The House Committee on Energy and Commerce, House Committee on The House and Senate Committees on Appropriations: consideration of The House Committee on Interior and Insular Affairs: hearings on Requested by: House Committee on Energy and Commerce, and its Subcommittee on Health and the Environment Senate Select Committee on Indian Affairs Projected Delivery Date to TAB: December 1985 PHYSICIANS AND MEDICAL TECHNOLOGY: USE, COST, AND PAYMENT METHODS Physicians directly or indirectly account for an estimated 80 percent of expenditures on medical technologies. Efforts to control the use and cost of medical technology have concentrated on hospitals, as evidenced by the current approach under Medicare to pay hospitals according to diagnosis related groups (DRGs). But attention is increasingly turning to physicians, because as gatekeepers, they control much of technology use and because technologies may move out of locations where payment is constrained and into physicians' offices and other ambulatory sites. And Medicare expenditures on physician services have been growing more rapidly than hospital care. In accordance with a provision in the Deficit Reduction Act of 1984 (Public Law 98-369) the Office of Technology Assessment is examining alternative methods of paying physicians under the Medicare program, with particular attention to the use and cost of medical technology. Congressional committees are interested in relative fees for different technologies and different physician specialties, incentives for the use of primary care and other technologies, moderation of increases in Medicare expenditures, participation of physicians in Medicare, access to care by Medicare beneficiaries, and quality of care provided. This study is examining current patterns of physician expenditures and use, identifying areas of inefficient or inequitable technology use for Medicare beneficiaries, and developing options for physician payment under Medicare to address the problems identified. Legislation: Consolidated Budget Reconciliation Act of 1985 (s. 1730) includes an 121 о H.R. 3290 contains provisions to: establish a commission that would Related Legislative Activity: The Senate Committee on Finance, the House Committee on Energy and Commerce, and the House Committee on Ways and Means: hearings and oversight activities on freeze on physician charges under Medicare; on changes in Medicare payment for physician services, including payment of inpatient physician services by diagnosis related groups; on Medicare expenditures for medical technologies and physician services, including preventive care; and on risk-sharing HMOs and CMPS contracting with Medicare under provisions of the Tax Equity and Fiscal Responsibility Act (TEFRA). The Senate Special Committee on Aging: hearings on HMOs contracting with Medicare and on Medicare expenditures for medical technologies and physician services. Requested by: Mandated by Public Law 98-369 Senate Select Committee on Aging Projected Delivery Date to TAB: December 1985 TECHNOLOGIES FOR DETECTING HERITABLE MUTATIONS IN HUMAN BEINGS Mutations are permanent changes in the genetic information contained in chromosomes and DNA of cells. When they occur in germ cells -- egg or sperm cells they are passed on to succeeding generations. Always a concern in public health, mutations are becoming a policy issue because of claims that they have been caused by exposures to radiation and chemicals. Little is known about the frequency of human mutations, and evidence is insufficient to decide whether or not external factors contribute in any significant way to the frequency despite the reasonable contention that they probably do. Technologic breakthroughs may make it possible to determine mutation rates directly. The new methods require drawing blood and analyzing proteins or DNA or a particular gene for genetic changes. The assessment is: 1) detailing the status and limits of knowledge about human mutations and mutation frequencies; 2) reviewing the current methods used to study human mutations; 3) describing methods now under development and being considered; 4) estimating when each of the new methods might be available for studying human populations and the size of the 5) developing policy options to spur the research and application of appropriate methods. Legislation: Reauthorization and continuing oversight of Federal Insecticide, Reauthorization and continuing oversight of Superfund and related Toxic Substances Control Act Requested by: Senate Committee on Veterans' Affairs House Committee on Science and Technology Projected Delivery Date to TAB: December 1985 TECHNOLOGY AND CHILD HEALTH The This project will bring together the current evidence on the effectiveness and costs of health care technologies in promoting and maintaining children's health. It will examine current patterns of availability of these technologies and barriers to their appropriate use. role of Federal policies, including Medicaid, Maternal and Child Health, and the Women, Infants, and Children (WIC) program, in providing access to preventive and therapeutic technologies will be examined. A range of illness prevention and therapeutic technologies is available at every phase of childhood and the prenatal period. Some, applied in the prenatal period, can reduce the risk of neonatal mortality and morbidity; others, applied later in the child's life, may prevent illnesses that typically manifest themselves in adulthood. New