simply stated, cms has three aims. one, better care for individuals through seamless coordinated health care. two, reducing costs to continuous improvement. and better population health. now, many other speakers have already talked about their success in achieving many of these goals so we know the delivery system can achieve these goals. but as was pointed out, we see significant variance. so what is causing this various? quite frankly, the way that we have reimbursed the system, the way that cms has acted towards its delivery system has created a culture in the delivery system that is actually at counter opposition to what we are trying to accomplish. instead, we have created a fragmented system instead of a cohesive integrated system. so we take that responsibility and we are realigning how cms will operate in the future. we can't ask the system to transform if we don't transform the way we do business. so as we look at our priorities we realize that excellence in operations that cms is how we relate to the system i

>>ledet: at a high we will get like $8.50 per cm. that can drop down to like $3.50 a cm. >>reporter: things are tough all over...at the house of fleming in atlanta, demand is down by about 30% against a couple of years ago...although the company, whose products are all custom made, has been lucky to hit one niche market that's proved very lucrative...pro golfers...who are happy to pay hundreds of dollars for a belt... >>fleming: there is a lot of competition on who can out dress the other. it's just their nature. >>reporter: ...and the free advertising has proved priceless... >>gibson: i saw graeme mcdowall wearing one at the open and i looked in the back of the digest it said house of flemings. i wanted an alligator belt, came in and bought one. now i'm here again today. i do fancythe alligator belts. >>reporter: now the near-prehistoric source material of this industry can live for around 50 years in the wild and grow to about 16ft...but even for experts like greg and jim, grabbing a good sized gator takes real skill... >>reporter: but finally, after hours of searching.

our cm team had to work with the contractor to come up with a creative solution to address that in the field, which we did. completion right now is about 25%, and we are estimating that we will be substantially complete by may of this year. the otp order to proceed -- you see the inflation of the bridge -- demolition of the bridge on top of our dam. that was done on time for us to begin our work shortly. my last two slides basically our report cards on our key project milestones. the first two columns in blue, compared to what we actually accomplish compared to what is planned, and we've missed one milestone on the local program. it was categorical exemption for one of our projects. we are on track now to obtain that this coming quarter. there were some issues with the design of the improvements. on the regional side, we actually missed four milestones. two of those are associated with one of our support projects. we missed a bid advertisement and a construction notice to proceed. we changed the contract thing strategy, which delayed the contract and going out to bid. it will have no i

checkbook, my publisher, had proposed to cms several years ago that cms release payment records for allhysicians in the country. how much is medicare paying the doctor by procedure for all the procedures he does, because checkbook has very good reason, i won't go into the details to believe that volume and quality have a huge relationship, okay, and that they want to steer people to docs that do more volume, besides which the real plan was to then get outcome data. this allegedly violated the privacy act. and the privacy act, the freedom of information act was in conflict. this goes back to an ancient court case. this went through a number of court hearings. into a court of appeals, two senile judges ruled releasing this data would have you absolutely no benefits in fraud reduction in medicare, which is one of checkbooks' arguments. i don't know how many of you read the "wall street journal" religiously, but if you read today's paper, you'll find a couple stories that pertain to everything i said. they are now suing to reopen what amounts to the checkbook case because the "wall street j

>> the board does not lie within cms. the president supports the independent -- the president supports the independent pavement advisory board. i care deeply about that sector. it is crucial to americans and our health-care system as a whole. i think that gives an opportunity to spread ideas elsewhere. that is one of the reasons why i suspended enforcement that i was asked about before. i want to make sure that we do not do anything that impedes care in rural settings. the act gives us a chance to understand more about input costs in rural hospitals. i look forward to working with you to make it a healthier part of our health-care system. >> are you willing to work with the administration to give critical access hospitals the same exemption? >> i am happy to talk with you .urther on that bridge to >> >> i wanted to follow up with my colleague from illinois about what the supreme court could be asked to do. i visited with many small businesses and large businesses in my district in kansas, and many of them are investing a

-- a cm whats -- of what cms will be driving the system to do. we have three games. one is better care for individuals their health care to reducing costs through improvement. many of the speakers have already talked about their success in achieving many of these goals. we know the system can achieve the goals. we see a significant variants. what is causing it? the way we have reimbursed the system has created a culture in the delivery system that is that counter opposition to what we are trying to accomplish. we take this responsibility and we realign how they will operate in the future. we cannot as the system to reform if we cannot do it ourselves. we realize the excellence and operations is how we relate to the system in the future and how we ensure our organizational alignment with organizations that are organically a line to helping us achieve it. it should go to the organizations. the patient delivery system and our community halt efforts have to be integrated with agencies that are focused on these particular areas. within the business en

