For example, Child and Grnbjerg (2007) suggest that lobbying helps NFP organizations access government grants or contracts. Government hospitals (e.g., Jackson Health System) are fully funded by a governmental entity (at the federal, state, or local level) in order to serve diverse constituents such as the military, people living in poverty, and the uninsured; for-profit hospitals (e.g., Tenet Healthcare Corporation) are owned by private investors that profit from providing services to paying patients; and NFP hospitals (e.g., University of Pittsburgh Medical Center [UPMC], Mayo Foundation for Medical Education and Research [Mayo Clinic], Ascension), managed by voluntary boards of trustees, are somewhere in the middle and provide care for paying patients and charitable services to people living in poverty (Baker et al. HOA Statistics [2023]: Average HOA Fees + Number of HOAs Besides salaries (49 percent), hospital costs include supplies (17 percent), uncompensated care (13 percent), and miscellaneous expenditures (21 percent) (Patrick 2014). Last, the Lobbying Disclosure Act of 1995 only requires that organizations that spend more than $10,000 on lobbying must register and file reports to disclose the lobbying issues and the amount spent. By continuing to use our website, you are agreeing to, Issues in Accounting Education Teaching Notes, AUDITING: A Journal of Practice and Theory, Current Issues in Auditing Teaching Notes, Journal of Emerging Technologies in Accounting, Journal of Emerging Technologies in Accounting Teaching Notes, Journal of Governmental & Nonprofit Accounting, Journal of Governmental & Nonprofit Accounting Teaching Notes, Journal of Information Systems Teaching Notes, Journal of International Accounting Research, Journal of Management Accounting Research, The Journal of the American Taxation Association, Journal of Forensic Accounting Research Teaching Notes, II. Further studies could explore this issue. Future research could examine the effects of hospital lobbying on these two areas if relevant data are available. To request permission to reproduce AHA content, please click here. In Section IV we present and discuss the results of the empirical tests. Charity care is never expected to be reimbursed, and it is different from bad debts that hospitals incur when they bill patients but do not receive payment (AHA 2010). A higher MCI indicates higher market competition, which may involve a higher human resource supply. Provides care to pediatric patients that is of a more intensive nature than that usually provided to pediatric patients. WebAmerican Hospital Association More records Hill outreach to oppose site-neutral payment cuts; Hill outreach in support of the Acute Hospital Care at Home program; Hill outreach Yangmei Wang, Yuewu Li, Jiao Li; Hospital Lobbying and Performance. The mean (median) of ROA is 0.044 (0.037), which is consistent with that in Collum et al. First, patients are different. Gapenski, Vogel, and Langland-Orban (1993) find several determinants of hospital performance including patient mix (i.e., Medicare/Medicaid mix) and organizational characters (i.e., size, teaching status, and network). The hospital industry has a broad spectrum of lobbying interests. Hospital lobbying increases employee salaries in government hospitals. One-time expenses triggered a $6.4 million loss for the American Hospital Association last year, a significant swing from its $11.2 million surplus in 2017. We re-estimate all models with the four independent variables, respectively. The extant research only focuses on one type of organization ownership to study the effects of lobbying. Long term care hospitals may be defined by different methods; here they include other hospitals with an average length of stay of 30 or more days. In this study, we choose to examine the effects of lobbying in the hospital industry because of the co-existence of three types of hospital ownership; namely, NFP, for-profit, and government. Lagged Effects of Hospital Lobbying on Performance. AMA membership dues We are proud of our work, aided in part by many RNs and like-minded partners. Teaching hospitals have to allocate some resources to teaching duties. 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The major stream of NFP lobbying literature focuses on the characteristics of NFP organizations that engage in lobbying, such as the size, age, location, and charitable status of the organization, as well as factors influencing lobbying decisions and strategies, such as the amount of donations received, IRS status, information technology, cross-sector competition, restrictions on delivering core services, policy network, and the perception of the probability of lobbying success (Chavesc, Stephens, and Galaskiewicz 2004; Child and Grnbjerg 2007; Nicholson-Crotty 2007, 2009; Surez and Hwang 2008; Mosley 2010; Fyall and McGuire 2015; Garrow and Hasenfeld 2014). The latest Updates and Resources on Novel