medical technology has also transformed formerly fatal childhood diseases into serious chronic illnesses, whose victims remain technology-dependent for extended periods of time. It is often feasible for these children to be cared for in the home, provided the financial and supportive resources are available. The availability of these life saving technologies raises questions about the private and public financing and organization of services for this small but growing population. This project will emphasize study of illness prevention technologies, including non-medical technologies such as promotion of safe behavior (e.g., seat-belt use) and improved nutrition. Among the preventive technologies to be considered will be prenatal screening, monitoring, and care; infant screening; immunizations; and early-childhood screening. Therapeutic technologies will include neo-natal intensive care and pediatric home care for technology-dependent children. Legislation: O S. 376: preventive health care services for children H.R. 3128: expanded Medicaid coverage for pregnant women and extended optional coverage for children; health and Human Services The Senate Committee on Labor and Human Resources: hearings on home care for children; further hearings are expected in Fall 1985 on child health issues, especially prevention. The Senate Committee on Finance: introduction of S. 376 to require businesses to include children's preventive health care in their employee plans as a requisite to make insurance premiums tax deductible. Requested by: House Committee on Energy and Commerce Hon. John D. Dingell, Chairman Hon. Henry A. Waxman, Chairman, Subcommittee on Health and the Hon. Edward R. Madigan, Ranking Minority Member, Subcommittee on Hon. Thomas J. Tauke Senate Committee on Labor and Human Resources Hon. Orrin G. Hatch, Chairman Senate Committee on Finance Hon. Bob Packwood, Chairman Hon. Russell B. Long, Ranking Minority Member Projected Delivery Date to TAB: March 1987 ALTERNATIVES TO ANIMAL USE IN TESTING, RESEARCH, AND EDUCATION Approximately 17-24 million animals are used annually for both toxicity testing and biomedical and behavioral research. In a large percentage of cases, these animals are killed during the course of, or following the completion of, the experimental protocol. Toxicity testing and biomedical and behavioral research are two very distinct disciplines, and animal use and its possible alternatives must be examined in light of their differences. This assessment is examining the current patterns of acquisition and use of animals in the distinctly different disciplines of toxicity testing and biomedical and behavioral research. In addition, the feasibility and cost of developing technologies that could potentially substitute for animals in either of these areas are being evaluated. Since toxicity testing employs about 20 percent of all laboratory animals used annually, OTA is also analyzing regulatory testing requirements in both the United States and selected foreign countries to determine whether they can be made more uniform in their acceptance of non-animal test results. Finally, this study will briefly summarize the ethical issues concerning animal use in order to help understand the reasons for the current controversy. Senate Committee on Labor and Human Resources House Committee on Science and Technology, Subcommittee on Science, Recent technological advances in the treatment of chronic disease and acute illness, combined with greater access to such care, make it possible to keep persons alive who might never have survived in the past. One result is that more older persons than ever before are surviving to the oldest ages (75 and over). These advances, however, are accompanied by complex legal, ethical, and financial issues concerning the definition of death, appropriate use of life-sustaining technologies, quality of life, patients' rights, surrogate decisionmaking, and the allocation of federal resources. Data indicate that up to 30 percent of all Medicare reimbursements (more than $57 billion in 1983) are made for care of older Americans in their last year of life; half of all nursing home costs are paid by federal Medicaid dollars. This assessment is examining these technological advances and their implications for the elderly. It will: 1) provide a classification of lifesustaining technologies and describe their development, including prospects for the future; 2) evaluate different technologies that are now applied in different situations and settings (e.g., end-stage renal dialysis, resuscitation, ventilation, alimentation, etc.); 3) describe the elderly subpopulations that are affected; 4) review ethical problems in different settings and situations (hospital, nursing home, residence); 5) evaluate the ethical issues related to patients' rights; 6) present data on attitudes toward life-sustaining technologies and patients' rights (professional associations, groups representing the elderly, surveys of the public and health care providers, etc.); 7) review methods for determining mental competence and surrogate decisionmaking for the demented elderly; 8) evaluate federal and State laws regarding patients' rights, surrogate decisionmaking, living wills, etc.; and 9) review data and issues concerning federal and other public costs related to current and potential applications of life-sustaining technologies. Interim Deliverables: Surrogate Decisionmaking (Background Paper) (shared effort with |