The Carter administration's controversial hospital cost control bill, which was received with skepticism and hostility when introduced in Congress three months ago, now appears more likely to emerge from the House --mentally intact.
Although the two House subcommittee chairmen responsible for action on the bill. Reps. Paul G. Rogers (D-Fla.) and Dan Rostenkowski (D-III.) have introduced amended versions of the administration's bill, the measure's basic approach remains.
Neither Rogers, chairman of the House commerce health subcommittee, nor Rostenkowski, chairman of the House Ways and Means health subcommittee, has challenged the administration's decision to impose a ceiling on the amount that hospitals can increase their revenues each year over a base period.
Rostenkowski's subcommittee will begin marking up his version of the bill later this week. Rogers has scheduled hearings for Monday on his version with markup to follow ina few weeks.
In the Senate, the health subcommittee of the Human Resources Committee is scheduled to mark up the bill beginning Thursday. Sen. Edward M. Kennedy (D-Mass.), chairman of the subcommittee, is expected to introduce a bill that accepts that basic approach followed by the administration but with provisions allowing consumers to file suits against hospitals to disclose finances and possibly imposing a complete moratorium on construction and equipment purchases.
The administration's Oct. 1 target date for the bill's implementation now seems hopeless. "We're talking about a Jan. 1  starting date," according to a Ways and Means subcommittee staff member. Even Jan. 1 may be optimistic if Sen. Herman E. Talmadge (D-Ga.) is not persuaded to bring the bill before his Senate Finance health subcommittee soon after the August recess.
The administration bill has two main features: first, a celing on revenue increases that a hospital could receive, based on a formula computed from a two-year base period. Second, a limit of $2.5 billion nationally --roughly half of what was spent in 1976 -- for capital expenditures for hospitals. Quotas for what each state could spend would be established on a population basis, with the states then charged with further assigning quotas within their borders.
The administration bill was roundly criticized at the time it was first introduced in April as being both too complicated and too simplistic in its approach.
Rostenkowski's amended version attempts to meet some of the criticism by simplifying the formula used to calculate the amount hospitals may increase their revenue -- substituting a flat 9 per cent a year -- and by eliminating about 3,300 small hospitals --those with fewer than 4,000 admissions. According to Rostenkowski, eliminating small hospitals from the bill would mean a reduction of 13 per cent in the total hospital expenses subject to federal control.
Rostenkowski's bill also changes the method used to compute the base period, a complicated procedure that resulted in the bill applying retroactively to some hospitals. Other changes in the Rostenkowski version attempt to make the bill more flexible and less punitive of hospitals experiencing some growth in admissions.
Rogers' bill directs its attention to different problems, attempting to provide incentives in addition to the penalties the administration seeks to encourage hospitals to become more efficient.
One addition made by Rogers, apparently welcomed by the administration, is to place a limit on out-of-hospital capital expenditures made to escape current federal limits that now apply only to hospitals. This provision would apply among other things, to physicians who purchase expensive equipment for use in their offices after a hospital they practice in has been denied authorization by the local planning association to buy the equipment.
Although administration officials indicated that specific provisions of the Rogers and Rostenkowski bills may pose problems and may reduce expected initial savings in hospital costs, the bill appears to be emerging basically intact.
One House committee staff member, skeptical of the bill's prospects in April, now believes the bill has a good chance of passing. "Something's coming," the aide said in an interview. "I wouldn't have said that a while ago."