Harmonizing Data to Achieve Excellence in Healthcare: Supply Chain Data is Key! In the NFP subsample, the mean of total assets is $431 million, and the mean of net incomes is $19.5 million. It is not a surprise that Uncomp is higher on average in government hospitals compared to either for-profit or NFP hospitals, because Cram et al. 2013; Bovbjerg et al. American The two datasets do not have matched observations before 2011. Our findings demonstrate that for-profit ownership contributes to this result because for-profit hospitals are more likely to strive for higher profitability than the other two types of hospitals. After merging data from the two data sources, we exclude observations that lack valid data needed to calculate the variables in our analyses. 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. Search for other works by this author on: To test our first set of hypotheses, we develop Model (1) as follows: \(\def\upalpha{\unicode[Times]{x3B1}}\)\(\def\upbeta{\unicode[Times]{x3B2}}\)\(\def\upgamma{\unicode[Times]{x3B3}}\)\(\def\updelta{\unicode[Times]{x3B4}}\)\(\def\upvarepsilon{\unicode[Times]{x3B5}}\)\(\def\upzeta{\unicode[Times]{x3B6}}\)\(\def\upeta{\unicode[Times]{x3B7}}\)\(\def\uptheta{\unicode[Times]{x3B8}}\)\(\def\upiota{\unicode[Times]{x3B9}}\)\(\def\upkappa{\unicode[Times]{x3BA}}\)\(\def\uplambda{\unicode[Times]{x3BB}}\)\(\def\upmu{\unicode[Times]{x3BC}}\)\(\def\upnu{\unicode[Times]{x3BD}}\)\(\def\upxi{\unicode[Times]{x3BE}}\)\(\def\upomicron{\unicode[Times]{x3BF}}\)\(\def\uppi{\unicode[Times]{x3C0}}\)\(\def\uprho{\unicode[Times]{x3C1}}\)\(\def\upsigma{\unicode[Times]{x3C3}}\)\(\def\uptau{\unicode[Times]{x3C4}}\)\(\def\upupsilon{\unicode[Times]{x3C5}}\)\(\def\upphi{\unicode[Times]{x3C6}}\)\(\def\upchi{\unicode[Times]{x3C7}}\)\(\def\uppsy{\unicode[Times]{x3C8}}\)\(\def\upomega{\unicode[Times]{x3C9}}\)\(\def\bialpha{\boldsymbol{\alpha}}\)\(\def\bibeta{\boldsymbol{\beta}}\)\(\def\bigamma{\boldsymbol{\gamma}}\)\(\def\bidelta{\boldsymbol{\delta}}\)\(\def\bivarepsilon{\boldsymbol{\varepsilon}}\)\(\def\bizeta{\boldsymbol{\zeta}}\)\(\def\bieta{\boldsymbol{\eta}}\)\(\def\bitheta{\boldsymbol{\theta}}\)\(\def\biiota{\boldsymbol{\iota}}\)\(\def\bikappa{\boldsymbol{\kappa}}\)\(\def\bilambda{\boldsymbol{\lambda}}\)\(\def\bimu{\boldsymbol{\mu}}\)\(\def\binu{\boldsymbol{\nu}}\)\(\def\bixi{\boldsymbol{\xi}}\)\(\def\biomicron{\boldsymbol{\micron}}\)\(\def\bipi{\boldsymbol{\pi}}\)\(\def\birho{\boldsymbol{\rho}}\)\(\def\bisigma{\boldsymbol{\sigma}}\)\(\def\bitau{\boldsymbol{\tau}}\)\(\def\biupsilon{\boldsymbol{\upsilon}}\)\(\def\biphi{\boldsymbol{\phi}}\)\(\def\bichi{\boldsymbol{\chi}}\)\(\def\bipsy{\boldsymbol{\psy}}\)\(\def\biomega{\boldsymbol{\omega}}\)\(\def\bupalpha{\bf{\alpha}}\)\(\def\bupbeta{\bf{\beta}}\)\(\def\bupgamma{\bf{\gamma}}\)\(\def\bupdelta{\bf{\delta}}\)\(\def\bupvarepsilon{\bf{\varepsilon}}\)\(\def\bupzeta{\bf{\zeta}}\)\(\def\bupeta{\bf{\eta}}\)\(\def\buptheta{\bf{\theta}}\)\(\def\bupiota{\bf{\iota}}\)\(\def\bupkappa{\bf{\kappa}}\)\(\def\buplambda{\bf{\lambda}}\)\(\def\bupmu{\bf{\mu}}\)\(\def\bupnu{\bf{\nu}}\)\(\def\bupxi{\bf{\xi}}\)\(\def\bupomicron{\bf{\micron}}\)\(\def\buppi{\bf{\pi}}\)\(\def\buprho{\bf{\rho}}\)\(\def\bupsigma{\bf{\sigma}}\)\(\def\buptau{\bf{\tau}}\)\(\def\bupupsilon{\bf{\upsilon}}\)\(\def\bupphi{\bf{\phi}}\)\(\def\bupchi{\bf{\chi}}\)\(\def\buppsy{\bf{\psy}}\)\(\def\bupomega{\bf{\omega}}\)\(\def\bGamma{\bf{\Gamma}}\)\(\def\bDelta{\bf{\Delta}}\)\(\def\bTheta{\bf{\Theta}}\)\(\def\bLambda{\bf{\Lambda}}\)\(\def\bXi{\bf{\Xi}}\)\(\def\bPi{\bf{\Pi}}\)\(\def\bSigma{\bf{\Sigma}}\)\(\def\bPhi{\bf{\Phi}}\)\(\def\bPsi{\bf{\Psi}}\)\(\def\bOmega{\bf{\Omega}}\)\begin{equation}\tag{1}Salar{y_{i,t}} = {\beta _0} + {\beta _1}Lobb{y_{i,t - 1}} + {\beta _2}MC{I_{i,t}} + {\beta _3}MedicareMi{x_{i,t}} + {\beta _4}MedicaidMi{x_{i,t}} + {\beta _5}Siz{e_{i,t}} + {\beta _6}Leverag{e_{i,t}} + {\beta _7}Teachin{g_{i,t}} + {\beta _8}Urba{n_{i,t}} + {\beta _9}Networ{k_{i,t}} + Yea{r_t} + Stat{e_i} + {\varepsilon _{i,t}} \end{equation}. 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). Arizona's Safety Net Care Pool expired in December 2017, and Hawaii's uncompensated care pool expired in June 2016. In the NFP and government subsamples, the estimated coefficients 1 on Lobby_dum or Lobby_exp are insignificant. 