As the calendar turned to 2001, the year picked up more or less where the previous one left off. The healthcare industry was obsessing over adequate federal reimbursement, the merits of a Medicare prescription-drug benefit and patient-protection legislation, as well as the specter of regulatory overload under the Health Insurance Portability and Accountability Act of 1996. The industry also faced another great unknown---the incoming administration of George W. Bush. Following are some of the key events of next year, at least through late summer...
January
* In issuing final regulations implementing the Stark II antikickback statutes, the federal government helps clarify provisions and appears to relax strict limits on physician self-referrals.
* Thomas Frist Jr., M.D., announces he'll step aside as chief executive officer of HCA-The Healthcare Co., Nashville, but remain chairman of the company's board of directors.
* George W. Bush is sworn in as the 43rd president of the United States. He orders a delay or rewrite of some healthcare regulations drafted before the start of his administration.
* Wisconsin Gov. Tommy Thompson is confirmed as HHS secretary.
February
* Sens. John Breaux (D-La.) and William Frist (R-Tenn.) reintroduce legislation aiming to transform Medicare into a subsidy program that helps seniors buy private-sector insurance coverage.
* An HHS report warns of serious shortfalls of registered nurses, saying the profession isn't attracting or retaining enough nurses to meet future demand. Meanwhile, another report on staffing in the skilled-nursing and assisted-living sectors also paints a grim picture.
* A presidential advisory committee issues a report criticizing the healthcare industry for its failure to use information technology to its full capabilities.
March
* The Institute of Medicine issues a second report critical of the healthcare industry. Titled Crossing the Quality Chasm: A New Health System for the 21st Century, it contends America's healthcare system is "plagued by a serious quality gap" and needs to be transformed.
* According to an advisory memo from the Internal Revenue Service, not-for-profits will have to be able to prove that they provide charity care to maintain their tax-exempt status.
* The debate over mandated nurse-staffing ratios heats up. Addressing California's first-of-its-kind law setting minimum requirements for nurse staffing, the California Nurses Association submits its formal recommendation-one nurse for every three patients, vs. a 1-to-10 ratio supported by the state's hospital association.
* President Bush nominates Thomas Scully, president of the Federation of American Hospitals, to head HCFA.
* The American Hospital Association announces plans to push for $17 billion in increased Medicare funding over five years citing the need for more money to woo quality healthcare workers.
* Members of the Massachusetts Nurses Association vote to bolt from the American Nurses Association after two previous disaffiliation votes failed.
* The Joint Commission on Accreditation of Healthcare Organizations proposes a model for the effectiveness of healthcare staffing that would eventually become part of the accreditation process.
April
* An HHS report contends that computerized medication order-entry systems could prevent 28% to 95% of adverse drug events. Another report shows hospitals have been slow to adopt the technology.
* The Bush administration opts not to delay the April effective date of the HIPAA patient-privacy regulations. This comes despite months of protests by hospitals, health plans and other providers-and after an extended public comment period.
* Although its Web-based healthcare information business continued to ail, drkoop.com, Santa Monica, Calif., enters the healthcare delivery business, announcing its acquisition of home infusion provider IVonyx, headquartered in Michigan.
* Triad Hospitals, Dallas, completes $2.4 billion acquisition of Quorum Health Group's hospitals, doubling the system's size and making it one of the largest investor-owned hospital chains. As a prelude to completion of the deal, Quorum, Brentwood, Tenn., agrees to pay $100.5 million to settle charges of Medicare fraud.
* Keeping a promise he made when he first took office, HHS Secretary Thompson launches a five-part campaign designed to increase organ donations.
May
* The renowned Menninger Clinic, which in mid-2000 unveiled plans to leave its longtime home in Topeka, Kan., announces it has put its relocation on hold.
* Sen. James Jeffords of Vermont says he is leaving the Republican Party to become an independent, giving the Democrats a majority in the Senate and altering the balance of power in Congress.
* Nurses win one and lose one in court. In two precedent-setting rulings, federal courts say nurses can sue institutions for fraud but they can't join unions if they are assigned even minor supervisory functions.
* It was a tough month for healthcare as a flurry of negative reports, surveys, studies and polls is released regarding the state of the industry and the prognosis for the future. Much of the scathing criticism comes from healthcare organizations.
June
* Shortage? What shortage? Healthcare providers and congressional researchers are at odds over the severity-or even the existence-of nationwide hospital staffing shortages. For example, the Congressional Research Service contends in a report that it can't state conclusively that an across-the-board shortage of registered nurses exists. The hospital industry takes issue with those findings.
* HCFA, the familiar acronym for the Health Care Financing Administration, the agency that oversees federal healthcare programs, officially becomes the Centers for Medicare and Medicaid Services, or the CMS.
* A federal appeals court upholds the 1999 convictions of a former hospital executive, Dan Anderson, and two physicians, Robert and Ronald LaHue, on criminal charges in a Kansas City, Mo., kickback case. In doing so, the court hands federal investigators a larger net to catch other healthcare executives involved in cash-for-patients schemes.
* The debate over patient-protection legislation heats up in the U.S. Senate.
* CMS Administrator Scully announces streamlined rulemaking for healthcare providers, including quarterly previews of pending regulations and once-a-month announcements of new regulations.
* Oregon lawmakers pass legislation limiting mandatory overtime for nurses and requiring hospitals to establish staffing plans.
* Saying they don't see the value of the JCAHO's surveys, one hospital tells the Joint Commission to take a hike, and at least two others seriously consider doing the same thing. The hospitals cite the high cost and cumbersome nature of the surveys.
* The American Medical Association fires E. Ratcliffe "Andy" Anderson, M.D., the association's executive vice president, 11 days after he filed a $5 million defamation of character and breach-of-contract lawsuit against the AMA.
July
* The first AbioCor artificial heart is implanted in a Kentucky man, Robert Tools. He lives five months on the device. By mid-December, six devices had been implanted in patients, and three of those had died.
* New patient-safety standards from the Joint Commission require hospitals to tell patients when their treatment outcomes vary from anticipated results.
* In a blow to organizations such as the Leapfrog Group-a coalition of large employers-a new federal report, "Making Health Care Safer: A Critical Analysis of Patient Safety Practices," contends some of the practices the group promotes lack clinical underpinnings.
* Another General Accounting Office report is issued on the state of the national nursing shortage. This one states that yes, there may indeed be a shortage, but insufficient data make it hard to define the overall severity.
* A government-sponsored study shows a continuing drop in hospital merger and acquisition activity.
* A study published in the Journal of the American Medical Association suggests the oft-cited medical-error statistics in the blockbuster 1999 Institute of Medicine report are probably "unreliable" and "misleading."
* The consumer advocacy group Public Citizen contends the pharmaceutical industry exaggerates the cost of developing new drugs by fivefold to justify high drug prices and fat profit margins.
August
* The House approves a patients' bill of rights. The legislation faces a conference committee to work out differences with a Senate-passed bill.
* The Allegheny Health, Education and Research Foundation scandal, more than 3 years old, continues as the Securities and Exchange Commission files a civil lawsuit charging three outside auditors with securities fraud in connection with their 1997 audit of the failed system.
* Thomas Frist Jr. announces he'll step down as chairman at HCA. CEO Jack Bovender adds that title.
* Janet Rehnquist is confirmed as the new HHS inspector general.
* After months of haggling among providers, Congress and the White House on how to spend the projected federal budget surplus, a flagging economy-and the vanishing surplus-make the issue moot.
* Bergen Brunswig Corp., Orange, Calif., and AmeriSource Health Corp., Valley Forge, Pa., merge to create the nation's largest drug distributor.
