his is about med caps -- medpac's recent report as well as the extenders. mr. thompson: that's what i'm asking, mr. chairman. chairman tiberi: about the report? mr. thompson: i'm asking if there are recommendations -- chairman tiberi: in the march report? mr. thompson: any report. recommendations by medpac that would cover the $75 billion loss that was brought about because of the legislation that was passed -- the republicans in this committee in march? mr. miller: without comment on the pending legislation, there are an array of recommendations in the medpac report that result in savings. so, nor example, -- for example, the post acute care things we talked through, we don't do estimates. that's c.b.o. and all the rest of t we think we're talking in the neighborhood of $30 billion. i mentioned the m.a. coding issues. there's potentially a savings there for example. we also think the changes in the part d recommendations could yield savings. and then also there is a couple of other places we haven't even talked about where we restrain the updates that would pr

and for the important role that medpac plays in informing medicare policy. we've had a chance to look at your report, maybe not read each page along one but an excellent executive summary. and unfortunately, as mr. tiberi and i discussed, this is the first hearing of this subcommittee. and i regret that we did not ve an earlier hearing on the consequential health legislation that the republicans introduced and passed. that bill, as we know, would have taken away coverage from 24 million americans while handing out nearly $1 trillion in tax cuts primarily for the wealthy, indeed the very wealthy and corporations. it would gut medicaid by cutting more than $800 billion from the fram -- program and shifting costs to patients. it would allow states to eliminate or weaken crucial market reforms, including essential health benefits, community rating and protections for older workers. it was opposed by doctors, hospitals, patients, aarp, almost everybody who is a participant in the work that you do, dr. miller. though all of our colleagues here on the republican si

can you talk about medpac's believe that this will strengthen the skilled nursing facilities? >> there are a few things we are seeing that we are responding to. it is not dissimilar -- inside the skilled nursing facility, overall spending is too high but we also think the way the system is structured but we get into the technical, the way the system is currently structured, not paying properly for different kinds of patients. and avoiding complex medical patients. patient need and barring a greater balance, improve value for the beneficiary, the greater balance in how the payment works, we mentioned the not-for-profit or for profit, it isn't about making the payment system peculiar to for profit or not-for-profit, it happens because the way the payments shift based on what those different types of providers take. the other two quick comments on value, we do talk about the notion of time, patience, payments to different outcomes, returning to the hospital, avoiding going to the emergency room. and other conversations about reorganizing the entire payment system, having unified

but other types of reforms that medpac would envision considering this statement of the three pieces here? higher quality care, better care transitions and more efficient provision of care? >> yeah. let me just -- okay. i think we would approach this from a couple of different perspectives. there is not patient selection and we're trying to make link payments to quality measurementes like avoiding readministrations, avoiding unnecessary hospitalizations, avoiding emergency room use that, tich thing. so the experience of the patient is they get their care and then something doesn't go wrong and they go -- they have to go back to the hospital or go to the emergency room. and build in financial incentives to the provider that says if this happens this is not going to play well in terms of your finances. that type of thing. but then we also have a set of thoughts where we have talked about delivery system reform where you're trying to take the risk and the delivery of the care to the entire patient. so there, i mean, we've made a number of recommendations inside the managed care space in