-- a cm whats -- of what cms will be driving the system to do. we have three games. one is better care for individuals their health care to reducing costs through improvement. many of the speakers have already talked about their success in achieving many of these goals. we know the system can achieve the goals. we see a significant variants. what is causing it? the way we have reimbursed the system has created a culture in the delivery system that is that counter opposition to what we are trying to accomplish. we take this responsibility and we realign how they will operate in the future. we cannot as the system to reform if we cannot do it ourselves. we realize the excellence and operations is how we relate to the system in the future and how we ensure our organizational alignment with organizations that are organically a line to helping us achieve it. it should go to the organizations. the patient delivery system and our community halt efforts have to be integrated with agencies that are focused on these particular areas. within the business en

i don't want to his a partly cloudy there's a solution i want to let you know cms has issued a request for proposal to do exactly what we're talking about. to do it before leverage analytics on what gets paid. >> all right. and i'll yield back the remainder of my time with just the comment that -- i really think part of what we need to be doing is looking for off the shelf solutions. we can -- we can plug into rather than trying to develop something custom for ourselves. that always tends to be much more expensive. thank you. >> would the gentleman yield? >> sure. >> mr. dodaro, one quick question, we haven't asked you to talk about the cyberthreat of both dollar waste and failure. could you comment on that for a moment for all of us. a lot of people are just getting up to speed on that. >> this is a very important hirsch i'm glad you asked me that question. we put computer security across the federal government as a high risk area. in 1997 because of concerns that we have. it was the very first time we designated something across the whole federal government is high risk and the risk

you need to not just look at aÑi portfolio, and maybe i'll cm conservative and think, maybe i'll liveou don't know how long you're going to live. and you don't want to find that out in your late 80s to find out you don't have enough. >> consuelo: chris, from an insurance person's point of view -- this is music to your ears -- but to answer that question of why doesn't a traditional stocks, bond and cash mix work, what can an insurance bond bring to the table that you cannot get from a traditional investment advisory? >> sure. one is a couple of -- one is mathematical. what that you can't tell me is the day you are going to die. if you told me i am going to live until i'm 81. i can build you a fabulous portfolio that will have you spending until you're 81. but i probably have to factor it until your 95. you can actually put products like an immediate annuity that can pay out through life expectancy. the risk of you living beyond that is borne by the insurance company. the emotional factor is more what kim is alluding to. if you know you're going to have expenses that will last forever,

blizzard conditions of are expecting their 15 cm where the snow as people are getting up this morning. oklahoma city coming down as well 40 mi. an hour wind gusts expected. several free of snow expected across the midwest, dress could pile it up towards 10 ft. in the snow drifts. you're driving conditions around oklahoma city. talks winter driving from the midwest down to dallas, up towards new england. oklahoma is showing the state of emergency. >> the latest as we monitor what's happening to the flights in san francisco, in fact because of the store. especially now that the dallas-fort worth airport is closed. will tran is live at sfo. >> they added another cancellation from the last time you saw me. this is that lana, everybody is staring at the departure board. dallas to flights have been canceled, in fact three flights they added another flight in the past 10 seconds. 720 fightflights are rd time. they could be in the air, they pack enough you'll just in case dallas does not dig itself out from the snow. in that case it or circle dallas. if they get a word that they can't land an

-- a cm whats -- of what cms will be driving the system to do. we have three games. one is better care for individuals their health care to reducing costs through improvement. many of the speakers have already talked about their success in achieving many of these goals. we know the system can achieve the goals. we see a significant variants. what is causing it? the way we have reimbursed the system has created a culture in the delivery system that is th counter opposition to what we are trying to accomplish. we take this responsibility and we realign how they will operate in the future. we cannot as the system to reform if we cannot do it ourselves. we realize the excellence and operations is how we relate to the system in the future and how we ensure our organizational alignment with organizations that are organically a line to helping us achieve it. it should go to the organizations. the patient delivery system and our community halt efforts have to be integrated with agencies that are focused on these particular areas. within the business envi

about $330 million of that goes to cms. the total headcount increase is distributed between some additions due to the incorporation of the office of consumer information and insurance oversight. that murder occurred a few weeks ago. -- that a merger occurred a few weeks ago. this is partly an expansion of normal operations and the incorporation of the center for consumer information and insurance oversight. >> ellen has the details for the sgr. there are mostly to ensure that medicare and medicaid get the best price. one is to allow hhs to audit as often as it would be cost- effective and allow medicaid to collect penalties from drug manufacturers for noncompliance, fraudulent noncompliance and requires all drugs to be properly listed with the fda. >> on that note, it looks like the pharmaceutical proposals would cut $12.9 billion, of which the biggest one is to prohibit brand engineering drug companies from the nut -- delaying the ability of new generic drugs. the pharmaceutical agenda agreed to $80 billion in cuts, and le

