The AHA's 2007 Advocacy Agenda

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“The hospital.”  The place Americans turn to when they are injured, or sick, or having a baby or for a host of other reasons.  It’s a tradition of being there to provide care 24/7.  But more and more that tradition is being paralleled by a new tradition, one that reaches out to the community to help people stay well in the first place.  In hundreds of ways in thousands of communities across the map, hospitals are no longer only the place you go for care, they are also the place that comes to you … providing immunizations in a local school, or helping people quit smoking at a local business, or teaching youngsters the perils of drug use at a local community center.  America’s hospitals are connecting with their communities in unprecedented ways, to keep those communities healthier. 

The American Hospital Association’s Advocacy Agenda for 2007 is designed to help hospitals continue their tradition of being there when they are needed, to meet soaring demand for services, to reach out to their communities in creative and healthy new ways, and to begin a national discussion about what the future of America’s health care will be.  The agenda is summarized in the following sections. 

	Ensure that hospitals have the resources they need to provide high quality care and meet their responsibilities to their communities.
	Improve quality of care and patient safety
	Expand health coverage to as many as possible as soon as possible.
	Make hospitals the employer of choice and prevent efforts to undermine the relationship between hospitals and their employees.
	Improve accountability for tax-exempt status.
	Ensure that a community’s essential health care services are not impeded by marketplace inequity.
	Begin a national discussion on what health care should be.

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Ensure that hospitals have the resources they need to provide high quality care and meet their responsibilities to their communities

• Fight proposed budget cuts to Medicare and Medicaid
  President Bush has proposed a fiscal year 2008 federal budget that includes more than $100 billion in funding cuts to Medicare and Medicaid over five years.  Included are dramatic cuts in funding for hospital services that are critical to the health and well being of America’s elderly, disabled and children.  At the same time, many in Congress are determined to cut the federal deficit by 2012, and could target Medicare and Medicaid to do it.  But such cuts would come at a time when demand for hospital services is rising as the nation ages, and as the number of uninsured Americans continues to soar.  A top priority this year is to fight these cuts and other efforts to balance the federal budget on the backs of patients and communities.
  
  
• Fight administrative cuts to Medicaid
  Ignoring the stated wishes of a majority in both the House and Senate, the Centers for Medicare & Medicaid Services (CMS) has proposed a regulation that would cut nearly $4 billion from the Medicaid program, harming important services that the nation’s poorest citizens rely on.  With our supporters on Capitol Hill and others, we will continue to seek legislation to stop this regulation before it can be implemented.
  
  
• Protect rural hospitals
  While all hospitals face challenges, America’s rural hospitals face unique circumstances as they strive to provide care.  We will support further efforts to protect critical access hospitals (CAHs), which are usually the only facility for miles, by expanding existing cost-based payment; allowing flexibility for bed size and relocation; ensuring that CAHs that contract with Medicare Advantage plans are appropriately reimbursed; and allowing CAHs to utilize reference labs to provide services to the beneficiaries they serve.  We also will recommend cost-based payment for rural hospitals with 50 beds or fewer, and support restoring the full value of the outpatient hold-harmless provision to small rural and sole community hospitals.
  
  
• Protect teaching hospitals
  We will fight any efforts to harm America’s teaching hospitals by reducing funding for programs, like graduate medical education funding from Medicare and Medicaid, that helps them provide care for America’s most needy and, at the same time, train the next generation of physicians and other caregivers.
  
  
• Fix the “75% Rule” and protect the full range of health care services
  We will support legislation that freezes the 75% rule at the current 60% level and protect rehabilitation care for those who need it.  The rule requires that, to be reimbursed as an inpatient facility under Medicare, 75% of a rehabilitation facility’s patients must be treated for a set of 13 specific conditions.  But that set of conditions has not been adequately updated to reflect modern medical rehabilitation practices and advances.   Congress recently slowed a phase-in of the rule’s implementation, but without legislation like the AHA-backed the Preserving Patient Access to Inpatient Rehabilitation Hospitals Act (S. 543), the threshold for the rule will jump to 65% beginning July 1, 2007 and to 75% in July 2008.  At the same time we will fight for other services, such as home health and long-term care, that are critical to the lives of millions of Americans.
  
