Because hospital associations around the country act like bickering children so much of the time, when everyone plays well together, it's worth noting.
Earlier this month, a task force of 16 hospital groups met at the Washington office of the American Hospital Association to discuss how Medicare should handle issues surrounding the hospital wage index. Participants included the Federation of American Health Systems and the hospital associations of California, New York and Pennsylvania.
At stake is about $300 million in Medicare reimbursements, which could be moved from states with a large concentration of teaching hospitals, like New York and Pennsylvania, to states without many teaching hospitals. This shouldn't surprise those of you who have followed Medicare redistribution issues over the years. Redistribution fights have one thing in common: Everyone wants New York's money. (New slogan for New York hospitals: It's our damn money; leave us alone!)
The issue came up in 1994 when HCFA released a regulation that would have changed the way the agency accounts for the hospital wage index in calculating Medicare hospital reimbursements.
The change would have meant that some of the costs of teaching programs weren't factored in, thus lowering the Medicare reimbursements for teaching-heavy states.
To allow hospitals to adjust to the change, HCFA said the regulation would take effect Oct. 1, 1999, the beginning of the federal government's fiscal 2000.
But earlier this year, HCFA reversed itself and decided not to make the change. The agency's decision came after a lobbying campaign by the New York and Pennsylvania hospital associations and the AHA.
Of course, when hospitals in areas that would have benefited from the original change got wind of HCFA's reversal, they complained. They also criticized the AHA for taking sides.
This had all the makings of the kind of interhospital donnybrook that makes AHA leaders feel as if they're driving a huge family station wagon with about 51 kids in the back. Remember last year's bruising battle over Medicare bad-debt payments?
There are a number of reasons why state and national hospital associations bicker. Foremost is money. As in dues money. All the associations are fighting over the same members.
Let's face it, you can only form so many boutique hospital associations. It's hard to justify your existence when you are the Society of Ecumenical Nonprofit Diversified Corporate and Specialty Hospitals (SEND CASH).
All this infighting and backbiting would make a great TV miniseries if the story did not also involve such coma-inducing topics as hospital geographic reclassification and bad-debt payments.
But the wage index issue was different. This time, the AHA decided to get all the parties together before things blew up and before Congress got involved. (New congressional slogan: There is no problem so bad we can't screw it up worse.)
The hospital groups met four times over two months and eventually came to a compromise that everyone hates. That means it must have been well-crafted.
But while no one seems to like the plan, all the groups say they accepted it in the spirit of hospital unity.
"That was 99% important in our decision," says Dan Sisto, president of the Healthcare Association of New York State. "We have to work together next year."
Kenneth Raske, president of the Greater New York Hospital Association, says that "what was at stake here was harmony.
"We've agreed with it, but it was very difficult for all of us," he adds. "We're agreeable, but that doesn't necessarily mean I like it."
Thomas Scully, president of the Federation of American Health Systems, which represents investor-owned hospitals, says that when he went into the meetings, "I didn't think there was a snowball's chance in hell, but I was very pleasantly surprised."
The federation, which represents investor-owned hospitals, opposed HCFA's last-minute change of heart. That put the group at odds with the New York and Pennsylvania hospital associations.
Scully says that while he believes he had the votes in Congress to win if it came to that, he was glad things were settled amicably so that his group and others didn't have to spend resources beating up on each other next year.
"(Hospitals) have a huge number of issues next year, and we have to be together," Scully says.
Among those issues are fixing the Medicare home health payment system, the Medicare outpatient prospective payment system and the hospital transfer policy.
It will be interesting to see if the cease-fire holds.
To Rep. William Thomas (R-Calif.) and the members of the House Ways and Means health subcommittee who continue to try to deal with healthcare issues while everyone else in Washington is focused on something else. I forget what that is, but it ain't the Medicare outpatient PPS.
To HCFA for pressing forward with the Medicare risk adjustment system using hospital data that everyone agrees are terrible. Risk adjustment is necessary and overdue, but for providers to take it seriously, it has to be based on a solid foundation of data.