It's time again to grade the Washington lobbying shops on their work during 1998, a year that generated a lot of heat but little fire.
American Association of Health Plans -- Grade: B
Through hard work and a lot of luck, the AAHP dodged a huge bullet when managed-care regulation stalled in the Senate. But the issue will return this year. Democrats, emboldened by their surprise showing in the November elections, could make life even tougher for HMOs.
Real trouble exists in the Medicare HMO market, though most of it was unavoidable. The AAHP and its allies were unable to get some of the Medicare reimbursement changes they needed, and they continue to play a game of chicken with HCFA over HMO Medicare pullouts.
The bad publicity from jettisoning nearly 500,000 seniors from HMOs adds to the woes of a group that has now slipped below toenail fungus, which only 23% of plans cover, in popularity polls.
New slogan (borrowed from providers): "More money or else!"
American Hospital Association -- Grade: B+
The AHA's grade is based primarily on its strong work on the federal False Claims Act. It brought together the entire hospital community, and other provider groups, to show what can be done when industry players stick together.
In this case, it got the U.S. Justice Department to change the way the department does business. U.S. attorneys previously sent letters to nearly all hospitals, accusing them of Medicare fraud and demanding reimbursement for overpayment. Now the attorneys must consider mitigating circumstances, such as whether fiscal intermediaries gave clear guidance to providers.
Traditionally the AHA has had no qualms about jumping in front of the grand marshal at a parade in progress and claiming the parade was in its honor. But this time the association actually organized the parade and deserved the credit.
On the other hand, after months of saying it opposed managed-care regulation, the AHA picked the day before the GOP measure passed the House to proclaim its backing. Now that's timing.
New slogan: "We're right behind you when the shooting starts."
American Medical Association -- Grade: C+
This is a tough one. The AMA turned 180 degrees this year when it supported the Democratic patient-protection bill.
A cynic would say the AMA was following its pocketbook and bashing managed care. But let's assume it chose its conscience over blind party loyalty. For that the AMA gets high praise.
But it loses points for clumsy handling of managed-care regulation. It was maneuvered into hosting a roundtable discussion featuring President Clinton at the association's Washington office, and its representatives appeared with Democrats at several rallies. Those activities infuriated the AMA's GOP allies.
Too bad principles get short shrift in today's partisan politics.
New slogan: "Finding our conscience, losing our friends."
Blue Cross and Blue Shield Association -- Grade: C
The association is largely in the same boat as the AAHP, though slightly more popular than toenail fungus.
It supported the anti-managed-care fight. It also was a stalwart during negotiations over solvency standards for provider-sponsored organizations. The high solvency standards, combined with low reimbursements in many areas, mean the threat of competition from PSOs ranks somewhere behind the chance that HMOs will face a foreign invasion.
But with all its resources, the Blues should be a lobbying Juggernaut.
New slogan: "We put the `pay' in patient protection."
Federation of American Health Systems -- Grade: B
Over the past year, President Thomas Scully has taken the FAHS from being the bomb-throwing terrorists of the hospital lobby to a strategically astute group that maneuvers to take advantage of its strengths while choosing its battles.
The federation was largely responsible for identifying a little-noticed change in the way HCFA accounts for hospital bad debt. That small change has saved millions of dollars for hospitals. The FAHS also opposed a change in the Medicare wage index that would have helped teaching hospitals but hurt practically everyone else.
Among hospital lobbyists, it's still fashionable to say that the FAHS isn't what it was under former President Michael Bromberg. But times have changed. Bromberg is rightfully a legend in the hospital community, but the FAHS under Scully seems to be finding its stride.
New slogan: "More Medicare money -- legally!"
National Association for Home Care -- Grade: C
The NAHC did an impressive job -- maybe too good -- of energizing its grass-roots groups to interest Congress in Medicare home health payments. Many lawmakers were angered by the volume of calls they received, and in the end Congress changed the way Medicare pays home health agencies, but it did not do what the NAHC wanted.
New slogan: "We're not as bad as nursing homes."