i would caution that observation reform to enforce observation rules. the society looks forward to working with the committee and identify workable solutions to problems mr. chairman, members of the committee. i'm a senior advocate for the center of advocacy. the center is a nonprofit, nonpartisan public interest law firm based in connecticut that provides education advocacy and legal assistance to medicare beneficiaries. we are very please today be invited to testify today about the impact of medicare patients of outpatient status and observation status. six years ago, a woman called our office with a medicare problem. the facility told her that

medicare, part a, would not pay for her stay because she had not been an inpatient in an acute care hospital for three days. she asked how that could possibly be true. after all, she had been in the hospital for 13 days. it turned out that the hospital had called her an out patient for all 13 days. the wisconsin woman had no way of knowing she was an outpatient in observation status. she was in a bed in the hospital for 13 nights. she had diagnostic tests, received physician and nursing care, medications, treatment, food, a wristband. her care was indistinguishable from the medically necessary care she would have been given if she were formally interviewed. even the patients and nurses providing care to her didn't know whether she was an inpatient or an outpatient. and the hospital was not required by cms rules to inform her that she was an outpatient or the consequences of that status.

but solely because she was called an outpatient in observation status, medicare, part a, did not pay for her post-hospital care. medicare limits came for hospital patients who are called inpatients for three consecutive days, not counting the day of discharge. what we call the three-midnight rule. in the past six years, the center has spoken with literally hundreds of families all over the country with similar experiences. it's a very rare day that goes by that we don't hear from one person and usually more. i would like to describe the more recent case. as her father was being wheeled into the operating room, the hematoma burst. he remained in the hospital for

four midnights, all outpatient. from the hospital, he went to the skilled nursing facility for rehabilitation, stayed for 18 days and went home. medicare pays for everything that the patient needs. medicare pays a hundred percent of the cost for the first 20 days and, beginning on day 21, the resident pays a copayment up to a hundred day maximum number of days in the benefit period. but because her father had been called an out patient, medicare part a did not pay. the man had to pay the sniff charges for room and board, the charges were $4,573 for the 18-day stay. in addition, he had to pay medicare part b copayments for

all of the therapy he received daily and he had to pay for his prescription drugs ft administrative law judge found that the man's primary care physician supported an inpatient physician and she also found that he had not been informed of his out patient status. never the less, she upheld denial of part a payment for his sniff stay solely because he was, as she described him, hospitalized as an outpatient. obviously, from the perspective of patients and their families, what is happening makes no sense. when patients need to be in the hospital for the diagnosis and treatment of acute care conditions and when they're getting medically necessary care they need in the hospital for multiple days and nights, they do not understand why they're called out patients and why their care will not be covered. you've heard from physicians and hospitals this morning why calling hospitalized patients is causing hardship for them. some of the issue that is we've been discussing are very

complex. but the move is simple and straight forward. as of last week, there were 145 co-sponsors and the bills are by partisan. we urge the committee to quickly move on this legislation as you consider these other, far more complicated issues. >> thank you all ffr your testimony. do you think you view the rack's disproportionately target high-value inpatient claims. >> yes. in the appeals of those, do you

know the true cost? my assumption is i value claims more complex. there's more of the file term. you're obviously bringing in medical professionals as well as the appeals process chlts. >> we actually, as a permanent part of the program, we actually went through the process to estimate the cost of an individual appeal. you have to add into that all of the costs associated with the medical record requests, the issues in terms of loading this into sochtware and then you've got 50% of those that may be denied. so then the tracking and everything that goes along with that. so there is all of that prior work. and then there is the estimation

of time it is for our nurses to review the case. >> what do you think that cost is? we estimated it was about $2,000 an appeal. at the first and second level. but when you get up to the alj level, that requires another add-on because you need attorney support with that, as well as physician advisor support during that time. >> we, as a house system, spent about $4 million just gearing up for the rack process to add on additional personnel it would take to manage that process. >> is that compliance in-field?

>> just tracking the whole process as well, as software. >> thank you. do you have an estimate on the cost of appeal? on a high value? >> i don't have an estimate, but i can say the resources our hospital puts forth in the whole auditing process, we have multiple case managers that their entire job is to determine status. the numbers of staff can calculate that this is a costly endeavor to our hospital. >> did both of you hear mr. cavanaugh describe one solution to out lying approach? do you have a view of whether that helps? hurts? doesn't solve the problem?

