Special Interest Groups

• WHAT IS ITS MISSION?
• HOW IS IT STRUCTURED?
• PRIMARY FUNCTIONS
• PROGRAMS
• BUDGET INFORMATION
• HISTORY
• CURRENT POLITICAL ISSUES
• FUTURE DIRECTIONS
• GROUP RESOURCES
• GROUP PUBLICATIONS
• FAST FACTS
• BIBLIOGRAPHY

ESTABLISHED: September 1899
EMPLOYEES: 500
MEMBERS: 45,600
PAC: American Hospital Association Political Action Committee

Contact Information:
ADDRESS: One N. Franklin Ave. Chicago, IL 60606
PHONE: (312) 422-3000
TOLL FREE: (800) 424-4301
FAX: (312) 422-4796
URL: http://www.aha.org
PRESIDENT: Dick Davidson
CEO: Jack Lord, M.D.

WHAT IS ITS MISSION?

The American Hospital Association (AHA) is a national nonprofit organization that serves the interests of hospitals and health care networks. In doing so, it also improves health care services to patients as well as to the community at large. The mission of the AHA is to improve the health of individuals and raise the standard of health care services in communities nationwide.

HOW IS IT STRUCTURED?

The organization's Chicago office was established as AHA national headquarters in 1920. This office houses the majority of the AHA's programs, including member services and leadership programs, as well as the majority of AHA employees. The AHA's office in Washington, D.C., houses the office of the president and AHA policy, communication, and national advocacy staff. Teams of legislative directors and regional executives are officed throughout the United States.

The AHA Board of Trustees acts as the executive branch of the organization. The board consists of 25 trustees, including a chairperson and chairperson-elect. The speaker of the house and the president also sit on the board. The board of trustees has final policy approval authority. The AHA has a House of Delegates that meets annually and serves as the legislative arm of the AHA. Delegates are apportioned according to the number of institutional and personal members in each state. The speaker of the house presides over each sitting of the House of Delegates. Regional policy boards meet between the sessions of the House of Delegates to debate AHA policy options. State hospital association executives from each region serve as ex officio members of the regional policy boards.

Constituency Sections

In 1983 the AHA added seven constituency sections—committees made up of AHA members from across the United States—as a means to better serve and represent the distinct needs of each of its members. Each constituency section is composed of an average of 22 representatives who meet to discuss economic and political issues of common interest. The seven groups are health care systems, small or rural hospitals, metropolitan hospitals, federal hospitals, long-term care and rehabilitation, psychiatric and substance abuse services, and maternal and child health.

Membership

Membership in the AHA is divided into three categories: institutional, associate, and personal. Institutional members include hospitals, preacute and postacute non-hospital facilities, and hospital-affiliated educational programs. Associate members include organizations ineligible for institutional membership, such as commercial firms, consultants, and suppliers. Personal members include those working in the health care field in either private- or government-sector jobs, students studying hospital administration, and health care executive assistants. The AHA has over 5,000 institutional, 600 associate, and 40,000 personal members. It also maintains partnerships with 52 state associations, including Puerto Rico and the District of Columbia, and over 30 metropolitan associations.

PRIMARY FUNCTIONS

The AHA operates on behalf of both its members and the general public in health care delivery matters. Through advocacy, education and information, and leadership development, the organization seeks to impact the formation of legislation and regulatory policy at the national level, as well as provide services and support at the community level.

Advocacy

The AHA uses its Center for Public Affairs (CPA), based in Washington, D.C., to advocate for legislative and regulatory reform and to influence the executive branch of the federal government. The goal of the CPA is to monitor, evaluate, and influence federal policy making. To this end, the AHA makes its leadership available to aid in CPA lobbying efforts, such as testifying before congressional committees and federal agencies. The AHA also issues formal comments in response to proposed court and administrative rulings and new government policy.

By monitoring pending legislation affecting health care delivery, the AHA lobbies Congress on issues such as ensuring access to home health services, treatment and health insurance plans, Medicare and Medicaid, affordable care, and care for children. In 1978 the organization established the AHA Political Action Committee to increase pressure on Congress and the executive branch.

Education and Information

Education and information offered by the AHA responds to members' needs to stay abreast of current regulations, policies, and social trends. The AHA also helps members remain in compliance with the many regulatory and statutory requirements of hospital administration. Educational and informational services are available to AHA members in several formats.