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. We find that hospital lobbying increases employee salaries in NFP hospitals, reduces uncompensated care costs in NFP and for-profit hospitals, and increases ROA in for-profit hospitals; however, all these effects of lobbying are insignificant in government hospitals. A 501(c)(3) tax-exempt, charitable organization, 1100 13th Street, NW, Suite 800 For permission to reprint for commercial uses, Lobbying WebThe following is a list of events affecting American television in 2023.Events listed include television show debuts, finales, and cancellations; channel launches, closures, and re-brandings; stations changing or adding their network affiliations; information on controversies, business transactions, and carriage disputes; and deaths of those who 2015). Follow the money on gun rights and gun control groups. AHA reports $6.4 million loss in 2018; lobbying holds steady To interpret the economic magnitude of the results, it is necessary to understand the dependent variable, Salary, and the variable of interest, Lobby_exp, because they are scaled measures rather than raw salaries and lobbying expenses. If you look at the high-ranking legislators who are supporting AHA, it holds a clue of what may happen. Economies of scale also play a role in hospital financial performance. Your subscription has been Hospitals can sell bad debts to collection agencies for partial payment but need to absorb charity care costs by themselves. Web41 out of 91 American Hospital Assn lobbyists in 2020 have previously held government jobs. Prior studies find that business organizations that engage in lobbying activities can gain a variety of benefits. American Hospital Assn Lobbying Profile OpenSecrets Another stream of the literature examines the benefits of lobbying for NFP organizations. Open Secrets following the money in politics, OpenSecrets Following the money in politics. A special interest's lobbying activity may go up or down over time, depending on how much attention the federal government is giving their issues. Community hospitals include academic medical centers or other teaching hospitals if they are nonfederal short-term hospitals. After all, they are the ones who can really bring speed to market, so why not work with them to bring about that massive change? We expect that lobbying hospitals could be more effective at cost reduction than their nonlobbying peers. Why do business organizations spend so much money on lobbying? Grants, contracts, and interest group lobbying behavior, Do firm's organisational slacks influence the relationship between corporate lobbying and corporate financial performance? After reviewing previously cited estimates, we examine and independently validate supply expense data (collected by the American Hospital Association) for over Well, who's up for re-election? Pediatric intensive care. 10 Largest Lobbyist Groups In The United We predict the directions of the control variables in Model (1). First, it extends lobbying research in the hospital industry by examining the relationship between lobbying and hospital performance. The results suggest that hospital lobbying lowers uncompensated care costs in NFP and for-profit hospitals, supporting our H2a and H2c. Regression of Hospital Uncompensated Care Costs on Lobbying. Rural Hospitals Infographic, Fast Facts on U.S. 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. Further studies could explore this issue. However, unlike for-profit organizations, NFP organizations may have different purposes when they engage in lobbying activities (McFarland 1995). 2023 Healthcare IT News is a publication of HIMSS Media. 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. Cardiac intensive care. We predict that Size is positively correlated with Salary. The Center for Responsive Politics (OpenSecrets.org) provides us with hospital lobbying data regarding total lobbying expenses at the federal level. Lobbying is one of the most dominant types of political involvement (Lin 2019; Cao, Fernando, Tripathy, and Upadhyay 2018). Business organizations use lobbying as a vehicle to promote and protect their interests. NFP and government hospitals need to lobby for more funding or raising the standard of reasonable compensation to protect employees' incomes. Hospitals with higher leverage are more likely to be financially constrained, and thus cannot pay high salaries. Researchers also find that lobbying business organizations have a better potential of gaining direct help from the government, in the form of bailouts (Faccio et al. Therefore, ROA only increases in for-profit hospitals. 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. Note that the ICU beds data is not published in AHA Hospital Statistics. It is reasonable to expect that savings in uncompensated care costs are less than lobbying spending. Hospitals 2023 Infographics, View the Fast Facts: U.S. Table 3 presents the results from estimating Model (1). For example, both Collum, Menachemi, and Sen (2016) and Cho, Ke, Atems, and Chang (2018) use the 2010 American Hospital Association survey data. Healthcare Management Degree Guide (HMDG). Other hospitals include nonfederal long term care hospitals and hospital units within an institution such as a prison hospital or school infirmary. 