On July 27, 2000, Congressman Bill Thomas (R-CA), Chairman of the House Ways and Means Subcommittee on Health, sent a letter to his fellow Republican members of the House urging them to "take the temperature of healthcare providers" in their districts to ascertain the true need for relief from the Medicare cuts contained in the Balanced Budget Act of 1997 (BBA). "As the temperature rises during the 'dog days' of August, health care providers in your district may be turning up the heat on Congress about their financial situation and Medicare payments," the letter said. Reminding his colleagues that Congress provided some relief in the Balanced Budget Refinement Act of 1999 (BBRA), Thomas states in the letter, "We are currently considering, and plan to address in September, many health care providers' concerns to assure that the Medicare program remains strong and vibrant for all our seniors...." He enclosed some questions for use in hospital administrators' meetings with health care providers, including "What data can you show to prove your hospital is faring poorly due to Medicare payments?... Are you making or losing money on the Medicare patients you serve? What is your Medicare inpatient margin...? Have any of your competing hospitals closed?" In addition, Congressman Thomas suggests probing hospitals about occupancy trends, readiness for the implementation of the outpatient prospective payment system (PPS), case mix and length-of-stay trends, labor force trends, and a variety of other topics. To skilled nursing facilities (SNFs), Thomas suggests asking, "On average, what percentage of your revenue is attributable to Medicare? What percentage of your SNF's local patient days is attributable to Medicare? How much, on average, does Medicaid pay per day for nursing home care in your state? How much does Medicare pay for each day of care?" Congressman Thomas also suggests asking SNFs whether their residents need more skilled care than previously, whether SNFs are having more difficulty hiring and retaining personnel, whether they are more cautious about admitting high-cost patients due to the SNF PPS, and whether the BBRA's changes to the SNF PPS will help. Thomas suggests similar questions for home health agencies. As Congressman Thomas states in the letter, Congress is expected to consider further BBA relief legislation some time in September.