To head off federal legislative "patient protection" efforts, the American Hospital Association is working behind the scenes in Washington to garner support for a private-sector, voluntary effort, MODERN HEALTHCARE has learned.
The move by the nation's largest hospital trade group seemingly aligns its interests with those of the health insurance industry. Hundreds of hospitals run their own commercial managed-care plans, and others want to get into Medicare risk-contracting as provider-sponsored organizations.
The AHA hopes to bring together a variety of provider and managed-care groups within the next several months under the aegis of an organization without a direct stake in the issue, such as a think tank. The AHA already has contacted a number of hospital groups about the idea.
"At this point, we are not prepared to support any legislation," said Richard Wade, the AHA's senior vice president for communications. "We ought to be able to do this with a strong private-sector initiative."
While many of the details of the proposed private-sector initiative have yet to be fleshed out, it appears the group is moving in the direction of President Clinton's Advisory Commission on Consumer Protection and Quality in the Health Care Industry.
Earlier this year, the quality commission completed its work, eschewing legislation in favor of a market-based solution built around an ongoing public-private quality committee.
The commission subcommittee that decided against a legislative solution was chaired by former AHA board Chairman Gail Warden, president and chief executive officer of Henry Ford Health System in Detroit. Henry Ford owns Michigan's second-largest HMO, the 540,000-enrollee Health Alliance Plan.
The AHA's direction also appears to be similar to that of the American Association of Health Plans, the managed-care trade group that also has called for a voluntary program. The AAHP is considering a variety of private-sector and quasi-public-sector structures, based on groups like the Securities and Exchange Commission and the Financial Accounting Standards Board, to regulate healthcare quality.
"We would be happy to sit down with anyone to work on a solution," said AAHP President Karen Ignagni. "It is time for groups in the private sector to get together and try to be helpful."
Wade said the AHA supports many parts of the leading patient protection bills before Congress, such as requiring plans to pay for emergency room care a patient reasonably thought was necessary and giving patients the right to appeal health plan decisions.
But he said the AHA opposes other aspects of the congressional bills, such as allowing beneficiaries to sue health plans.
One provision strongly opposed by the AHA is included in the leading Democratic package, sponsored by Rep. John Dingell (D-Mich.) and Sen. Edward Kennedy (D-Mass.). It would prohibit retaliation by hospitals against workers who report quality problems.
During the last round of meetings between the AHA staff and its regional policy boards, held last month, the boards were briefed on leading patient protection legislation.
According to Wade, "there was no sentiment for federal oversight" among the policy board members.
Wade said the AHA is concerned that quality legislation, no matter how well-intended, will become an onerous package of mandates.
"Legislation like this seldom is what it appears to be when it is first passed," Wade said.
One reason some hospitals are against federal quality legislation is that any mandates likely would also apply to PSOs. Under last year's balanced-budget law, PSOs will be able to contract directly with Medicare beginning next year.
One hospital group that overtly opposes patient protection legislation is the not-for-profit Premier alliance. Premier is a member of the Health Benefits Coalition, a managed-care and employer group that has pledged to spend more than $1 million to defeat the legislation in Congress (Feb. 16, p. 6). Premier cited the effect the legislation would have on PSOs as its primary reason for joining the coalition.
The idea of a voluntary, private-sector effort was dismissed by an aide to Rep. Charles Norwood (R-Ga.), whose Patient Access to Responsible Care Act already has enough co-sponsors to pass the House.
"Voluntary quality control measures don't work," the aide said. "There are always unscrupulous plans out there, and they get away with murder."