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Press Release

    Pork Barrel Spending and Over Regulation, the Other White Meat

    10/05/2005

    In the wake of Hurricane Katrina, very few members have stepped forward with a meaningful plan for paying what's already an astronomical tab, other than driving the nation deeper into the red. While the hurricane relief debt steadily climbs, only a few members of Congress have dared to suggest that they offset this spending by reducing ever so slightly some of the billions in taxpayer dollars spent on pork-barrel special interest programs.

    When it comes to re-asserting fiscal responsibility and sound economic policies, the administration has a golden opportunity to save hundreds of billions of dollars by doing little more than applying some common sense to the already oppressive and burdensome realm of federal regulations. All too often, the burden of regulation is overlooked, yet a recent study suggests that regulations cost Americans more than $1.1 trillion dollars in 2004 alone.

    One glaring example of government bureaucracy at its worst that will add unnecessary costs to our nation's hospitals with no benefit is the HCAHPS— an exercise in regulatory overkill that expert after expert has indicated will actually hinder its supposed goal. More specifically, HCAHPS is a survey on hospital care dreamed up by Medicare and the Agency for Healthcare Research and Quality (AHRQ). Bureaucrats at these two departments have decided that all hospitals participating in Medicare—virtually every one in the nation—should "voluntarily" post patient responses to a quality survey on the Medicare website.

    Never mind that about 80 percent of our nation's hospitals already survey a percentage of patients upon discharge. Hospitals expend a lot of money on surveys because they want to improve the quality of care they provide, and the results speak for themselves. All four hospitals that have been awarded the federal government's prestigious Malcolm Baldrige National Quality Award are aggressive users of private sector survey products, and are outspoken advocates of quality initiatives. Hospitals support public reporting of patient satisfaction data and have said they will voluntarily participate if only the government would not add a cost burden to their operations.

    Despite a well-functioning private sector, Medicare and AHRQ bureaucrats have spent three-plus years developing a laundry list of ultra-specific questions, including a pair about bed pan usage. The many incarnations of the HCAHPS questionnaire have ranged from 66 questions to 25; the present version is 27. During two separate comment periods, more than 1,900 hospital officials have recommended keeping the number of HCAHPS questions to between eight and ten, a range that would enable hospitals to include the government-sponsored questions in their own surveys and collect results at less of an added cost. Otherwise, existing data collection efforts will suffer and hospitals will have to engage in costly new practices—such as multiple mailings and telephone surveys—just to acquire enough feedback to keep federal regulators happy.

    A shorter and simpler HCAHPS, however, just doesn’t cut it for the Washington bureaucrats who are being driven by the AARP and AFL-CIO to produce a government survey. What these folks are not considering is the tremendous cost burden that will be placed on hospitals if they have to send and collect data from two separate surveys. Studies by leading economists have concluded that the nationwide burden on hospitals of a lengthy HCAHPS could range from $100 million to over a half billion dollars over the next five years alone. Even the boys at FEMA should be gasping at that one.

    In addition to being a colossal waste of money, an HCAHPS that reads like a shopping list rather than a short survey will actually hinder data collection and confuse consumers. Leading researchers at Stanford University, who have studied this issue for years, have concluded consumers benefit most from feedback to a short list of overarching questions.

    It may be too late for our federal government to patch up the gaping hole in the levee guarding the Treasury, but the Bush administration has a chance to stand up for fiscal restraint and common sense by ensuring the federal hospital survey known as HCAHPS does no harm.