The AHA Resource Center provides extensive information services to health care professionals. In existence for over 75 years, the Resource Center houses more than 64,000 volumes of current and historical documents on health care administration. The Resource Center is staffed by trained information specialists who locate and retrieve information in support of management decisions and policies, strategic planning, education, and research. The Resource Center also houses the HealthSTAR database and Hospital and Health Administration Index. Both resources provide comprehensive information on issues, trends, and developments in all areas of health care delivery, including hospital management and public policy. Another responsibility of the Resource Center is the maintenance of the official Center for Hospital and Healthcare Administration History and the National Information Center for Health Services Administration.

Through its Web site, the AHA is able to continually update its members on developments in legal, regulatory, and legislative arenas. The AHA's on-line Legal Resource Library offers a listing of AHA responses to all pending legal and regulatory actions that affect healthcare delivery in the United States. Complicated new regulations, pending policies, and laws are explained in a way that helps members understand their impact. For example, when the federal budget was approved in 1997 as Public Law 105-33, the AHA responded by posting a summary of major provisions, estimated dollar impact of budget provisions, and explanations of particular subjects such as skilled nursing facilities, medical outpatient services, and private contracting under Medicare. The AHA also offers its members a Regulatory Standards Manual.

Leadership

Ongoing leadership training and support is offered through the AHA's Center for Health Care Leadership. The Center provides AHA-member executives assistance in navigating marketing and management issues. Services include providing current information, resources for building a community-based network, educational and networking opportunities, and forums to bring together executive leaders having common interests and goals. The AHA's Division of Trustee and Community Leadership helps health care trustees, executives, and community leaders make strategic decisions, form community partnerships, and improve local health-care services.

PROGRAMS

The AHA sponsors a wide range of programs for its members. In January 1997, for example, the AHA initiated the New Partnership for Action (PFA). PFA is a legislative and grassroots advocacy program designed to build a team of hospital and health care system advocates called "key contacts." The PFA program is open to anyone—members and nonmembers—in the health care system. Key contacts range from hospital administrators, senior staff, and trustees to volunteers and patients. Through distribution of resources and up-to-date information, the AHA prepares its key contacts to advocate for the hospital and health care system.

In an attempt to bring the issue of health care coverage to the forefront of the public policy agenda, the AHA created its "Campaign for Coverage: A Community Health Challenge" program in 1997. The campaign's goal was to reduce the number of people without health care coverage by four million during 1998. In conjunction with state associations the AHA used the Campaign for Coverage as a forum to increase public awareness, advocate at the state and federal level for legislative actions, and encourage member organizations to expand the number of their own employees covered by health insurance.

The AHA also attempted to address the problem posed by the "millennium bug"—the inability of computer chips to recognize the year 2000. Because hospitals operate seven days a week, 24 hours a day, and are heavily dependent on computer operations to deliver safe, effective care, the AHA formed a task force to study the Y2K problem. The objective of the task force was to educate health care practitioners and patients about the potential problems of the "millennium bug" and press medical device and computer manufacturers to bring equipment into compliance with Year 2000 standards.

BUDGET INFORMATION

Not made available.

HISTORY

The AHA had its origins in the Association of Hospital Superintendents formed in Cleveland, Ohio, in 1899 by eight hospital superintendents. Originally, only superintendents were allowed membership; in 1906 the organization expanded to include other hospital executives as non-voting, associate members, and also changed its name to the American Hospital Association. Institutional membership was incorporated into the AHA structure in 1918.

Upon its formation, the Association of Hospital Superintendents focused on hospital management: procedures and methods, hospital economics, and hospital inspection concerns. As the AHA broadened its membership, its goals also broadened, and by 1937 the organization's focus was the development of outpatient services, professional education, and scientific research. By 1920, shortly after expanding its membership, AHA headquarters was located in Chicago; in 1942, in response to the supply shortage caused by World War II (1939–45), a second office was opened in Washington, D.C. to help members contact federal agencies and obtain needed supplies. The Washington office now serves as the lobbying center for the AHA.

