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B-199563 1 (1980-07-16)

handle is hein.gao/gaobabjuq0001 and id is 1 raw text is: I B-199563 .We understand the need for the study required by section 554(b)(2) to resolve the longstanding issue of the appropriate basis for payments to hospitals for the costs of providing routine nursing care to Medicare beneficiaries. We wish to call to your attention, however, factors that will affect our ability to carry out the study or to fully meet the study's stated requirements in the allotted time. The study called for would require extensive onsite work sampling at a sample of the approximately 7,000 hospitals participating in the Medicare program, followed by analysis of the data acquired to determine the extent to which differ- ential payment may be justified. Our preliminary estimate is that a study designed to measure, with an acceptable degree of reliability, the justifiable average aggregate differential (without breakdown of providers classified on the basis of type, size, location, patient characteristics, etc.) would require work sampling studies at about 75 hospitals on a 24-hour basis for about 14 days each. This effort would require about 300 people for about a 3-month period at a cost of about $4 million. If adequate resources are available to us, we can complete a study of this magnitude by April 1, 1981. Such a study could provide some insight into whether or not it is likely that any justifiable differential would vary by different classifica- tions of providers (by size, type, location, patient charac- teristics, etc.); however, without additional data collection and analysis, the existence or amount of such varying differ- entials for different classifications of providers probably could not be rigorously confirmed or measured with an accept- able degree of reliability. If we were to complete the study by April 1, 1981, there- fore, it would be our intent to determine with an acceptable degree of reliability the justifiable average aggregate dif- ferential on a nationwide basis, and then consider, in consul- tation with the appropriate congressional committees, whether further study of the issue and refinement of the measurement o/f the differential should be undertaken. Clearly, the study we would intend to do would be a major undertaking requiring considerable resources. The bulk of these resources would be expended in collecting data at a sample of hospitals, a task which we believe could be accom- plished more economically and effectively with contract assis- tance under our direct supervision rather than with our own professional staff.

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