[Congressional Record Volume 145, Number 130 (Thursday, September 30, 1999)]
[Extensions of Remarks]
[Page E1995]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

[[Page E1995]]



   INTRODUCTION OF THE MEDICARE HOSPITAL OUTPATIENT PAYMENT EQUALITY 
                              ``HOPE'' ACT

                                 ______
                                 

                            HON. RICK LAZIO

                              of new york

                    in the house of representatives

                      Thursday, September 30, 1999

  Mr. LAZIO. Mr. Speaker, I rise today to introduce legislation to 
provide needed relief for our Nation's hospitals seeking redress from 
the Balanced Budget Act (BBA). My legislation, the Medicare Hospital 
Outpatient Payment Equality (HOPE) Act, addresses the Health Care 
Financing Administration's (HCFA) proposal to implement the Medicare 
Outpatient Prospective Payment System (PPS). HCFA's proposal will 
affect a hospital's ability to deliver outpatient services through 
reimbursement reductions up to 30 to 40 percent.
  Under the PPS, in my home State of New York, hospitals from every 
corner of the State would see major reductions in their outpatient 
payments. Hospitals in my district on Long Island would be harmed. 
Hospitals in northern New York rural areas, such as the Adirondack 
Medical Center in Lake Placid will realize reductions totaling 16.9 
percent in one year. Urban hospitals in New York's major cities, like 
their rural counterparts, will witness similar reductions. Mt. Sinai 
Medical Center, one of America's premier teaching hospitals, will see 
their outpatient payments cut by 37.6 percent in just one year. In 
fact, New York's urban hospitals are among the most severely hurt by 
the proposed PPS in the Nation. According to HCFA's own analysis, 19 of 
the top 100 hospitals in the Nation that are hurt by the proposed PPS 
are in New York State.
  Most importantly, the HCFA proposal could harm seniors. For example, 
a Medicare beneficiary living in the most underserved parts of New York 
City receive routine, preventive health services from a local clinic. 
Clinics provide cost-efficient, low-cost, quality care. This patient's 
health care needs, under my bill, would be preserved because the clinic 
would be able to stay open to serve seniors.
  Another example of who my bill helps is the senior living in any 
small town in northern New York. Under the HCFA PPS, that senior's care 
will be jeopardized because of inadequate reimbursements to the local 
emergency room and they may end up having to close their doors because 
of financial reasons. The closest ER, then, may be 100-150 miles away. 
Emergency rooms are not a profitable part of the hospital and require 
adequate reimbursement to care for seniors with emergency needs. If 
this patient needs immediate attention for a heart condition, requiring 
them to travel hours to the nearest emergency room is not a good way to 
provide care. The ERs need to be there. My bill would ensure that these 
ER services are available to seniors.
  The outpatient reductions are due to go into effect in early 2000. I 
introduce this legislation today because we must take steps to ensure 
seniors' access to care. We must address the inadequacies in the 
Medicare outpatient payment system by restoring funds to all hospitals 
so they can take care of our seniors. My legislation would do so 
through several changes.
  First, the Medicare HOPE Act would implement a three-year transition 
to limit losses as a result of HCFA's PPS. Any new payment system must 
include a transition mechanism to enable hospitals to gradually adjust 
to the new PPS.
  Second, the Medicare HOPE Act would increase payments for emergency 
room and clinic visits. One of the ways to help many of the essential 
city, suburban, and rural safety net hospitals with large losses due to 
the PPS is to increase payments for emergency room and clinic services. 
Emergency rooms provide life-saving care that is not available to 
Medicare beneficiaries in any other setting. These services are 
provided without consideration of one's ability to pay and it is 
essential that Medicare adequately reimburse hospitals for its share of 
emergency room services. Also, clinics provide many preventative and 
inexpensive services that monitor and manage the health status of 
Medicare beneficiaries. This results in lower utilization of more 
expensive health care services. Hospitals that have the highest share 
of clinic visits also treat the highest percentage of poor patients. 
For this reason, my legislation addresses the specific, unique needs of 
these hospitals.
  Finally, the Medicare HOPE Act would rescind the annual 1 percent 
reduction in the outpatient PPS ``inflation'' update factor. Without 
this restoration, payments for outpatient services would be reduced by 
an additional 3 percent.
  By introducing this bill today, I join many of my colleagues that 
have introduced or cosponsored legislation which recognizes that 
America's hospitals are heavily burdened by the unintended consequences 
of the BBA.
  My legislation helps all types of hospitals across this country 
because HCFA's outpatient PPS hurts many hospitals across the country. 
The legislation offers a solution for my colleagues seeking relief for 
hospitals. This legislation is endorsed by the American Hospital 
Association and several State hospital associations including the 
Healthcare Association of New York State.
  I urge all of my colleagues to join me in cosponsoring the Medicare 
HOPE Act.

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