Until a House of Delegates was established in 1938, every AHA member attending the organization's annual convention had a vote. Thus, those members closest to the convention site had a major voting advantage. With the formation of the AHA House of Delegates, proportionate representation from each state created the voting body at annual meetings. In the same year, the AHA formed its first six policy development councils.

In 1968 regional advisory boards (RABs) were created to improve communications between trustees and delegates on the matter of policy issues. With one board representing each of nine regions, RAB members originally discussed policy and relayed concerns, issues, and interests to the Board of Trustees. The AHA underwent further restructuring in 1987, altering its executive and legislative bodies and expanding its mission to stress leadership in public policy, representation and advocacy, and services. In addition, RABs were transformed into regional policy boards authorized to debate policy options. Final policy approval authority was removed from the House of Delegates and given to the Board of Trustees.

Developing the Organization

In the late 1930s health insurance coverage was new and controversial. In 1937 the AHA established the Hospital Service Plan Commission (HSPC) and two years later adopted a blue cross as a logo designating health coverage plans that met certain criteria of this new organization. The HSPC eventually became Blue Cross/Blue Shield, and the AHA retained close ties with it until 1960 when the Blue Cross Association was created. Formal relations between the two were dissolved in 1972.

The AHA was instrumental in creating the Commission on Hospital Care which, in 1946, set forth the recommendations that served as the basis for the Hospital Survey and Construction Act. This act, also known as the Hill-Burton Act, earmarked federal funds for modernizing those hospitals that had postponed updating their facilities during the Great Depression and World War II (1939–45). Beginning in 1946 more than $4.6 billion in grant money, along with $1.5 billion in loans, was distributed to approximately 6,800 health care facilities in more than 4,000 communities. In return for funding, hospitals agreed to provide free or reduced-fee care to persons unable to pay for treatment. AHA contributions to patient welfare continued in 1951 with the establishment of the Commission on Financing of Hospital Services, which focused on health care problems unique to the elderly and led to the creation of Medicare in 1965.

CURRENT POLITICAL ISSUES

Public policy issues surrounding health care delivery are extensive and complex. Much of the AHA's lobbying efforts revolve around interpreting and implementing federal policy, law, and programs such as Medicare. Created in 1965 as part of the Social Security Act, Title XVIII, Medicare is a federally funded health insurance program for Americans 65 years and older and those with special disabilities. Because Medicare directly impacts the economic management of hospitals and health care facilities, the AHA has a vested interest in the formation of Medicare-related policies.

Case Study: The False Claims Act

The False Claims Act authorizes the U.S. Department of Justice to sue any person or company that has submitted a false claim for payment. The law, which had been in existence for several years, was added to the AHA's agenda when the Justice Department began a major investigation of Medicare billing practices at 4,700 hospitals across the United States. With the threat of significant fines and legal costs mounting, the AHA worked to repeal or change the False Claims Act to limit member liability.

The False Claims Act allows the government to recover up to three times the amount of money falsely claimed. For example, if a hospital received $50,000 from Medicare for services not rendered, they could be fined $150,000. Also, the Act imposes a punitive fine of $5,000 to $10,000 for every fraudulent claim made.

The False Claim Act addresses three areas where erroneous billing can result: laboratory "unbundling," the "diagnostic-related group (DRG) three-day window," and "physicians at teaching hospitals" or PATH audits. Penalties are incurred from hospitals submitting bills for individual laboratory tests when tests should be "bundled" and submitted together for a lower reimbursement per test. Second, Medicare's DRG three-day window requiring that hospitals bill inpatients for certain pre-admission services provided within three days of admission is suspect as an avenue for double billing. And finally, the government investigates physicians at teaching hospitals who falsely bill Medicare for services actually performed by medical residents.

In response to the Justice Department probe, the AHA claims hospitals have been unfairly targeted and assumed to be guilty. While acknowledging that billing errors are made, the organization insists that errors do not constitute fraud. Hospitals and health systems submit on average nearly 200,000 Medicare claims each day, totaling approximately 72 million a year. Total compliance requires following 1,800 pages of law, 1,300 pages of regulations interpreting the law, and thousands of additional pages of instructions. Under such a complicated and oftentimes contradictory set of guidelines, errors naturally occur.

