We got lucky. That's the sentiment of some hospital lobbyists, who saw the year dawn with the specter of more restraints on Medicare provider payments, the potential of a nationwide reporting system for medical errors and the possibility of a blanket antitrust waiver for physician networks.
As legislative work winds down in this presidential election year, however, it appears that the worst that could happen for hospitals will be that they get only one year of Medicare payment increases rather than two.
Most of the initiatives seen as potentially damaging to the industry never gained momentum or were beaten back by opponents'--sometimes hospital groups'--hostile lobbying.
Meanwhile, lobbyists for provider organizations used their members to pressure Congress to roll back growth caps in the Balanced Budget Act of 1997, yielding almost the only healthcare initiative to emerge from Congress this year.
"In the scheme of things, we're looking a lot better than we did six months ago," says Fish Brown, a lobbyist with the Catholic Health Association.
The most dramatic turnaround is on Medicare provider payments. Following up on last year's $16.1 billion package of provider payment increases from Medicare, Medicaid and the State Children's Health Insurance Program, President Clinton proposed a budget that would have trimmed $19 billion in payment increases from 2001 to 2005.
It did so in part by extending restraints on hospital inpatient payment growth imposed under the balanced-budget law.
But by June, Clinton reversed course and proposed a package of Medicare payment increases worth $21 billion through 2005, including a hospital inpatient payment update in 2001 equal to an inflation measure called the marketbasket index.
Hospitals have been pushing for an update equal to the marketbasket for 2001 and 2002--a provision worth $9.5 billion--as part of a $25 billion, five-year package of Medicare payment increases. Under the 1997 budget law, the Medicare inpatient hospital update was set at 1.1 percentage points less than the marketbasket for 2001 and 2002.
So far, as Congress puts together its own Medicare payment package, it is using Clinton's $21 billion figure as a base line. Congress also may heed Clinton's proposal to increase the hospital update for one year only.
"I hesitate to declare victory," says Richard Pollack, executive vice president of the American Hospital Association.
The apparent failure of a patients' bill of rights is a mixed bag for providers. Since early this year, members of Congress have sought to reach a compromise on differing versions of legislation passed by the Senate and House.
The big difference between the two bills was allowing beneficiaries the right to sue their health plans for damages resulting from the denial of covered benefits. The House plan allows lawsuits; the Senate plan doesn't, but it does require plans to provide an appeals process to adjudicate the dispute.
The House and Senate are at an impasse, making final passage of the legislation unlikely.
The House legislation contained protections against firing hospital workers who report legal violations, something many hospital groups have fought.
That version of the legislation also included prompt-pay measures that would require managed-care plans to pay providers within 30 days of receiving a correctly coded claim.
The likely death of the patients' bill of rights "certainly doesn't represent forward progress" on the issue of prompt payment, Pollack says.
Should hospitals come up short on a Medicare payment-increase package, it may not be possible for them to go hat-in-hand back to Capitol Hill next year.
Many of the balanced-budget law provisions that affect hospitals expire in 2002, so hospitals may have a hard time persuading Congress of the continuing effects of the law.
"There's only so long you can sustain a drive to roll back (Medicare) cuts that sunset," says the CHA's Brown.
In addition, lobbyists say members of Congress and their aides tell them they are beginning to tire of the campaign to increase Medicare payments, which is in its second year. If other providers walk away satisfied from this year's Medicare payment package, hospitals may be the only lobbying group still complaining about their compensation.