American Hospital Association officials touted an agenda of regulatory reform and hospital workforce development at the group's annual leadership meeting last week in Washington. But behind the curtain was an old message: Hospitals want more money from Medicare and Medicaid.
The AHA's public face was that a healthcare workforce shortage and a regulatory surplus are threatening quality of and access to care at hospitals nationwide. The nation's largest hospital lobby says there aren't enough nurses and other healthcare workers, and existing workers spend too much time filling out paperwork to spend adequate time on patient care.
But as they made their pitch, AHA officials argued that among the solutions to both impending crises is to increase reimbursement from Medicare and other government programs to help pay nurses more and absorb higher administrative costs imposed by expanding regulations.
In 1999 and 2000, Congress passed two laws that combined increased Medicare and Medicaid payments to providers by nearly $50 billion to compensate them for the spending limits imposed by the Balanced Budget Act of 1997. With a third relief bill considered a long shot this year, the AHA is finding it necessary to create a new message to deliver to Congress on Medicare payment issues.
"The issue isn't whether we call it (Balanced Budget Act) relief," Richard Pollack, the AHA's executive vice president, told 2,200 hospital executives at the meeting. "The issue is whether you have the resources."
Healthcare lobbyists acknowledge that the pitch to reverse those Medicare payment caps has been a harder sell on Capitol Hill this year (April 23, p. 26), and the AHA is adjusting its message to fit the antiregulatory mood of President Bush and the Republican-controlled Congress.
"It's what any good lobbying organization does: Find out what's hot and figure out how to package your agenda as being a part of that," said one healthcare lobbyist, who asked not to be named.
At a press conference to release a report on hospitals' paperwork burden, however, AHA President Richard Davidson said the organization would be pushing the antiregulatory message, even without the new resistance to Medicare payment increases in Congress.
"This is an agenda issue that can stand on its own," Davidson said.
The AHA's study of 19 hospitals found, for example, that an hour of skilled-nursing care required, on average, a half-hour of additional paperwork. An hour of inpatient care required 36 minutes of administrative work, and an hour of emergency care required an hour of paperwork, according to the study, which was prepared by PricewaterhouseCoopers at a cost of $127,000.
Among the recommendations to alleviate the burden, the AHA recommended increasing Medicare hospital payment updates whenever the federal government imposed new regulations to help hospitals absorb the administrative costs, much as productivity and technology costs are factored into the update.
Members of Congress and administration officials who addressed the hospital executives gave positive reviews to the regulatory relief agenda.
But in supporting the AHA, House Speaker J. Dennis Hastert (R-Ill.) gave Congress an excuse to ignore its plea for Medicare payment increases. In a speech transmitted by satellite to hospital executives, Hastert said regulatory reform not only will give medical practitioners more time to spend with patients, but also will "free up a lot of resources for hospitals to treat patients."
The Medicare payment issues received a mixed review from public officials who spoke to the AHA's membership. Responding to a question from an audience member, HHS Secretary Tommy Thompson backed the idea of increasing the labor-related reimbursement factors for rural hospitals and those in low-wage areas.
He said he supported doing so by diverting money from the federal budget surplus, now estimated at $5.6 trillion over the next 10 years, rather than taking the money away from hospitals with higher labor compensation.
"You can't expect to build up rural hospitals by tearing down urban ones," Thompson said.
That message is not being heard, however, by Rep. Nancy Johnson (R-Conn.), chairwoman of the House Ways and Means health subcommittee. She told the AHA executives it would be "irrational" to set a floor on the "wage index," a mathematical factor that reduces Medicare hospital payments in rural areas. Establishing a minimum labor-related reduction is a chief goal of rural hospitals this year, worth an estimated $6.1 billion during the next five years.
"It is truly not in your interest to reimburse on irrational factors," Johnson said. "In the end, (Medicare payment decisions) will all be totally political." zxxx