>> i think cms did intend to fix a problem in observation status and recognize the current observation policy. i think now we see that there's issues and we would hope that there's more consideration of policies going forward. a very short stay, a patient of very clinical needs prior to going forward. we would also strongly advocate for a pilot. >> i would agree with that. one of the statements that was made earlier is there was

disparity of observation stays. there was a period of time to determine whether or not the patient needed hospitalization as an inpatient or could be sebt home. by the time they need to be admitted, sometimes those patients turn around in less than two days and we should not be penalized for being efficient in our ability to manage those patients as an inpatient. >> thank you. you made a point that grew my atechx.

>> any idea what percentage of the report of decline that might represent? >> we don't have data that would indicate what portion are not readmitted because of observation. nobody has ever brought up the hospital readmissions issue. but we know that is now in effect and it obviously has some impact. if somebody returns to the hospital as an out patient, that does not count as an inpatient. >> dr. evans, when there are costs associated with the hospital payment, especially in high-value, inpatient claims, and they are overturned the rack returns commission? >> that's correct. >> do they share in the cost of

that appeal at all? >> well, the cost of our work doing that appeal and the work doing the review, initially. >> having lost that claim, does a rack reimburse some portion of the costs? that's the financial penalty that occurs. there's not a payment for any of the costs of the hospital. so i'm not aware. >> the impact is you return the commission and you don't share in the cost of the lost appeal. >> we pay our portion of attending the appeal. >> we pay our portion of attending the appeal and the provider pays their portion of attending the appeal. win or lose, that's how it's done? >> thaekt. so when we win, there's not any difference, either.

>> and i'll finish with this. listening to testimony today, there are a nice number of short stays that may be problematic. did cms ever intervene to quickly and easily solve the problem of the short stage drgs? >> the intervention has been to stop the short-stay reviews with a two-night rule. i think what we've heard said today is there's a lot of difference across providers and their rate of improper payment. and i think we've also seen that -- this set. and we've also seen discussion that we feed to look at where we go forward. for instance, cms is posing the project that we have a variation

in the amount of medical records reviewed, based on the providers' outcomes. if we have a provider with a very low rate of improper payment, we would expect to decrease. if we have a provider with a higher rate, we would expect to increase that going forward. so i think what i would say is we want to collaborate with you and i think this opportunity to share information is very good and i look forward to be involved in continuing this sort of information exchange. >> thank you. >> there was a senator who said there are a lot of simple answers around, but we need a great complex filler. the fact is we have a very complex question here. the next level is going to be, it seem fos me, even more complex. you've all agreed that the

patients get treated the same. the patient get what is they're supposed to get. so what we're discussing here is who pays how much to whom? it's a question of whether the beneficiaries get more or the hospital gets more money. one of the issues that's come up here is one that i'd like to hear your thoughts about. people are suggesting that we roll our part a and part b together and that that somehow will eliminate or alleviate something in this whole process. i'd like to hear from you as a patient advocate what you think will happen to beneficiaries if we roll the a and b together but

specifically, in this outpaishlt observation status. we don't want to take it another step that takes it even first. so give me your ideas. >> thank you for that question. >> they also prohint policy that is provide first dollar coverage. so the consequence is that these combined part a, part b obligations would shift costs to the patients. the idea of that is, in fact, to make people pay more out-of-pocket on the asuchgs that there will be more careful health care consumers.

but what we know will happen is people will avoid medically necessary care. they really cannot ford to pay more out of care pocket. it's been a number of decyberthat is we've seen. medicare advocate submitted a statement about concerns, about the medicare redesign proposals. i'll be happy to submit that for the record. >> how would the rolling of the two together affect this whole question of observation vers versus -- or there would be no question anymore.

it would just be a patient and a system. >> it depends upon how the specifics of the redesign work and he wouldn't have to pay right now. >> does the three-day stay have to be there? >> that's been approved. if they're in the hospital and the hospital calls it an observation, they do not get the credit for going into the nursing home? >> they do not get the three midnights do not stay. the woman who was in wisconsin for 13 days, consecutive days,

as an outpatient, did not have the three-day qualifying inpatient stay. >> and rolling part b together would not change that? >> wouldn't change the three-midnight rule. that is still there. >> how would you design -- you know what we're trying to do? how would you design what we should do at this point. nobody -- everybody's saying we should call a committee together or something. i'd like somebody to put something on the table and say if anybody has an idea, what we should do in this situation, i'd like to hear it. it doesn't deal with whether observation makes sense or doesn't make sense. it doesn't deal with recovery auditors.

