On February 26, Linda Brady, M.D., President and CEO of the Kingsbrook Jewish Medical Center and Vice Chair of GNYHA's Board of Governors, testified on behalf of the American Hospital Association at a hearing of the Small Business Committee of the U.S. House of Representatives in Washington, D.C. The hearing—"Improving the Paperwork Reduction Act for Small Businesses"—was chaired by Congresswoman Nydia Vel‡zquez (D-NY) and was called to determine ways to remove excessive paperwork burdens for small businesses as a result of Federal rules and regulations. 
     
Dr. Brady pointed out the devastating impact of the President's budget and proposed Medicare and Medicaid cuts on hospitals nationally, including his proposed regulations eliminating Medicaid graduate medical education payments for teaching hospitals. She pointed out the considerable new paperwork and administrative burdens placed on providers following the shift from Medicare fee-for-service to Medicare managed care, and she outlined the duplicative nature of Federal audit practices. Specifically, the Centers for Medicare & Medicaid Services conducts six types of activities to protect against improper payments, waste, and fraud and abuse: cost-report auditing, medical reviews, benefit integrity, Medicare secondary payer reviews, provider education, and matching Medicare and Medicaid claims. Dr. Brady pointed out that quality improvement organizations, fiscal intermediaries, Medicare administrative contractors, carriers, program integrity officers, and recovery audit contractors (RACs), among others, are all tasked with carrying out these activities to one degree or another. While each contractor has an individual Statement of Work, their tasks often overlap, meaning nurses and coders must pull patient charts time and again and go through a repetitive process. The RAC process has been particularly challenging, as the RACs have had little experience with the Medicare program and, thus, have required countless hours of hospital staff time to respond to RAC requests. 
     
Dr. Brady also outlined a number of other Federal rules and requirements, including quality reporting, that add burdens and costs for financially strapped health care providers. To view a full copy of Dr. Brady's testimony, go to www.house.gov/smbiz.