  
• Protect physicians
  We will continue to oppose Medicare payment cuts to physicians; at the same time, we also will oppose using hospital payment reductions as an offset to finance the costs of that change.

Improve quality of care and patient safety

• Continue leadership role in the Hospital Quality Alliance
  By making hospital performance data widely available to the public, the Hospital Quality Alliance (HQA) has helped consumers make better-informed decisions about their care.  The AHA will continue its leadership role on the Alliance and work to support HQA as the national platform for transparency, including working with the National Quality Forum to shape quality goals; for pay-for-performance measures; and for surgical infection prevention measures.
  
  
• Address disparities in care
  The AHA will support efforts to reduce racial and ethnic disparities in health care outcomes by targeting clinical practices, health professions education and research.  At the same time, we will advocate for data collection that better identifies and addresses disparities in care, and best practices that can help others in their quest for health care equality.
  
  
• Harness the power of Health Information Technology
  Information technology (IT) has the potential to dramatically improve both the delivery and efficiency of care.  The AHA will work toward federal approaches that help hospitals with the funding needed to implement health care IT.  We will advocate for the modernization of federal “Stark” laws so hospitals can help physicians integrate electronic medical records based on recent Centers for Medicare & Medicaid Services regulations, and demonstrate to the IRS the public benefit of these activities.  We also will work with key stakeholders to select interoperable standards that help facilitate the use of health IT and urge timely implementation of ICD-10.

Expand health coverage to as many as possible as soon as possible.

• Start with the 9 million uninsured children
  Nearly 47 million Americans have no health care insurance, a number that continues to rise and an issue that has an impact on every aspect of health care in America today.  One way to begin to reverse this unfortunate trend is to make sure all of America’s children have coverage.  The very successful State Children’s Health Insurance Program (SCHIP) must be reauthorized by Congress this year, and we will push hard to ensure that reauthorization extends the program to all children who remain uninsured. 
  
  
• Build on the Health Coverage Coalition for the Uninsured plan
  The AHA will continue its leadership role in the Health Coverage Coalition for the Uninsured (HCCU), a mix of disparate national organizations representing businesses, caregivers and others, who have set aside their policy differences to agree on a proposal to extend coverage to millions of Americans by extending public programs for the poor, providing meaningful tax subsidies for the purchase of private health insurance, and maintaining incentives for employers to offer coverage. 
  
  
• Continue Cover the Uninsured Week support
  We will continue our support for Cover the Uninsured Week, which shines the national and local spotlight on the problem, as well as efforts to create equal health insurance coverage for mental and physical illnesses.

Make hospitals the employer of choice and prevent efforts to undermine the relationship between hospitals and their employees.

• Support funding, training efforts
  In addition to ensuring appropriate funding for federal programs that help train health care workers, the AHA supports legislative efforts to increase the nation’s capacity to train more nurses and health care workers as well as flexibility in immigration laws to allow hospitals to continue to employ foreign-trained health care professionals.  This includes approaches for increasing the number of graduate medical slots authorized under Medicare, increasing the number of nurses and well-trained allied health care professionals, and reauthorizing the Nurse Reinvestment Act with an emphasis on increasing funding for additional faculty needed to educate more nurses.
  
  
• Support fair and open union elections
  We will support maintaining current law under which labor unions must organize workers through a free and open election process supervised by the National Labor Relations Board, and retaining hospital management flexibility to ensure that enough qualified staff is on hand to ensure that patients receive the care they need at all times.
  

Improve accountability for tax-exempt status.

• Help hospitals meet community needs, report community benefit
  Among the obligations conferred on not-for-profit hospitals by their special tax status is the development of strategies to meet the health care demands of their communities.  We will continue our work to help the field meet those obligations, including publicly reporting, in a uniform manner, the many benefits they provide for their communities.  At the same time we will provide tools, resources and best practices on complying with AHA guidelines regarding billing and collection practices, including policies related to providing discounts to the uninsured of limited means. 
  