when medicare was enacted in 1965, the avenue rachblg stay was 12 plus days. the average length of stay now is five plus days. so it's really not -- the three-midnight rule is a problem. >> ms. deutschendorf, in your testimony, you basically say that the two-mid night policy bands the medical test when determining the aploep rat session of care. and, instead, opposes a rigid time base. can you e lab rate or expand on that a bit? >> so, for our providers, what happens now is the patient presents to the emergency department and now they're faced

with this question, do you expect that the time this patient will require hospital services will be greater than two midnights. or whether they would need to be hospitalized for up to 48 hours. a lot can happen in 48 hours. and what we have found since october 1 is that we have tripled the amount of patient who is have started out as an outpatient and has been convert today an inpatient. in fact, we got it wrong. patients present with a myriad of problems.

there's no way of knowing that. and we're doing the right things. they now have to run around the hospital we have been instructed by cms that they will be con verted, even if it's in the next few hours. it's a difficult policy to implement and has required a lot of financial increases as a result of that.

>> koild i have the other three of you please give us your thoughts. what specifically change was and what kind of new methodology ought to be employed so that there's a fairness, an equity in a short stay. >> thank you for that question. i think it's a very difficult question. a simple answer is difficult to give. i think getting back to the principles of observation being a triaging definition, it was always meant to be whether someone need ed more hours. i think we need to come up with a methodology that respects that definition.

how i can explain that to that patient, that they are an outpatient. getting back to the heart of what obama ser variation mean social security what we need to focus oncoming up with a new policy. >> i think we will see the unintended coops kwenss. i think we'll better understand how a policy should be audited. hospitals across the country are not investing a lot of money on a whole new plan that has a lot of issues. >> as far as from the rack

perspective, again, i think the collaboration, the discussion, is very good. i think the idea that some changes can be made would be good. i'm very interested in this. personally, if after the meeting you wanted to talk to me as a taxpayer, i'm a physician -- >> you don't have heart palpitations right now? >> no, i love this. i think it's really excellent to have this discussion. that's what i'm doing this work for so that this would happen. and i'm running over. i just want to say i've been medical director at the nursing facility and now at the hdi. i've got a lot of ideas, but i think we would support this type of reform and offer discussion and support. >> thank you, mr. chairman. i want to thank our panelists for excellent presentation today. i've had the opportunity back

home to visit the dw hospital system and have always been impressed with the quality of out come and measurements. you're probably sensing a source of frustration. we're listening to you trying to thread the needle. as policymakers, we're going to have a hard time being able to provide direction at this level of expertise or knowledge that's required of it. it's really the kind of frustration we have with the overall health care payment system that we have in our country today. many of us have been pushing hard to move to a more quality reimbursement system.

we're going to release a heck of a lot of innovation. knowing what those benchmarks are, where those measurements are and figuring out a way to meet them. there are only a few options that we can go down the road with. one is greater cost shifting. we see those pushing those hospital cuts out for those infinities, at this point.

no more technical decisions for patients and providers alike. we're not going to have observational status trying to figure out what the best policy is in addressing it. >> thank you for the question and for all of the work that you do for the state of wisconsin. i think it is very complicated. i think as hospitalists, we're trying to figure out exactly how we fit into that payment model. going forward, i think, you know, i'm from a small town in wisconsin, as well.

i think if we could get back to thinking about these are medicare patients. they've worked their whole lives. and what is the right thing to do for them? e think we're going to find those solutions. >> i am concerned about the impact. yet, within the medicare system itself, we've seen payments come down dramatically in recent years.

