If your hospital is being hounded by federal investigators and you can't figure out why, maybe you should blame your location.
At least that's how it works under first lady Hillary Rodham Clinton's latest "We didn't do anything wrong, everyone's just out to get us" theory. Mrs. Clinton attributes her husband's-and his administration's-legal problems to an anti-Arkansas bias.
"I think a lot of this is prejudice against our state," Mrs. Clinton told the Arkansas Democrat-Gazette earlier this month. "They wouldn't be doing this if we were from some other state." (Oh sure, and people rejected her 17-million-page healthcare reform plan because of America's strong anti-Canadian bias, right?)
The "location bigotry" defense is an interesting new strategy (not to mention a case of denial that would make any psychologist drool). The tactic might also be used in the healthcare arena.
For example, Columbia/HCA Healthcare Corp. could claim its recent battles with the U.S. Department of Justice exist because it's headquartered in Nashville.
"We think the government is biased against country music," a Columbia spokesman might say. "If this were some highbrow classical music town, we wouldn't be having these problems."
Or the Philadelphia teaching hospitals that paid huge fines under the Physicians at Teaching Hospitals investigation could blame the government's investigation on their location.
"If you were a teaching physician, would you want to be in Philadelphia?" a spokesman for the hospitals might say. "I mean, come on, so what if the doctors weren't actually here to supervise procedures? You try to get people with advanced degrees to come here on purpose." (Since the first lady has already claimed the Arkansas defense, this strategy could be a little more problematic for Fort Smith, Ark.-based Beverly, which recently disclosed it was under review.)
Clearly, this new "locale" defense is the kind of creative thinking healthcare providers need in their disagreements with the federal government.
Right now, I'd put the chances of federal enactment of managed-care regulation this year at about 10%.
The only scenario that could lead to a White House signing ceremony is if Republicans return next month after having heard an unequivocal mandate from their constituents during the August recess. And not just a mandate for something to be done, but one for a comprehensive bill.
And that ain't gonna happen.
Much of the air has leaked out of the managed-care regulation balloon, according to the Republican National Committee, the National Republican Congressional Committee and several pollsters.
"Right now this is a nonissue, campaign-wise," one GOP spokesman said.
Why that is, I can't really say. It seems that by passing their own bill in the House and introducing a bill in the Senate, congressional Republicans have neutralized much of the traditional Democratic advantage on healthcare.
To make sure the electorate remains confused, groups on both sides of the issue are running ads in congressional districts this month. Groups are also mounting aggressive grass-roots campaigns to sway their lawmakers while they're at home.
It is also possible that the American people are preoccupied with other issues.
"The only thing people are talking about is a certain blue dress," said one pollster.
As long as I'm making predictions, I don't think there will be a home health payment fix this year either. There are too many competing plans before Congress and not enough consensus to move forward.
Home health agencies are scheduled to move to a prospective payment system in 2000, under last year's balanced-budget law. Until then, HCFA has implemented an interim payment system, which took effect July 1. That system blends agency-specific costs and a national average.
Some agencies, at least those with low costs, have been screaming to Congress that the IPS locks-in inefficiencies and rewards high-cost providers.
To make matters worse, HCFA announced it will not meet the 2000 deadline for the home health PPS because it is dedicating its resources to fixing its year-2000 computer problem (suggested new name: the "indeterminate length or until such time as we get our act together payment system").
Since it is unlikely that more money will be added to the program, any change in the current IPS formula simply creates a new set of winners and losers.
That is a problem for Congress, which doesn't like issues that split Congress geographically. After all, for people used to repeating partisan rhetoric, it takes a lot of thought to come up with an attack on a straightforward state like North Dakota (but not Arkansas, according to Mrs. Clinton).
Adding to the confusion is the fact that the home health industry hasn't coalesced around a single plan.
Republicans continue to call on HCFA to propose solutions for the problems in the home health IPS. This is a political ploy designed to embarrass the administration and take some heat off of Congress, which has just about had it up to here with home health agencies.
The administration has made it clear that it has absolutely no intention of putting forth its own plan.
So what we have is yet another game of political chicken.
To the American Association of Retired Persons' Public Policy Institute. It recently released a study showing that only 11% of seniors surveyed understand the differences between managed-care plans and traditional Medicare well enough to make an informed choice. HCFA has had to delay the release of its beneficiary information handbook for the new Medicare+Choice program because the handbook isn't ready. If this situation isn't a disaster waiting to happen, I don't know what is.
To Senate leaders of both parties for delaying a vote on managed-care regulation while they argue over the shape of the table. This is a serious issue that deserves serious debate, not petty bickering. We already know the Republicans don't want to pass a bill, and it looks like the Democrats only want a campaign issue.