Coronavirus (COVID-19). Lobbying expenses, however, are the highest in for-profit hospitals, and the lowest in government hospitals, because governmental and charity money cannot be used for lobbying (Andrzejewski 2019; Leech 2006). Neonatal intensive care. Recall our main results in Table 3, which reveal that lobbying increases employee salaries in NFP hospitals rather than in for-profit hospitals. In the for-profit subsample, the estimated coefficients are positive (0.0294 and 0.1138, respectively) and significant (p = 0.078, and p = 0.016, respectively), suggesting that lobbying increases ROA only in for-profit hospitals. Millions are stuck in dental deserts, with no access to oral health May include myocardial infarction, pulmonary care, and heart transplant units. Modernizing healthcare payments: exploring the opportunities, challenges and solutions, Leverage a data lakehouse to drive incremental value and quick wins, Nurses' clinical decision-making gets boost from predictive modeling. Some special interests retain lobbying firms, many of them located along Washington's legendary K Street; others have lobbyists working in-house. If hospital lobbying increases employee salaries and/or reduces uncompensated care costs, it is rational to assume that lobbying activities can influence hospitals' ROA, but the combined effects are unpredictable. Most recently, in response to the global COVID-19 pandemic, the American Hospital Association (AHA) and the American Nurses Association (ANA) have joined forces to lobby congressional leaders for more funding to enhance healthcare workers' pay (Shinkman 2020b). Hospitals 2022 Infographics PDF, Fast Facts: U.S. Finally, in Section VI, we discuss the conclusions and implications of the current study. In the United States, lobbying is practiced primarily by business organizations using either external lobbyists or in-house professionals. For-profit hospitals can lawfully release patients who lack the ability to pay for further treatment after establishing that the patients are out of danger, whereas NFP hospitals are obligated to treat all conditions, whether life-threatening or not, regardless of the patients' financial or health insurance status (Healthcare Management Degree Guide [HMDG] 2020). Beyond conventional marketing and management strategies, lobbying is often used to shape the external environment by influencing legislation, regulations, or policies to gain advantages, such as increased market power (McWilliams, Van Fleet, and Cory 2002), tax reductions (Alexander, Mazza, and Scholz 2009), government bailouts (Faccio, Masulis, and McConnell 2006), government contracts (Hansen and Mitchell 2000), and federal funds (de Figueiredo and Silverman 2006). We predict that Size is negatively correlated with Uncomp. Lobbying may have other substantial savings/benefits from the other items, such as employee training and insurance allocations. For-profit organizations lobby for policies that maximize their profitability, while NFP organizations are also responsive to social needs and public services beyond their own interests (McFarland 1995; Barragato 2002). Whereas some hospitals could benefit from lobbying due to a specific rule or legislation changes, others might be hurt. Intensive care bed counts are reported on the AHA Annual Survey by approximately 80% of hospitals. Regression of Hospital Net Patient Revenue on Lobbying. Congress has responded by appropriating tens of billions of dollars for both hospitals and their employees (Muchmore 2020). Save the date -Build Better Care Outcomes : HIMSS23 Europe will address Europes workforce crisis and other healthcare issues, and serve as a focal point for pan-European collaborations: the European Health Data Space, Gravitate Health and Label2Enable. Therefore, we expect that lobbying activities have different outcomes among the three types of ownership in the hospital industry. Ohio Hospital Association It is not included in prior healthcare studies. Single, freestanding hospitals may be categorized as a system by bringing into membership three or more, and at least 25 percent, of their owned or leased non-hospital pre-acute or post-acute health care organizations. Largest Lobbying The most recent financial data from Definitive Healthcare (generated on 6/20/2020) are fiscal year 2018 data. He was the industrys 2015). The influence of physician board participation on hospital financial performance, Organizational resources and environmental incentives: Understanding the policy advocacy involvement of human service nonprofits, Network structure and hospital financial performance in New York State: 19911995, Politics, policy, and the motivations for advocacy in nonprofit reproductive health and family planning providers, The stages and strategies of advocacy among nonprofit reproductive health providers. Regression of Hospital Total Salaries on Lobbying. 