The year-end $388 billion appropriations bill Congress passed Nov. 20 threw a few crumbs at the hospital industry but didn't go as far as some had hoped, Washington insiders and hospital association officials said last week.
Among the winners were nursing education and retention programs and children's hospitals, and among the losers was President Bush's 7-month-old Office of the National Health Information Technology Coordinator. The 3,016-page bill that doles out funds for fiscal 2005 cut spending on hospital bioterrorism preparedness but increased it for nursing programs and remained flat for rural health support.
Chip Kahn, president of the Federation of American Hospitals, said the bill also delays CMS implementation of the so-called "75% rule" defining rehabilitation hospitals. That regulation requires rehabilitation hospitals to admit 75% of their patients based on certain rehabilitation DRG codes. Implementation will be postponed until a Government Accountability Office report studying the regulation is released. Kahn said the federation would have preferred a stronger provision recognizing the valuable contribution that rehabilitation hospitals provide to patients. "Hopefully that will come across in the GAO study," Kahn said.
Carla Luggiero, senior director of federal relations at the American Hospital Association, said one of the bill's highlights was $152 million aimed at nursing programs, including advanced nurse education, diversity, retention, loan repayment and scholarship programs. Luggiero said that reflects a $10 million increase from fiscal 2004 spending. Luggiero also said she was pleased that rural health outreach and research programs remained on par with 2004 funding at $88.1 million.
While legislators trimmed the hospital component of a bioterrorism funding bill by $22.6 million-from $518 million to $495.4 million-Luggiero said much of the preparedness work had already been completed.
She applauded the $303.2 million in funding for graduate medical education for children's hospitals. "That's particularly important because there is no support in Medicare for pediatrician training. This helps maintain the pediatrician population and gets care to the kids who need it," she said.
One controversial amendment to the bill has attracted some attention. Rep. David Weldon (R-Fla.) attached a rider that blocks states and localities from receiving federal funding if they compel healthcare providers or insurers to provide, pay for or refer patients for abortion services. Weldon, a physician, said he was concerned that government entities or insurers would require those services. Luggiero said she's unsure how this will affect hospitals. "Some of our religious-based members will be happy they won't be forced to do something that conflicts with their mission," she said. "Others may be afraid to perform those services for fear of losing federal funding."
The bill was also notable for what it did not include. Roughly half of the $100 million that President Bush had requested for healthcare information technology was axed in the negotiating process, a congressional staffer told Modern Healthcare. While the Agency for Healthcare Research and Quality is to receive $50 million for IT projects, and another $10 million for patient-related safety initiatives, the Office of the National Health Information Technology Coordinator headed by David Brailer will receive $4 million, as opposed to the $50 million the administration had requested. The House version of the bill had requested $25 million, while the Senate had not included anything in its version, so "getting $50 million would have been tough," the congressional staffer said.
Brailer's office did not respond to calls seeking comment by deadline.
"What it signals to me is that we have to work harder to educate members of Congress," said Thomas Leary, director of federal affairs at the Healthcare Information and Management Systems Society.
Another $200 million in funding to perform hospital-based cancer research that had been targeted for cuts survived the bill's passage, the congressional staffer said. About 70 teaching hospitals will qualify for the money, which was authorized in last year's Medicare reform law. "It's a loan fund to complete infrastructure work, and the hospitals must repay it unless they are among a very small group of hospitals meeting specific requirements about the populations they serve," the staffer said.