-day capitated payment is the renewal process which now you have to go through all the same questions over again. We're taking the number of questions in that survey from 92 down to 25, so from 92 questions down to 25 questions is a pretty significant reduction.
So overall we're going to keep plugging away and working at it. We would have done more. To be honest with you, there is two other major questions. One is, as some of you may know, I'm kind of a zealot as the Secretary on public information. And we did six dates with nursing homes over this year, and we did that based on the MDS date.
There were some other things we could have taken out of OASIS, but we're very interested and in fact are planning to do at least six demonstration states next spring. The cycle we've gone through with publication of skilled nursing facility data was six dates this fall, six dates in the spring. April 15th and all fifty states October 15th.
We're planning to repeat that cycle with home health next year, and we're concerned and the major reason I didn't lukewarm the OASIS data form is that we have to make sure we have the right quality data. If we're going to put out home health quality data, the home health agencies want to be sure we're putting out the right quality data and not putting out half-baked quality data.
So we took down everything that I thought, and I went through this thing for hours, and my poor staff went through for many more hours. Everything we thought we possibly could from OASIS without lessening the validity of our quality samplings. And we're going to keep pushing to do more. But, anyway, we've announced this today. The Secretary didn't have all the details before he left last night. But we are saying we're going to do this today. It is probably going to take until December 1st to actually have it out there, and we're going to keep doing more. And if we can find ways to reduce OASIS even further, we're clearly going to