>> the cost-shifting in the orb ser vags status is considerable. and we know that some people really do not have the must be to pay for the nursing home cost care out-of pocket and then they go home. medicare is not paying for the nursing home, so we've heard of a nephew being asked to bring a check to the nursing home today for $7,0000 for his aunt to get care. people are doing that. they need to get the nursing home care. it's having a tremendous act on families trying to pay these high costs. the average private rates are only $250 a day.

i was in a nursing home in boss ton last month and the private rates for $450 to $480 a day. most people can't pay that. i happened to introduce the administrative and relief payments act. have you reviewed that bill? can you reflect on that at all? >> i have not. but i would be happy to respond in writing. do you believe that medicare beneficiaries are very familiar with financialsing or the

various -- i mean, we've heard a lot of technical things there. i started keeping a list here. how familiar are seniors with that type of thing. do you believe that there is a cost to that? given the existence of that disconnect with paishlts and i don't believe we could expect them to be intricate with the details. is there any possible way that just to have a system to wear

they certainly thought that they were an inpatient. what do you think the alternatives should be. >> some people in a couple of states have passed laws, maryland and new york, requiring that people be informed that they are outpatients and love the consequences. unlike medicare systems, they don't have an opportunity to have to coffin test.

there's an immediate appeal to a representative of the medicare program to make a decision in observation status. there is no due process right for the medicare patients. so giving them information is helpful, but we also need to give them an opportunity to say i should be called an outparent. >> would you agree that the more the government has gotten involved, the more expensive health care has become? >> i don't know if the cost of the government has been the cause of health care becoming expensive. certainly before the government was involved, a lot of people didn't get health care.

>> mr. chairman, i'd like to just make a couple of points in response to my friend, mr. roscam's comments in the last panel about state budget neutrality, which is interesting to define. and how it affects what it's talking about. i'd like to point out that the permanent adjustments have always been bassed on the national budget. always. so this includes a justice for access. ironically, there are 53 critical access hospitals in mr.

roscam's state of illinois. they have run into problems with the way they were classified. in your experience, do beneficiaries generally know whether they are classify ied a inparkts or under observation status? in your experience. >> most patients do not know that they are in observation and the medicare program does not require hospitals to tell them. >> do they have a right to know that? >> they should have a right to know it, yes. they should. >> now, when do patients generally find out what their status is.

>> usually, at the time of discharge. >> when they don't pay their bills. >> you mentioned earlier observation status is particularly problematic in a skilled nursing facility after leaving the hospital. because medcare won't cover these services unless a patient has been classified as an inpatient for at least three days? am i right so far. >> yes. >> ms. eddelman, in the cases your organization has handed, what is happening to observation status patients. in need of care at a skilled nursing facility. after leaving the hospital.

tryings to appeal between the administrative process. but many of the people that i've spoken to do not pursue the appeals. they give up. it's just too complicated. too time consuming. they give up. >> are any of these seniors paying out of pocket? >> yes, and their families are, as well. sign seniors, anybody, has a right to know what status they're in, what that implies and how much it's going to cost them eventually if they don't

get out of that status. i think that this is sooers business. when a patient enters the hospital, they're either classified as observation, they'they not admitted. there's all kinds of things. we're putting in classifications. why? because we don't want to be penalized if you're in the hospital. again, i'm not blaming the hospitals in that sense.

it's one of the reasons why i introduced the bill that requires a secretary of hhs to adjust the payment methodology. this will make a difference across the country. we need to make sure that there are patients in the hospital that are going to come back to the hospital. and those pashlgts are being penalized. i still have a problem with a patient who should be going

directly to the nursing home, but we have another policy that says you have to go to the hospital first and spend three days. and then that person go there, spends three days, they don't know whether they're observation or inpatient. they come out, they go home and then they're penalized. now, there are some patients that have to go to the hospital. i question paying going to the hospital for three days versus going into the nursing home where the avenue advantage stay is around 27 days. quite frankly, it doesn't make sense. we're spending money that's not necessary. i would actuallily -- do you

think the elimination of the three-day hospital setting is a good policy? the lekt of stay in hospitals has gone down so much, the three days is a length of portion of what time people do spend in the hospital. the long term care commission endorsed elimination of the three-days stay. >> so this is where as congress is at the top end of the discussi discussion, this should certainly be part of the discussion. we want to make sure that there's not a lot of gaming in nursing homes. we want to be careful of that possibility. >> i don't know if there's anyone else that looks at hr 48.

we shouldn't have an adjustment for those. is there anyone. >> i am responsible for the johns hopkins health system in our hospital. we have been at this for four years and we've been working really, really hard to implement all of the strategies that were suggested in the demonstration projects. and in an academic center where we take care of some of the sickest patients in the country who are transplants, we have not been able to move that ball.