whole series of delivery system reforms that for the first time i think are part of the directive to cms, and so woe have everything from resources in the innovation center which will encourage modeling of various kind of care strategies that we know are more effective and less expense i because they're happening in various parts of the country. the accountable care organization structures that are coming together in what we very much anticipate both through the new office of eligibles but also with very close coordination with states is using the medicare strategies for the first time also and encouraging states to pick up those same strategies in their medicaid budgets. >> with the accountable care organizations, there's a thought out there that it's going to accomplish the opposite of what you had hoped. in other words, get efficiency. lower the cost and lower the utilization. and the theory behind that goes is that all these hospitals are buying all the practices. and in fact, you're going to have less competition, not more. do you have any concerns about that? >> yeah. i do think th

a lot of what happens in terms of the prosecution of fraudulent claims within cms unfortunately does not occur until it meets a certain threshold of money, so a lot of these claims. >> whose threshold is that? >> i'm sorry? >> who sets the threshold? >> it is cms for their ones that determine based on allocation of resources what claims they can go after. >> let me ask about the allocation of resources because of my numbers are correct there are almost 50 different investigative agencies that are seeking waste, fraud and abuse just within health care. that along is an example of waste and fraud and abuse. 50 different agencies. >> the huge irony that exists is my next., is that there is waste going on between all of those organizations in the sense there's a lack of data-sharing going on between them so for instance even with let's say medicare part a or d you are missing data-sharing between those two that they would be able to use to identify who potential crooks are and so as a result, they are losing out on being able to cross-reference these individuals and some of these people

now, let's get creative, and let me tell you, i have spent more time dealing with bureaucrats at cms and elsewhere in the administration, i apoll gil jio those of you who were there, in terms of trying to be creative, i was in a room and after one hour i couldn't take it. you know what we're trying to do back on medicare plus choice, figure out the phone number that people could call to get help on medicare. so for an hour they were up there with chalk and a blackboard trying to create an acronym that people would use to call 1-800-medicare. i finally just said why don't you put out that it's 1-800-m 1-800-medica 1-800-medicare? and they looked at me, they said that's too many letters. i said dial it. the last letter doesn't mean anything. the last number doesn't mean anything. it will go through when you get to the "r," so why try to create an acronym that people won't understand? just tell the folk dial 1-800-medicare, you'll get us. "oh. does that work?" "yeah." so here we go with the grand political design. admit mandatory coverage. you can't really start a structure without it b

cms said ok, you can have a contract, but she cannot do the things to save the money. sabin's were essentially taken out of the cut -- savings were essentially taken out one year later. the idea that the federal government knows better than we do want pre-existing conditions, i deserve no credit. 3600 people in our risk groups, about 160% of what standard premiums would pay. they will not let us use that risk pool to meet the requirements of the new act. so, they set up their own risk pool. they cut the premiums to get more people in that and is still only has 58 people. it might grow later, but the idea that the federal government has to create their own, or forced us to create a new risk school, that is not the kind of flexibility we are looking for. i am glad for the state that get it, but it is not my experience. >> my experience is similar to the governor's. we cannot get a response or did anything done. we will not get control health- care costs until we change how we deal with providers. we need to not restrict competition. two, we have to allow individuals to p

proposals enhance prepayment scrutiny, expanded audits, increasing penalties, and strengthening the cms ability to implement corrective actions. in closing, mr. chairman, we've made eliminating waste, fraud, and abuse a priority across our entire department. but we know that isn't enough. so over the last few months, we've also gone through our department's budget program by program to find additional savings and opportunities where we can make our resources go further. for example, in 2009, congress created a grant program to expand health coverage in 13 states. the work we are doing right now under the health law to expand the affordable care act allows this program to be cut so we don't duplicate our efforts. another example of cdc funding to help states reduce chronic disease. previously, the funding was split between different diseases, one grant for heart disease, another for diabetes, it didn't make sense, since those conditions often have the same risk factors like smokes and obesity. now states will get one comprehensive grant that allows them the flexibility to address chronic

