The ink is barely dry on the law restoring some Medicare payment cuts imposed in 1997, but hospital lobbyists are meeting behind closed doors to figure out how to get more.
The trouble is, they don't know what their priorities will be or how much they will be able to ask for. They may not get as friendly a hearing on Capitol Hill as they did last year, when Congress passed legislation that offers $15 billion in relief to Medicare payment restraints enacted under the Balanced Budget Act of 1997.
These factors could be key in an election-shortened congressional year that will find Congress spending more time on the campaign trail than on legislative business.
Unless they move quickly and show convincing evidence of hospitals' plight, hospitals may find themselves out of the running in this year's federal spending derby.
"There won't be a Medicare bill enacted this year," said Frederick Graefe, a healthcare lobbyist with the law firm Baker & Hostetler in Washington. "The legislative calendar is too tight, too short."
That isn't deterring the American Hospital Association from discussing a possible follow-up to the balanced-budget relief measures contained in the fiscal 2000 federal budget.
State hospital association executives met in Washington last week to discuss new relief proposals.
They ranged from a proposal called the "3% solution," which asks that 3% more of the $112 billion in savings called for under the budget law be returned to providers, to a possible increase in the annual hospital update, which will be 1.1% below the hospital inflation rate in fiscal 2001.
Also under consideration: asking Congress to stop implementation of the Balanced Budget Act when Medicare reaches its savings goals.
Richard Wade, the AHA's senior vice president for communications, said the state association executives did not decide on their strategy but did not rule anything out.
As evidence that congressional interest may be waning, however, Democratic and Republican leaders alike outlined agendas for this year that did not include increased Medicare provider payments.
House Minority Leader Richard Gephardt (D-Mo.) said adding prescription drugs to the Medicare benefit package and diverting federal surplus dollars to the Medicare Hospital Insurance Trust Fund was a priority, however.
When asked about the prospects of a follow-up to last year's relief bill, House Majority Leader Richard Armey (R-Texas) expressed openness: "Legitimate providers that are providing care to patients need to be compensated adequately."
A Senate GOP aide said the likelihood of the Congressional Budget Office projecting some fat budget surpluses later this month will make the hospitals' case easier to make.
"It's party time for the kids," the aide said. "Everybody gets a party favor."
Some congressional aides were less optimistic, tying the possibility of new payment increases this year to a November 1999 Institute of Medicine report, which recommended providers reduce medical errors that cause deaths or injuries.
"Why should we pay for bad care?" a House Republican aide asked. "Maybe we should tie payment to quality."
Some hospital groups have a clearer view of the corrections they would like to see.
Rural hospitals want technical corrections that will funnel some physician reimbursement through payments to specially designated rural critical-access hospitals.
Teaching hospitals, meanwhile, don't want indirect graduate medical education payments to decrease in 2001.