it's all about numerators and denominators. so having that bill with taking out transplants and end stage renal discussing disease, substance abuse and psychoses and some of the other things would would certainly help us. it's very important that we share this responsibility six years. >>. >> thank you, mr. chairman. my rule rural hospitals, in particular. >> >>. >> >>. >> are strug ming. as many rural new york hospital, jones has limited resources trying to keep costs down to the overall health care as much. and then she goes on, in 2012, jones began receiving draft program audit notices. the case is dated back to 2009. they received a total of 240 inpatient claim denials. to date, joan has appealed and won approximately 197 of those claims. of the 240 claims, 18 were not successful on appeal.

so pretty good outcome. make sure that someone is here majority of the time to ensure compliance with the two mid night rum. we we have three billing and medical records staff that spend their time on appeals. the dollars for the hospital are unsustainable. now, when i hear eva write me that letter and i know eva very well, eva does a great job there at jones memorial. my concern is this. how are these rural hospitals going to sustain themselves if they have to take on those administrative cost burdens that we just articulated there and keep the doors open and comply with this complexity coming out of washington, d.c. do you share with me -- anyone on the panel disagree with me? that, in particular, our rural

hospitals are at a distinct threat as a result of the burdens out of this ambiguity? >> i can answer that question. my primary practice is at university of wisconsin which is a tertiary care hospital. it's a small hospital. i agree with you. i think that the burden on smaller hospitals 1 enormous. i also think a lot of these smaller hospitals have contracted with -- there are private companies now who will actually do what you have described. i think the cost is enormous. it's staggering.

>> those are dollars that other wise could be going to the community as opposed to complying with administrative burdens. they have essentially five full-time workers. how can we do better? >> i just want to say one thing. that hospitals are spending an enormous amount of time and money trying to make these inpatient, outpatient decisions. the first thing we do is buy a proprietary computer program and then hires staff to make decisions. the ad hoc coalition supporting hr1179 did a survey of their members. three quarters of the hospitals reported hiring staff just to be making inpatient, outpatient

medical necessity decisions, a third of them had spent more than $150,000 a couple of years ago on that staff. and then, they're also using an outside secondary reviewer. a company that we know of used to report on its web site how many medical necessity cases they had done. since 1997, they've done four million. that is a lot of money to go out of the system, outs of the medicare system, which should be designed for providing care to people. but it's only to make the decision whether people should be admitted as inpatients or called outparabltients and the is identical. it makes no sense. >> my balance is expired and i thank you for that input. >> thank you, mrs. black. thank you for allowing me to sit with the committee and ask questions. i want to go back to the issue of the aljs and the amount of

overturned cases. and we just hear -- i know this is a complex situation. and we hear these numbers that keep floating around and there is a report that i want to submit for the record. general, the improvements are needed at the administrative law judge level of medicare appeals. there are some good pieces in here, as well, but dr. evans i want to start with you on the question. our members are hearing, at least 70% number, that the providers win these appeals at the alj level. i understand there's two different ways that the alj adjudicates cases and can you explain how the view of the overturn rate, and how the numbers can be deceiving when looked at out of context? >> yes, the report that you have are from 2010. it is good it's brought up here, i think there's further

investigation of the data that can be done among the different experts like oig and et cetera, at that time, we were getting no information from the alj hearings. we were not hearing and we were asking about them. what we found out was they were 89%, 90%, i can -- they were huge numbers that were on the record. the on the record is a high overturn rate. it's pretty much they are all overturned. all of the contractors across the cms have data that shows that and in fact cms did a study with one of the contractors where the attendance of cms at the hearing makes a difference in the outcome of those hearings. where the medicare rules and regulations and the medical record compared to the claim is reviewed. so, i think it's an area that we can be looked at. but i think that is part of the difficulty, if you look at the last study.

the 7% overturn across the board is the last data that we have. >> could those who are providers weigh in on this from your perspective at well, the cases that get to the alj level? >> thank you for the question. we have little data on the alj level 3 appeals at this time. the majority of our appeals are turned over in level 1 or level 2. i will just comment that i think the 2010 data is, i think, the rac process, and observation care has evolved enormously in the last four years that i think it's worth looking at a new set of numbers and data. we know that the rac recovery rate for back to the government has increased, we know the number of rac audits has increased that is why there's a hold on further audits and appeals.