10 Largest Lobbyist Groups In The United Lee and Baik (2010) find that the more business organizations spend on lobbying, the larger the amount of tariff reduction they will receive from U.S. Customs and Border Protection. Your subscription has been Dues-paying members are eligible to receive a print copy of JAMA , the Journal of the American Medical Association. We predict that MCI is negatively correlated with Uncomp. The results show that two-year-lagged lobbying has results similar to those in our main analyses, but three-year-lagged lobbying does not. A specially staffed, specialty equipped, separate section of a hospital dedicated to the observation, care, and treatment of patients with life-threatening illnesses, injuries, or complications from which recovery is possible. We choose the hospital industry to examine the effects of lobbying because of the co-existence of the three distinct types of hospital ownership; namely, NFP, government, and for-profit. 9. These hospitals cannot pay employees more than reasonable compensation for services rendered (Becker et al. Hospital characteristics vary widely due to different types of ownership (see Appendix B for a review), and these differences affect their lobbying goals and outcomes. Distinctive Characteristics of Hospital Ownership Types. HIMSS23 Global Health Conference & Exhibition. For example, Richter, Samphantharak, and Timmons (2009) find that a 1 percent increase in lobbying spending will lower effective tax rates by 0.5 to 1.6 percent. Thus, government hospitals have less incentive to lobby for expanded reimbursement coverage and Medicaid to reduce uncompensated care costs (Bovbjerg et al. Compared to other political activities, lobbying has fewer restrictions and greater efficiency (Hansen and Mitchell 2000; Eun and Lee 2019). If you look at the high-ranking legislators who are supporting AHA, it holds a clue of what may happen. When Lobby_dumt3 and Lobby_expt3 are the variables of interest, the significance disappears. The mean (median) of Salary is 0.456 (0.383). Similar to our predictions in Model (1), we predict that the directions of the coefficients on MedicareMix and MedicaidMix are unknown. All the above benefits gained from lobbying contribute positively toward business profitability. Rural Hospitals Infographic, Fast Facts on U.S. Using Analytics to Improve Revenue Cycle May 10, Latest Cyber Threats, Legislation and Policy Updates, Marcom Budgets By the Numbers: Key Findings from 2022 SHSMD Benchmarking, The New Playbook: Creating Measurable ROI through Sponsorships, Part 3Assess: Building a Data Process for Reporting, Research and More Nov 16, Optimizing Your Workforce Strategy With an Integrated Analytics Approach to Boost Engagement, Part 2Connect: Building Bridges from Health Care to Social Care Oct 26, Apply Enriched Data Analysis to Improve Operations and Health Outcomes, Planning Marcom Budgets By the Numbers: Preliminary Findings from SHSMD Benchmarking, The Important Role Hospitals Have in Serving Their Communities, American Organization for Nursing Leadership. MCI is a characteristic of the hospitals' market environment. Why do business organizations spend so much money on lobbying? The results support our H1a, indicating that pay for employees is an important aim of lobbying in NFP hospitals. An interactive online version is also available. We present the results in Table 7. Pediatric intensive care. 2023 Healthcare IT News is a publication of HIMSS Media. What's wrong with this provision? Future studies can utilize different techniques, such as surveys or interviews (i.e., self-reported data) or other available data to explore the effects of lobbying activities that are not regulated by the Lobbying Disclosure Act of 1995 as well as those that are conducted at the state and local level. In this paper, the control variables include the market concentration index (MCI), Medicare mix (MedicareMix), Medicaid mix (MedicaidMix), hospital size (Size), hospital leverage (Leverage),5 medical school affiliation (Teaching), hospital location (Urban), and networked hospital designation (Network). Previously held government jobs: 50.00% Did not previously hold government jobs: 50.00% 2022 $2,960,000 REVOLVING DOOR 9 out of 19 National Education Assn lobbyists in 2022 have previously held Table 4 presents the results from estimating Model (2). 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NFP and for-profit hospitals lobby to classify more healthcare services as normal services rather than charity care and lobby to expand reimbursement coverage and Medicaid under the Affordable Care Act to reduce uncompensated care costs (Nikpay, Buchmueller, and Levy 2015, 2016). More recently, Brown (2016) finds that lobbying activities are associated with a high ROA, return on invested capital (ROIC), and ROE in Fortune 500 firms. Therefore, we expect that lobbying is positively related to employee salaries in NFP and government hospitals, whereas this effect does not exist in for-profit hospitals. 