2013; Duggan 2000). The coefficient on Lobby_dum is 0.0114 (0.0180) in the NFP (for-profit) subsample, suggesting that if an NFP (for-profit) hospital incurs lobbying expenses, the average saving in uncompensated care costs is $3.135 ($2.214) million. He was the industrys dealmaker on every big health policy battle of the last 25 years, from the fight over the Affordable Care Act to the creation of Medicares drug benefit to the deficit reduction frenzy of the 1990s. HIMSS23 Global Health Conference & Exhibition. NICU has potential for providing mechanical ventilation, neonatal surgery, and special care for the sickest infants born in the hospital or transferred from another institution. 9. The coefficients on Lobby are positive and significant in NFP and for-profit hospitals, suggesting that hospital lobbying increases hospital net patient revenue in NFP and for-profit hospitals. OHA represents hospitals and health systems throughout Ohio. 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. Therefore, we posit our second set of hypotheses as follows: Hospital lobbying reduces uncompensated care costs in NFP hospitals. Prior years include spending from January through December. Hospital Lobbying and Performance | Journal of Governmental The coefficient on Lobby_exp is 0.0570, suggesting that each additional $1 spent on lobbying results in a $1.26 (i.e., $431 0.057/19.5) salary increase in an NFP hospital. Other intensive care. However, because Medicare and Medicaid are mainly reimbursed by CMS and state/local governments, those payments are more secure than patients' payments. de Figueiredo and Silverman (2006) find that lobbying by public universities increases the amount of federal funding they can receive for academic research. Under the pressure of CMS review, NFP and for-profit hospitals lobbied lawmakers during the waiver review process to keep uncompensated care pool funds (Hawryluk 2015). 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The focus of AHA's discontent is the provision that makes hospitals, regardless of how many campuses they have, eligible for only one incentive payment if the multiple facilities share the same Medicare provider number. Patients are the major stakeholders for all types of hospitals and are priorities of hospitals regardless of ownership types. Did not previously hold government jobs: 54.95% Previously held government jobs: Lobbying Percentage We are proud of our work, aided in part by many RNs and like-minded partners. In untabulated analyses, we re-estimate the regression models without controlling Leverage. 5. Hospital Supply Expenses: An Important Ingredient in Health In an increasingly competitive environment, it is critical that business organizations know how to boost performance. 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. 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. Lobby_expt2 and Lobby_expt3 are continuous variables of Lobby_exp in year t2 and year t3, respectively. 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. Hospital & Healthsystem Assn of Pennsylvania, Oregon Assn of Hospitals & Health Systems. (2016). Rachel Cohrs reports on the intersection of politics and health policy. 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). 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. 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. Table 5 presents the results from estimating Model (3). 10. 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). For example, Child and Grnbjerg (2007) suggest that lobbying helps NFP organizations access government grants or contracts. The beneficiaries of Medicare and Medicaid are less likely to pay their bills in full amounts. But not accommodating this huge cost factor could very well drag out adoption, and that's something neither HHS nor ONC want to see happen. AHA Center for Health Innovation Market Scan, Updates and Resources on Novel Coronavirus (COVID-19), Institute for Diversity and Health Equity, Rural Health and Critical Access Hospitals, National Uniform Billing Committee (NUBC), AHA Rural Health Care Leadership Conference, Individual Membership Organization Events, Map of Community Hospitals in the United States, View the Fast Facts: U.S. 2018 Year of Advocacy: Pursuing positive change on every level 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.
