Though healthcare lobbies in Washington often use the power of television advertising in lawmakers' states to press their legislative agenda, the tactic is risky. In fact, nursing homes learned recently that this none-too-subtle technique can backfire, as Dick Cheney might say, big time.
As the Senate Finance Committee was drawing up a bill in November to ease the burden of Medicare regulations on providers, the Alliance for Quality Nursing Home Care, which represents nursing home owners, aired advertisements in Montana and South Dakota calling on Congress to reverse some new restraints on Medicare spending set to take effect in October 2002. For those who don't follow Beltway events closely, those are the respective home states of Finance Committee Chairman Max Baucus and Senate Majority Leader Thomas Daschle, both Democrats. Before the advertisements ran, officials of the American Health Care Association, a nursing home group coordinating the alliance, told Jeff Forbes, Baucus' chief of staff, about the groups' plan. Forbes asked them not to run the ads, committee sources said.
When the alliance went ahead, sources said, Forbes ordered committee aides to eliminate proposed language that would have helped nursing homes appeal federal orders to shut down their nurse-aide training programs. It was a wrist-slap that could have been worse for the troubled industry.
The nursing home debacle underscores the danger of television advertising aimed at persuading-and sometimes pressuring-lawmakers to take action. Sometimes, it has the opposite impact.
"You have to do something that's going to resonate with the influential audiences, but at the same time you have to do something that essentially is going to give the lawmakers a way to accommodate it," says Marilyn Castaldi, senior partner and healthcare practice director at public relations firm Fleishman-Hillard, St. Louis.
"They needed to appreciate the sensitivities of the situation and craft a message to allow the congressmen in those states to respond without casting blame," she says.
It was a harder advertising pitch than the one made by hospitals this fall. Two ad campaigns, one by an alliance of hospitals and one by the Federation of American Hospitals, focused on hospital workers and their role in everyday health and safety as well as emergency response, in an effort to win more Medicare and homeland security dollars (Nov. 19, p. 6).
Baucus' staff did not return telephone calls seeking comment on the imbroglio, and an alliance spokesman said he hadn't heard about the senator's reaction to the ads. Baucus, a moderate-to-liberal Democrat in an overwhelmingly Republican state, is a constantly endangered candidate whose term expires in 2002, and he may be sensitive to any issue advertisements that appear to attack his record.
Furthermore, the choice to advertise in Daschle's home state may also have raised Baucus' ire. Many observers believe Daschle is directing the agenda of Baucus' committee behind the scenes, citing as evidence Baucus' cooperation with Republicans over a tax-cut law enacted earlier this year.
The AHCA and the nursing home industry have been friendly to Baucus in the past. The AHCA's political action committee has given Baucus $7,000 in preparation for the 2002 campaign, and an investor-owned nursing home company and AHCA member, Beverly Enterprises, has contributed another $3,000.
The provision Baucus ordered withdrawn would have speeded nursing homes' appeals of orders to shut down their nurse-aide programs because inspectors have cited the facilities for substandard care, one of many sanctions inspectors use to drive compliance with quality standards.
The remainder of the regulatory relief bill, which has passed the House but is still awaiting Senate action, contains many items for nursing homes to be happy about. For example, it will expedite providers' appeals of orders to kick providers out of Medicare because of erroneous billing or substandard care.
Clearly, this is not the year for nursing homes to tangle with influential members of Congress. Beyond regulatory relief is the more-pressing issue of Medicare payment. With the federal budget sinking back into deficits, and with Medicare HMOs, physicians and hospitals already trying to elbow their way to the front of the line for limited dollars, nursing homes already were facing an uphill battle for increased payments.
And Alan DeFend, an AHCA spokesman, says nursing homes are going to fall off a Medicare funding "cliff" when payment increases enacted in 1999 and 2000 expire in September 2002.