1. In this study, we examine the association between lobbying and hospital performance and find that the effects of lobbying activities on hospital performance vary according to the distinct types of hospital ownership. Patients are the major stakeholders for all types of hospitals and are priorities of hospitals regardless of ownership types. After merging data from the two data sources, we exclude observations that lack valid data needed to calculate the variables in our analyses. CHA Publishes Lobbying Percentage of Dues for Medicare Cost Reports - California Hospital Association / CHA News CHA News 28 Oct 2021 CHA Publishes Lobbying Percentage of Dues for Medicare Cost Reports For CFOs, controllers Jennifer Newman Senior Vice President & Chief Financial Officer The unit is staffed with specially trained personnel and contains monitoring and specialized support equipment for treatment of patients who, because of shock, trauma, or other life-threatening conditions, require intensified, comprehensive observation and care. Shaffer, Quasney, and Grimm (2000) find a positive relationship between lobbying and net income in the airline industry. First, lobbying hospitals maintain a close relationship with legislators so that they can earlier obtain and better understand important information regarding regulatory agendas, policy changes, and other factors than nonlobbying hospitals. The data below are examples of the types of insights that can be pulled from the AHA Annual Survey. 1987; Scott et al. The unit is staffed with specially trained nursing personnel and contains monitoring and specialized support or treatment equipment for patients who, because of heart seizure, open-heart surgery, or other life-threatening conditions, require intensified, comprehensive observation and care. Prior research finds the lagged effect of corporate lobbying on financial performance (Chen et al. Our findings suggest that NFP hospitals lobby to protect employees' interests and for-profit hospitals lobby to maximize investors' interests, while government hospitals are inactive or less interested in the above lobbying activities. According to the extant literature, one goal of hospital lobbying is to protect employees' incomes (Landers and Sehgal 2004; Pradhan 2020). Early Medicaid expansion in Connecticut stemmed the growth in hospital uncompensated care, Affordable Care Act Medicaid expansion reduced uninsured hospital stays in 2014, The causes and consequences of internal control problems in nonprofit organizations, Firm level performance implications of nonmarket actions, Regulation and the rising cost of hospital care, Hospitals known for nursing excellence associated with better hospital experience for patients, Civic engagement and nonprofit lobbying in California, 19982003, Management strategies and financial performance in rural and urban hospitals, Hospital lobbying blitz starts paying off, This site uses cookies. Both Medicare and Medicaid are government-sponsored health insurance plans. AHA Hospital Statistics is published annually by Health Forum, an affiliate of the American Hospital Association. 10. CMS reviews these waivers during the waiver renewal process (Mahan and Callow 2015). Some feel that business organizations abuse lobbying for their selfish interests, which leads to corruption, while others think that lobbying is necessary because it prevents potentially harmful policies by providing important information to policymakers (Anderson, Martin, and Lee 2018). Furthermore, it is important to note that lobbying has complex outcomes, and cost saving is only one of its goals. American Lobbying Hospital lobbying reduces uncompensated care costs in for-profit hospitals. saved. Under the current prospective payment system, the reimbursement rate for a specific procedure/treatment at the Centers for Medicare and Medicaid Services (CMS) or insurance companies is predetermined, which creates tremendous pressures on hospitals (K. Chang and G. Chang 2017). Second, although we find that the lobbying effects diminish in the second year after lobbying and disappear in the third year, the underlying factors behind this trend remain unclear. WebLobbying 2022 2021 $2,720,000 REVOLVING DOOR 9 out of 18 National Education Assn lobbyists in 2021 have previously held government jobs. 4. American Hospital Assn Lobbying Profile OpenSecrets After reviewing previously cited estimates, we examine and independently validate supply expense data (collected by the American Hospital Association) for over Plenty of studies find that firms' abnormal returns are positively associated with lobbying (see Lo 2003; Hochberg, Sapienza, and Vissing-Jrgensen 2009; Hill, Kelly, Lockhart, and Van Ness 2013; Mathur, Singh, Thompson, and Nejadmalayeri 2013; Borisov, Goldman, and Gupta 2016). And now as the hospital industry stares down a newly empowered Democratic Party eyeing a litany of unprecedented health reforms Nickels is retiring at 