The Justice Department's approach to the problem—hospitals under investigation were sent a letter demanding they choose between being penalized for false claims or settling within 20 days for a much smaller amount—was called "heavy-handed" by the AHA. In fact, demand letters with fines and penalties totaling almost $36 million were sent to 22 hospitals in Massachusetts. A survey found that, in a group of over two million bills totaling more than $2.3 billion, only 2,960 claims were in error, the total of the error $450,000. However, rather than face legal costs and the possibility of larger fines, the hospitals settled for approximately $943,000.

Insisting that the Justice Department misused the False Claims Act, the AHA has argued that, although providers make every possible effort to minimize errors, some errors are unavoidable due to confusing, unclear, and contradictory policies and procedures. In an effort to eliminate the fines imposed on what they claim were honest mistakes, the AHA threw its support behind the proposed Health Care Claims Guidance Act of 1998.

The Health Care Claims Guidance Act, designed to amend the False Claims Act to distinguish between fraud and mistakes, would only apply to federally funded health care, namely Medicare and Medicaid. Under the act, fines would be reduced to the amount erroneously billed plus interest, rather than $5,000 to $10,000 per bill; health care claims would only fall under the False Claims Act if the overbilling was greater than a set percentage of the provider's total annual claims; and the Justice Department would be required to show "clear and convincing evidence" of fraud rather than a "preponderance of evidence."

Strong initial support for the Health Care Claims Guidance Act prompted action by the Department of Health and Human Services Office of the Inspector General (OIG). In 1998 the OIG announced new guidelines for investigating hospital fraud, agreeing to establish minimum monetary thresholds for billing error investigations. The Justice Department also stated its intention to seek substantial evidence before launching a full investigation.

Public Impact

Although the Health Care Claims Guidance Act did not pass, the AHA considers itself the victor in the battle over false claims: The sentiment represented by the bill forced the government to initiate new policies answering two of the AHA's three demands. However, according to the AHA, the unfair enforcement of the False Claims Act left hospitals and health care systems in a precarious position. Forced to pay settlement costs to avoid legal fees and large-scale penalties wrongly imposed, the health care delivery system is now under siege. While the AHA works vigorously to persuade the government to find a different resolution to honest mistakes, taxpayer groups, such as Taxpayers against Fraud and Citizens against Government Waste, have given voice to a rising concern over the mismanagement and waste of taxpayer money. With health care costs continuing to rise and budget cuts underway, such battles for fiscal responsibility will continue to be waged.

FUTURE DIRECTIONS

The AHA continues to address the False Claims Act and other regulatory and legislative issues affecting the field of medicine. For example, as part of the Balanced Budget Act of 1997 hospitals began to be penalized for releasing patients from treatment earlier than the national average. These hospitals now receive lower reimbursement rates from Medicare, costing those facilities $450 million and undermining their ability to provide cost-effective care. The AHA also suggests that reducing funding for home health care, also a result of the Balanced Budget Act, would jeopardize seriously ill individuals, and supports legislation designed to protect home health agencies' ability to remain financially solvent while caring for their patients.

GROUP RESOURCES

The AHA maintains a Web site at http://www.aha.org that includes current, comprehensive information on organization activities. While select information is only available to members via password, most of the Web site can be accessed by the public. Information available includes updates on pending legislative and regulatory issues, programs such as the Campaign for Coverage and Year 2000, and leadership and educational opportunities. The site also offers compliance resources and access to on-line resources such as the Legal Resource Library and the Resource Center catalog. The Resource Center provides extensive informational services on a fee-forservice basis. The AHA's Washington, D.C. office can be contacted toll-free at 1-800-424-4301.

GROUP PUBLICATIONS

All AHA publications are produced through the AHA-owned American Hospital Publishing, Inc., which puts out five publications. On-line versions and subscription information are available at http://www.amhpi.com. With a paid circulation of over 105,000, Hospitals & Health Networks is read primarily by hospital managers and focuses on trends and issues affecting health care delivery. Materials and Management is utilized by health care executives responsible for purchasing and managing supplies and equipment and has a paid circulation of over 26,000. Health Facilities Management and Trustee, both with a paid circulation over 30,000, target facilities management administrators and trustees of local hospitals. The AHA News, which has a circulation of almost 25,000, is a weekly newspaper for health care delivery executives that covers federal and state public policy and health care news. The subscription rate is $50 per year for AHA members and $110 per year for nonmembers.