we know it's a lot due to rac denials. and so i think we really do need to look at a fresh set of numbers before we start thinking about a 7% number. i can speak on behalf of our hospital, we appeal everything and win almost everything. in our last year, we appealed 92% of the audits that the racs made and we were winning 2/3 of them and the rest are in level 1 or level 2 of the appeals. i think there's a lot of hospitals out there that are similar. >> that's good piece of information, thank you so much. others want to weigh in to that? >> so, we do not have any, we have ten cases at the alj level that have just made it there, and part of that has to do with the delay in the actual recoupment. we were able to take 239 cases of our 430 some denials directly for discussion.

and we took -- we spent a lot of time preparing with legal, and also with our physician advisers and went straight to the medical directors of our rac and 135 of the cases were overturned just at the discussion and remainder of those are in the appeal process now. that's a 55% overturn rate just at the discussion level. i just want to say one other thing. we had 108 cases denied for intensity modified radiation therapy. all 108 of those cases were overturned at the discussion level. again, because they were medically necessary services that the rac was really not able to understand why these cases were brought forward. >> thank you, and mr. chairman, thank you so much for this hearing. it just seems to me that one of the things that i have learned from this hearing is that this certainly needs to have more

oversight, more investigation to find out just how the program is working because i am so concerned as being a nurse for over 40 years that the care that we are giving and, doctor, please every time you give testimony, use the example of a diabetic, it's so compelling to make the case how you just don't know what the patient will need when you receive them into the hospital. thank you so much, mr. chairman. i will look forward to more hearings. >> thank you. an inquiry, again, thank you for all the witnesses. in the first panel, again from dr. evans we heard repeatedly, the audits are not a problem. 94% are not appealed and those that are, half are overturned and percentage wise it's a small amount. not a big problem. that is at odds with what we hear from the local hospitals in a major way. and what i think i just heard from the doctors, is that that

is old data. that current appeals are much greater than that. and the overturn rate is substantial as well. and while they may be a small percentage, these are more of the high value claims. so, proportionally more important probably more expensive to appeal. is that correct? and in a nutshell? what else -- what other perspective should we bring to this? >> i think it's a correct assessment. another data point, one of the numbers they cited which i think it's why it's old data, they said in january of 2012, the omha was hearing about 1250 appeals a week. and at the end of 2013 they were getting 15,000. so i think the rate has just accelerated over two years and i think that number tells you how

audits have changed, how our practice has changed. >> the inspector general's report was from '10 and 2011, so, that is what you are saying? >> so, i would agree with that. that the appeals have mounted as hospitals have been able to change their processes and also, that they have regress utilization processes. we in our compliance program, we self deny almost $4 million a year in medicare days that we feel we cannot justify for medical necessity. so, we feel that anything that we appeal is justifiable. anything that is denied by rac we appeal. >> i'm like you, a bit confused from what i'm hearing here.

it seems that what you are saying is that the racs operate like the fishermen in my district. they go out and throw a great big net and they bring in -- that's where the 12,000 -- you jump from 1500 at the end of one year to 12,000 in the next one. and they caught a lot of stuff in there, most of which turns out to be not justified. is that -- is that -- because they are going on volume, you are saying that they are going on volume and they have a lot of bi-catch and they have to throw it back because it does not work. >> that's exactly right. they cast a very broad net, and what is considered improper we respectfully disagree that they are not improper payments, so we appeal all of them. we appeal 92%, it's almost the same as what the doctor said. >> thank you. >> if i could say one thing,

it's so complicated for hospitals to do the appeals, you can imagine what it's like for the beneficiaries to do it on their own. there's a gentleman from chicago that i talk to every couple of months. he is in his 80s and he is homebound, he was describing his cancer and the therapy he is having and he is trying to do the appeal for his wife. it's difficult for beneficiaries, if they even get to that stage to appeal their out-patient status. >> thank you. i would like to thank our witnesses for their testimony today, and appreciate the assistance of the questions that are getting answers today. this committee and our providers, we have to address this head on to ensure that seniors are treated fairly and it's important to get the issues straightened out. i look forward to working with the witnesses and the committee to do this.

any member wishing to submit a question for the record, they have 14 days to do so. and i ask the witnesses respond in a timely manner, with that the subcommittee is adjourned. 40 years ago this summer richard nixon became the only president in u.s. history to resign. coming up shortly we'll take you back to a house judiciary committee hearing from the evening of july 29th, 1974, where members debate impeaching president nixon for abuse of power. this was the second of three impeachment articles that the committee ultimately adopted. we'll start off with the conversation with the former director of the richard nixon