68. Second, lobbyists can actively communicate crucial information to government officials in order to influence or shape policies to fit hospital strategies and interests, and therefore help hospitals to maintain a competitive advantage (Chen, Parsley, and Yang 2015). Dorn Policy Group, Inc. 101 N. 1st Avenue 20th Floor, Suite 2090 Phoenix, Arizona 85003 Telephone: 602-606-4667 NFP and government hospitals need to lobby for more funding or raising the standard of reasonable compensation to protect employees' incomes. The American Hospital Association conducts an annual survey of hospitals in the United States. Other special hospitals include obstetrics and gynecology; eye, ear, nose, and throat; long term acute-care; rehabilitation; orthopedic; and other individually described specialty services. Nonprofit advocacy organizations: Their characteristics and activities, How does electronic health information exchange affect hospital performance efficiency? Editor's note: Accepted by Thomas E. Vermeer. Lobbying is an important avenue for business organizations to influence legislation, regulations, or policies in order to gain competitive advantage. Business organizations use lobbying as a vehicle to promote and protect their interests. Other hospitals include nonfederal long term care hospitals and hospital units within an institution such as a prison hospital or school infirmary. WASHINGTON Tom Nickels helped build the American Hospital Association into one of the biggest lobbying forces in Washington. Feel free to distribute or cite this material, but please credit OpenSecrets. The average ROA is the lowest (near zero) in government hospitals, slightly positive in NFP hospitals that must self-fund but do not need to reward shareholders, and the highest in for-profit hospitals where shareholders expect a positive return on their investments. Because they have readily available public funding for subsidizing uncompensated care costs, government hospitals typically do not become involved in lobbying activities that are related to uncompensated care costs (Bovbjerg, Cuellar, and Holahan 2000). Journal of Governmental & Nonprofit Accounting 1 January 2021; 10 (1): 125. Lobbying for AMERICAN HOSPITAL ASSOCIATION by This finding supports our H2b, which is not a surprise because government hospitals have public funding for subsidizing uncompensated care costs. The effects of breadth and depth of information sharing, Corporate politics, governance, and value before and after Citizens United, Does electronic health record use improve hospital financial performance? Lobbying We predict that Teaching is positively correlated with Salary. All rights reserved. Second, to our best knowledge, this is the first study that empirically examines the differences among NFP, for-profit, and government hospitals regarding lobbying purposes and effects. The Thus, we expect a positive relationship between hospital lobbying and employee salaries in NFP and government hospitals. In untabulated analyses, we re-estimate the regression models without controlling Leverage. Grants, contracts, and interest group lobbying behavior, Do firm's organisational slacks influence the relationship between corporate lobbying and corporate financial performance? The American Hospital Association is putting pressure on legislators to change one area of the final ruling on the federal incentives for the meaningful use of There are two ways lobbying hospitals could benefit more from policy changes than their nonlobbying peers. Healthcare report: How are U.S. healthcare organizations embracing intelligent automation to enhance patient centricity? Did not previously hold government jobs: 54.95% Previously held government jobs: More is not always better, Economic consequences of regulated changes in disclosure: The case of executive compensation, Corporate governance and lobbying strategies, Raising rivals' costs through political strategy: An extension of resource-based theory, Corporate PAC campaign contributions in perspective, Does the hospital board need a doctor? Hospitals 2022 PDF, Fast Facts on U.S. Prior years include spending from January through December. They will be the ones who reach out to the local physician groups to connect with them, thereby not only helping small physician offices adopt EHRs but aid in health information exchange. Hospitals 2023 Infographics PDF, Fast Facts on U.S. WebThis report represents a snapshot of the many activities and achievements that occurred throughout the ANA Enterprise in 2019 and as we began 2020. Some studies also use the market concentration index as a control variable for market competition (e.g., Goes and Zhan 1995; Alexander, Weiner, and Griffith 2006; Collum et al. Our study explores lobbying's effects in different types of hospital ownership; we choose the hospital industry due to the co-existence of three different types of hospital ownership.
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