While the hospital lobby tries to hang onto money with one hand, it reaches out for more with the other.
Contending that hospitals need more money to woo quality workers, the American Hospital Association will push Congress to boost hospital Medicare payments by at least another $17 billion during the next five years, a top AHA official said last week.
The effort comes as the AHA and other hospital groups try to prevent lawmakers from using future Medicare surpluses for other purposes (See related story, p. 9).
The association will seek full inflation updates to inpatient and outpatient payments in the next two years, more graduate medical education funds, several rate increases for rural hospitals and extensions of expiring payment provisions, said Richard Pollack, the AHA's executive vice president.
The payment increases are part of an advocacy agenda that makes top priorities of expanding health insurance coverage, resolving workforce shortages and reducing the federal regulatory burden.
Boosting payments for federal healthcare programs would help resolve workforce shortages by giving hospitals more money to increase workers' wages, Pollack said.
He characterized the proposed payment increases as a "reinvestment" in the healthcare system, which could be supported by a budget surplus now projected at $5.6 trillion in the next 10 years. The increases would be just, Pollack said, given that the surplus is a result in part of restraints on Medicare spending growth.
"You put (proposed payment increases) against the size of the surplus and what we contributed to the surplus, and what we see are real needs out there," Pollack said. "We don't think it's unreasonable."
Under the AHA proposal, Medicare payments for inpatient and outpatient services in general would increase by an estimated $5 billion over five years. Teaching-hospital reimbursement would grow by $3 billion. The proposed rural package would increase Medicare spending by $9 billion to $10 billion over five years.
But the message from Capitol Hill was mixed. Rep. W.J. "Billy" Tauzin (R-La.), chairman of the House Energy and Commerce Committee, told reporters he wasn't sure Congress would pass broad Medicare increases to reverse the payment restraints under the Balanced Budget Act of 1997. He said he is concerned chiefly with rural providers.
However, he didn't rule out some form of general provider payment increase.
Tauzin's comments came a week after Rep. Nancy Johnson (R-Conn.), chairwoman of the House Ways and Means Committee's health subcommittee, said there will be another round of Medicare payment increases. Such a measure would follow up on legislation in 1999 and 2000, which provided more than $50 billion in projected relief from 2000 to 2006, about $18 billion of which was slated for hospitals.
But one Capitol Hill source dismissed the likelihood of more relief, citing the past legislation, as well as Congress' focus on structural Medicare reform this year, better financial performance by hospitals and other providers, and a lack of revenue.
Separately last week, the Catholic Health Association released its 2001 legislative agenda. The association plans to press Congress to expand health-insurance coverage, improve programs to help safety-net providers and ensure that Roman Catholic hospitals aren't forced to provide services that conflict with their religious missions.
Association leaders said the agenda also emphasizes efforts to expand the healthcare workforce and ensure adequate Medicare and Medicaid payment rates for providers. Other goals on the group's legislative list are limiting government regulation, moving toward Medicare reform and adding prescription drugs to the Medicare benefit package.