cms said ok, you can have a contract, but she cannot do the things to save the money. sabin's were essentially taken out of the cut -- savings were essentially taken out one year later. the idea that the federal government knows better than we do want pre-existing conditions, i deserve no credit. 3600 people in our risk groups, about 160% of what standard premiums would pay. they will not let us use that risk pool to meet the requirements of the new act. so, they set up their own risk pool. they cut the premiums to get more people in that and is still only has 58 people. it might grow later, but the idea that the federal government has to create their own, or forced us to create a new risk school, that is not the kind of flexibility we are looking for. i am glad for the state that get it, but it is not my experience. >> my experience is similar to the governor's. we cannot get a response or did anything done. we will not get control health- care costs until we change how we deal with providers. we need to not restrict competition. two, we have to allow individuals to p

delighted to have you join the committee, senator coons, a graduate of amherst, bachelor of science in cm tree and political science. holds a graduate degree from yale in law and divinity. maybe we can get spiritual guidance as well. it would be valuable to the budget committee. the first truman scholar to serve in the senate. senator coons, welcome to the committee. >> thank you very much, chairman. thank you for your leadership on these very important issues. i very much look forward to working with you and with senator sessiontion. as you both said in your opening statements, we recognize across the partisan divide of the congress and badly across the country regardless of region, background, experience or education that we have as this panel has so uniformly and compellingly testified as simply unsustainable and unworkable tax system in the united states. we face a crushing national debt burden, a challenging deficit. you have all worked clearly very hard in putting together a series of proposals. as the questioning so far has surfaced, one of our big challenges is taking insightful,

in fact the cms chief actuary also verified the promise will confi be broken, confirming thatheir americans may lose their current health care coverage regardless if they want to keep it or not. to some of the president, i respond directly to my friends and colleaguescoll from vermont byepeal saying we want full repeal of simple obamacare for a very simple pro reason. the the big problems with the bill the the big problems with the planargin, are not at the margins, they are at the core. and the big problems can't be fixed with a protecting amendment, the changing of a p comma, changing punctuation resizing one or two or five or ten sentences. the big problems are at the core of the plan, starting with the vernme mandate from the federal government and president of the in every man, woman and child in america needs to go into the market and buy a particular we product.epeal. that's why we demand repeal. we'll that's why we will continue to pursue repeal of to what happens, and that is why we will replace this huge burdensome bill with targeted reforms like wit protecting folks with pre-exis

secretary, can you explain why it's so important for the deficit that cuts not be made to cms in orderthem to be able to fully implement the health reform law? >> well, the -- you know, the answer to that question, if you don't allow these reforms to get traction, to be implemented, you will not get the savings these reforms provide. if you delay them by slowing down the pace, you will delay and reduce the savings. it's just a simple proposition. >> thank you, mr. speaker. >> thank you, chairman ryan and secretary geithner for your testimony today. earlier in the conversation you talked about the basis, one the reasons lower rates and more jobs. that way you create more investment and more jobs. on the other hand, you say respect to high-income individuals the same rules don't apply. when you raise taxes on the highest tax brackets of americans, the group of people that creates 50 to 60% of the jobs. it's okay. you can do it there and still create jobs. but that this -- you use exactly the reverse logic for corporations. can you explain the obvious problem in that logic? >> absolutely.

the michigan senate and served t in majority floor leader from cm 1999-2000 before coming to congressger is in his fifth term in the house rvices cting maryland's seventh hestrict. he was w a baltimore county executive for 94-2000 and on thl county council from 85-94. he served as a county l prosecutor.ith organized crime, gangs and that sort of thing he brings that tht experience to his work on theo intelligence community.t cal our next phone call from chico, california. you're on the air. >> caller: yes.nd we i understand we are talking andi about national security. i have an issue right here unit within the united states.t as f i was wondering as far as national security, beingg terminally ill and having aids i have to wonder why i face havind my door kick in over medicalaria marijuana when we can't patrol or federal forests to make surfl that illegal immigrants aren'tna growing mass amounts ofo marijuana in order to trade for other drugs or weapons? >> guest: the first thing, ative your door, we live in a country that has checks and balances.ata emengreat system of government.c so

the proposals expanded auditing, increasing penalties for improper actions and strengthening the cms ability to implement corrective actions. in closing, mr. chairman, we've made eliminating waste, fraud and abuse a priority across our entire department, but we know that isn't enough. so far the last few months we've also gone through our department's budget program by program to find additional savings and opportunities where we can make our resources go further. for example, in 2009, congress created a grant program to expand health coverage in 13 states. the work we're doing right now under the health law to expand the affordable care act allows this program to be cut so we don't duplicate our efforts. another example is cdc funding to help states reduce chronic disease. previously the funding was split between different diseases. one grant for heart disease, another grant for diabetes. it didn't make sense since those conditions often have the same risk factors like smoking and obesity. now states will get one comprehensive grant that allows them the flexibility to address chroni