Although they are part of one of the most regulated industries in America, healthcare providers largely have sat on the sidelines during the regulatory-reform debate.
Unlike their counterparts in business, who have been asking the Republican-controlled Congress for broad relief from regulations that increase their costs of doing business, provider groups seem reluctant to speak out. In part, this is because they want to conserve resources by lobbying for repeal or relief from narrow rules that specifically affect providers, such as physician self-referral prohibitions or clinical laboratory quality standards.
But they also recognize that some regulations, in fact, are good for providers because they loosen burdensome requirements or allow activities prohibited in the past. They fear that such good rules also could be threatened in the name of "one-size-fits-all" regulatory relief.
The House already has passed legislation that would require regulatory agencies to judge whether the benefits of regulations outweigh their costs, so-called cost-benefit analyses. The Senate Judiciary Committee passed a similar bill requiring such analyses of any rule costing the economy more than $50 million a year, but Senate leaders have not scheduled it for floor debate.
The House also passed a measure that would freeze any regulation issued between the congressional election last November and June 30 of this year, although it is not expected to pass the Senate.
Provider groups caution that cost-benefit analyses could make regulatory agencies reluctant to propose regulations that benefit providers.
One such regulation is a segment of the 1995 Medicare physician fee schedule rule that requires HCFA to pay doctors for overseeing home care and care for patients in hospices, said Robert Doherty, vice president of government affairs and public policy with the American Society of Internal Medicine. Prior to the legislation, Medicare had provided no such compensation.
But if Congress mandates cost-benefit analyses, "Would that require regulations to jump through so many hoops that it will block the beneficial regulations?" Doherty asked.
In addition, detailed cost-benefit analyses would not necessarily help reduce government's size, said Linda Magno, director of policy development for the American Hospital Association. Instead, government agencies would grow because they would need more workers to conduct cost-benefit analyses.
"The bottom line is you have more people in government (accomplishing) less and less," Magno said.
Advocates of regulatory reform acknowledge that it can be a two-edged sword, but they say that in the long run they believe it will reduce the cost of doing business.
Jim Wholey, a partner in the law firm of Gardner, Carton & Douglas in Washington, points out that much of the cost of doing business in the healthcare sector results from complying with federal regulations.
"That's a large amount of the effort of administering hospitals, administering health plans, administering employee benefit plans," Wholey said of regulations. "If you can reduce directly the labor and cost of administration, you've had a tremendously profound effect on the cost of providing healthcare."