• Retain the current standard
  We will work with Congress and the IRS to ensure that the current community benefit standard for maintaining tax-exempt status is retained, because it allows hospitals the flexibility needed to tailor programs to the unique needs of their communities.

Ensure that a community’s essential health care services are not impeded by marketplace inequity.

• Extend moratorium on physician-owned, limited service providers
  Hospitals play a critical role in the health of their communities, from keeping emergency departments open 24/7 to being prepared to respond to manmade or natural disasters.  But in order to keep these and other important but money-losing community services available, hospitals and those competing with them to provide more-profitable services must operate on a level playing field.  In 2007 we will work to extend a moratorium on physician-owned, limited-service providers that ended in August of 2006.  Physicians who own specialty hospitals and then steer well-insured patients to them have a clear conflict of interest, one that could lead to important decisions being made for reasons other than the best interest of the patient.  At the same time, studies show that the practice hurts communities’ full-service hospitals that provide a full range of services including being open 24 hours a day. 
  

• In addition, we will work to achieve specific recommendations that the AHA Board of Trustees has developed addressing market inequities in the delivery of health care in ambulatory care settings.  We also will work to:
  

		Develop strategies to modernize the Emergency Medical Treatment and Labor Act, including facilitating hospitals’ ability to comply with the requirements by providing incentives for physicians to help hospitals meet these obligations.
		Build on the efforts of 32 states that have price transparency policies by supporting federal legislation to require states that have not adopted such strategies to do so or face federal requirements, and work to ensure that transparency requirements apply to all sectors of health care.
		Examine and analyze the consolidation of the health insurance industry and the standards under which they are reviewed by federal and state antitrust authorities to ensure that markets remain competitive and that hospitals and those they serve are not disadvantaged during negotiations as a result of health insurers’ accumulation of market power.
		Build on previous reports and continue to highlight the value that health care brings to communities and to the nation’s economy, as well as how improvements in health care and advances in medicine increase America’s productivity.

Begin a national discussion on what health care should be
Our nation leads the world in innovative treatments, clinical ingenuity, and best medical practices. We spend more money per capita on health care than anyone else.  Still, tens of millions of Americans have little or no access to even the most basic care: a regular checkup with a doctor. Even as costs keep rising, patients, families, employers and health care professionals struggle to cope with a system that’s not a system at all and that seems to get more complex, uncoordinated and frustrating every day. Yet it’s astonishing to realize that it’s been nearly 15 years since our last serious, national conversation about how to make health care work for all Americans.

America can and must do better. And hospitals should play a leadership role.  The months leading up to the 2008 national elections are an important opportunity to ignite a debate about our nation’s health care future. The AHA … led by its Board of Trustees …has developed a policy framework for a new health care direction for our nation.  It is built on five important goals that must be achieved to truly change health care. 

		Get value for the dollars we devote to health care. That means improving the quality, safety and performance of the organizations and people who deliver care.   It means rewarding excellence and creating real accountability.
		Care that is coordinated, where decisions are always made in the patient's best interests and where patients and caregivers work as a team to make the right decisions with the best possible information.
		Emphasize health. Keeping people well and improving their health must be a major focus of change.  It’s important to our nation’s quality of life, security and economy. Real change must promote preventive services and encourage and reward healthy lifestyles and individual responsibility.
		Access to information is the lynchpin of an efficient, world-class health care system.  Portable electronic health records have the potential to save lives and dollars, and we must tap that potential fully.  At the same time, useful information on quality and pricing must be made public.
		Health insurance must be available to all, and supported by all.  Coverage must be affordable and equitable, and individuals, employers and government should share the costs of coverage.

There are many ways to achieve these goals and that’s what a debate on the future of health care will be all about.  It’s time to come together as a field and support a new direction for our patients and communities.