MEETING HIGHLIGHTS

June 7-8, 1999 - Washington, DC

On June 7-8, 1999, the governing council of the AHA's Section for Metropolitan Hospitals met in Washington, DC. The meeting included discussions on federal advocacy and policy issues and initiatives, Y2K, domestic violence, eliminating variations in practice patterns, and a review of AHA's Balance Budget Act (BBA) relief agenda followed by visits to members of Congress. The council was joined by Jack McMeekin, president and CEO, Crozer-Keystone Health System, Springfield, PA, and an AHA Board member.

Chair's Report: James T. Paquette, CEO, SCL/HSC Montana Region, and the chair of the Metro section governing council reviewed the issues and actions from the previous meeting. He also reported on the recommendations of the section nominating committee that convened in May 1999.

Federal Legislative Update: AHA staff provided an overview of several advocacy issues not related to the BBA. In the absence of legislation by August 1999, the Secretary of the Department of Health and Human Services will develop rules on medical records confidentiality. The AHA opposes many of the Secretary's recommendations and supports legislation proposed by Sen. Robert Bennett (R-UT) because it frees patients from fragmented state confidentiality laws without hindering the ability of hospitals to make timely use of patient information to deliver high quality care. A compromise bill is being crafted from several bills proposed in the House and Senate. Key issues include preemption, hospital operations, access by law enforcement, use and disclosure, research, and private right of action. AHA has communicated its policy position to Congress and the public through testimony and its principles for confidentiality. Members support AHA's position and shared the Association's concern about the inflexibility and expense created by some bills. Members also expressed concern about federal control of data for research and unfettered access to and disclosure of records by law enforcement.

AHA staff reviewed liability legislation and reported on Congressional hearings and AHA testimony on Y2K readiness. Staff also reported that recent media attention on the use of and deaths associated with restraints and seclusion has generated considerable reaction from Congress. AHA is working with the National Association of Psychiatric Health Systems to develop policy and shape legislation.

Lastly, staff reviewed bills proposed by Congress on patient protection. AHA supports access to emergency medical services, mandatory external appeals and due process, and access for women's health emergencies. AHA opposes mandatory point-of-service in non-emergencies and whistle blower provisions.

Federal Policy Update: Staff led a discussion on the threats to and AHA's principles for funding medical education. A growing number of policy makers and members of Congress believe that medical education funding has no place in the Medicare Trust Fund and have advanced proposals to remove graduate medical education (GME) from Medicare and make it an annual or muti-year appropriation. AHA believes that medical education must have a consistent funding source, supports an all-payer trust fund, and believes that GME payment should go to the entities that incur the costs of teaching.

Staff gave an overview of bills sponsored by Sen. Moynihan (D-NY) and Rep. Cardin (D-MD). Members were concerned about both the short and long-term funding of medical education. They want assurances for the continued funding of DME and agree with AHA's support of bills by Sen. Moynihan and Rep. Cardin. They also want assurances for the long-term viability of funding for medical education and fear that research will be compromised if funding is cut. It is believed that failure to assure the long-term viability of medical education funding would jeopardize the mission of every teaching hospital. Members see business as particularly obstructive to and uninformed of the mission and goals of academic health centers. Finally, members believe policy on medical education must also support nurse training and supply.

Y2K Readiness: Staff reported on the outcome of an AHA survey that measured hospital readiness for information systems, medical devices, and infrastructure for Y2K. Very few members reported actual compliance, but a great majority of those surveyed reported progress at all levels. Members believe hospitals are much further along in readiness than suggested by the survey results.

Staff reported on the AHA's work with vendors and manufacturers to discourage stock piling of medical supplies and pharmaceuticals. Members agree with a high profile, public campaign supported by major purchasers and industry leaders to inspire community contingency planning and discourage stock piling. Members also supported another survey to measure readiness at the end of the summer.

Domestic Violence: Domestic violence as a community health priority is a growing concern for many metropolitan hospitals and systems. Marty Diamond, president and CEO, John Muir Medical Center, Walnut Creek, CA reviewed several resources from his hospital and the Family Violence Prevention Fund. He also reviewed findings from a study by the HRET of New Jersey that reported the tremendous variation in hospital training, emergency department policies, and organizational arrangements for managing domestic violence. Members characterized the incidence of domestic violence as serious to epidemic and were outspoken in the need to make this a priority at the executive management level of hospitals and health systems. They said the issue is consistent with the AHA's vision and mission and challenged the Association to be a resource for leadership by developing an infrastructure for support.

Eliminating Variations in Practice Patterns: John Combes, M.D. led a discussion on eliminating variations in practice patterns using the Dartmouth Atlas. Members saw considerable value in using the Atlas to eliminate variations, but also saw some limitations. Data are best used in aggregate and do not reflect quality of care, just differences in approaches to treatment. Nevertheless, members agree that data show a level of opportunity, but must be managed carefully. They would like to see the Atlas and guidelines for its use developed more fully. They also recommended organizing the Atlas in a manner that separates data on a scientific basis and that would better facilitate its use in eliminating variations and improving patient care.

AHA BBA Relief Agenda: Rick Pollack, EVP, AHA Government and Public Affairs, and Carmela Coyle, senior vice president, AHA Policy Development briefed members on AHA's relief agenda for the BBA. Mr. Pollack reviewed AHA's strategy for fixing the BBA. AHA will focus on the items with the largest budget impact and that provide relief for all hospitals such as eliminating transfers and lessening the impact of PPS for outpatient, skilled nursing, and inpatient services. He reviewed legislation that has been proposed that would provide relief to hospitals. To support this effort, AHA is expanding advertising, placing editorials, polling the public, and introducing BBA priorities as part of the agenda for those campaigning for political office in 2000.

Ms. Coyle reported on the financial impact of the BBA on hospitals and health systems using data gathered from a study by the Lewin Group and AHA. Data show the BBA resulted in the largest reduction ever to hospital Medicare payments, all margins are negative in the aggregate, and 70% of all hospitals have negative total margins in 2002. Mr. Pollack concluded the briefing by reviewing AHA's grassroots advocacy efforts including a BBA relief action alert to members, constituency-based advocacy days, and targeted Congressional initiatives. He reported that members of Congress were sensitive to the real pain caused by the BBA and have expressed a willingness to consider fixes, but much work must be done to convince Congress to take action.

Next Meeting: The next governing council meeting is scheduled for September 27-28, 1999 at the Doubletree Hotel in Salt Lake City, UT.

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