according to the american hospital association, there are 629 different regulatory requirements from four different federal agencies that doctors, hospitals and other healthcare providers have to comply with. these range from credentials for doctors and nurses to participate in medicare and maintaining compliance to privacy laws, to making sure the right signs are hanging around a doctor's office. the average community hospital needs 23 full-time employees to keep up with the regulations about what a hospital needs to do to participate in medicare, called conditions of participation, according to the american hospital association. when the federal government adds one more question or one more rule, it may not seem like it makes much of a difference, but added together for doctors and hospitals, those questions and rules that up to more time spent on paperwork, less time seeing patients and an increase to the cost of healthcare. the trump administration is looking at what administrative tasks are required by the federal government. i am glad to see the administrator of cms which overse

her experience includes the national institute of health, the american hospital association, intermountain health care, and providence health and services. nancy, great to see you again, thank you for making that long trip. we appreciate it. chairman thank you, senator. tibbetts, an administrator of a physician owned surgical center in rural southern utah. in the surgical center began 2014, posting cash prices online for all of its surgical procedures that patient could know the cost of their care upfront. in addition, they also accept medicaid, medicare, and commercial insurance for the services provided. welcome to all of our witnesses. ms. binder let's start with you. >> thank you, chairman. i am appreciative of the opportunity to be here. i am leah binder from the leapfrog group. we are an independent, national, based here in d.c. we are with other purchasers of health benefits, attempting to improve health care through transparency and publicly reporting on the performance of hospitals. we have been doing this for 18 years, so we have a great deal of experience and have found it to be

health care before leaving the alliance includes the american hospital association,. it is great to see you again. welcome back to washington d.c. thank you for making the long trip out here. we appreciate it. >> next, mr. tai tippets, sage or surgical center, and go through surgical center and burrell southern utah. 2014 the surgical center began posting cash prices online for all its surgical procedures so that patients could build the cost of their care upfront. in addition to accepting cosh, st. george expects medicaid, medicare and commercial insurance for the services provided. welcome again to oliver witnesses. ms. binder, let's start with you. >> thank you, chairman alexander and ranking member murray. i'm very appreciative of the opportunity to be here with you today. i am leah binder from the leapfrog group. we are a nonprofit. we are independent national base here in d.c. we represent the employer is another purchasers of benefits attempting to improve the health care in part through transparency by publicly reporting on the performance of hospitals and oth

individuals that are healthy. >> let me ask because if we had a representative of the american hospital associationhere, she will be saying aha! there cherry picking there taking the healthiest patients. and we are left with those the most complicated of course we look worse in quality and cost because we are the person with the disease. how would you respond to that? >> absolutely. we are not at the hospital. we recognize that we have individuals with very complex physical issues. and the hospitals and asc 's should be compensated for the level of complexity a patient needs or has appeared only about 40 percent, 40 to 50 percent of the total can be done in the outpatient center should go to an outpatient setting. because of age. diabetes, sleep apnea, any of those. they need to go to the hospital. >> any community is a differential payment based on coal abilities? >> will choose to accept patients -- >> but i'm sorry if you at the general hospital where you are asc is, what i pay more war with the insurance company pay more five diabetes and heart disease along with my need to replace my hip or is

american medical association brand name drugs make up a whopping seventy two percent of drug spending across the u.s. but as concerns continue to grow over the rising drug prices we may be seeing more hospitals turning to the not for profit generic drug companies in washington thera montecito r t. one. spittles boost up the cost of service resolder the cost rejoins it costs one hundred per cent higher than what they paid highway robbery now if there was a box of the room number back in the ninety's when it came out the hospitals were charging one hundred dollars for aspirin. nothing's changed they just got better at it they figured out even better ways as they charge ridiculous amounts for simple things to it seventy five eighty five eighty five one hundred dollars for sale. for a white for those if you really look at your bill when you go in the hospital and it's astronomical it's a room and again it speaks to i'm sorry you can call me a dirty evil's socialist of the day i'm sorry. life liberty the pursuit of happiness you can't have liberty and the pursuit of happiness without life you can't have life without proper health care and right now we're failing at that our privatized version of

american association of neurological surgeons — an organisation that stipulates members must be licensed to practise medicine. sam eljamel no longer is. not something he told them, though. and when the bbc contacted connecticut's hartford hospitalit told us he never finished the course. in spite of seemingly having a presence in the us, we couldn't find him here. and it turns out that even lawyers in scotland taking cases against him are having trouble tracking him down. in fact, we've discovered they've become so frustrated at being unable to get hold of mr eljamel that they've asked for the court of session in edinburgh to order him to provide an up—to—date address so he can be contacted. nhs tayside told us it has listened to patients' concerns and taken appropriate action to support them. it said there has been much learning by the organisation and many improvements made, and that the board complies with all national standards relating to spinal surgery. mr eljamel‘s lawyer told us his client had no comment to make. our investigation has discovered deep flaws in a system that allowed harm to be done to patients over and over again — harm that cannot be undone. it points to a scandal that goes beyond one surgeon to a failure

please note, there is a hospitality suite that they are sponsoring across the hall from us and the association of mature american citizens is sponsoring a cafe when made to order coffee in the exhibit hall. now, could you please join me in thanking all of our great sponsors. [applause] >> thank you ladies and gentlemen. we appreciate also your understanding with enhanced security, it is the time in which we live, so no backpacks are allowed in the ballroom, all bags are subject to search if necessary by our security team, and of course, name badges -- unlike me, i am not wearing one, but if any to come back income i need to wear my name badge, and so do you -- that is required for all sessions. also a reminder that campaign signs and distribution of campaign literature is also prohibited. one of the practical takeaways that we went to feature this year is to pick up one of these dvds and offer to your church leaders, with a word of encouragement to have a voter sign-up sunday. folks, when it comes to values voters, there are more of us than it is of them. so if we just simply show up and vote, we can determine t

please also there's hospitality suite, a sponsor and is right across the hall from us and the association for mature american citizens is sponsoring a cafÉ with made-to-order coffee in the exhibit hall. and i would you please join me in thanking all of our great sponsors. [applause] >> thank you ladies and gentlemen. we appreciate also your understanding with enhanced security, it's a time in which we live no backpacks are allowed, no bags, all bags are subject to search if deemed necessary by our security team and, of course, name badges unlike me, i'm not wearing one can but if i want to get back in, i forgot to wear my name badge, including you. so that is required for all sessions for admits. also a reminder that campaign signs into to become campaign is also prohibited. one of the practical takeaways that we want to feature this year at our summit is to pick up one of these voter in fact, an offer to your church leaders with the word of encouragement to have a boundary sign up sunday on september 30. folks, when it comes to values voter there there's more than n it's of them. and so we just simply show