Cleveland Clinic leads Ohio hospital lobby, spends $1.15 million

Ohio health-care systems spent more than $2 million last year lobbying the federal government – roughly half of which was spent by the Cleveland Clinic, according to documents filed under the Lobbying Disclosure Act.

The Clinic is annually one of the biggest individual spenders among health systems nationwide, easily topping systems including Mayo Clinic and Johns Hopkins. Cleveland Clinic used $1.15 million(pdf) to work with four firms, and lobbied for issues including Medicare reimbursement and research funding from the Department of Defense.

Some policy analysts say health care is lobbying’s boom industry. Individual hospitals usually lobby for issues specific to their systems. The hospitals are then reinforced by – or compete against – trade organizations like the American Medical Association that work on broader interests in health care.

Wednesday was the deadline to submit lobbying disclosures for the final three months of 2008. All the disclosures are available on the Lobbying Disclosure Act database.

“Health is the new defense,” said Michael Heaney, an assistant professor of political science at the University of Florida who has written extensively on health-care policy.

“All the margin in lobbying was in defense, and lobbying was about trying to get your new weapon system picked up by the Pentagon,” Heaney said. “What’s really happened in the last 10 years is that defense is being displaced by health.”

Oliver Henkel, chief external affairs officer at the Clinic, said the system’s spending is a result of its size and work in places such as the Lerner Research Institute, as well as the fact it doesn’t have full-time staff working in Washington, D.C.

“It is because we are far and away the largest hospital system in Ohio, and we have the greatest reach,” Henkel said.

Lobbying on the Clinic’s behalf to the Defense Department helped secure $10 million-worth of a $42 million research grant to find ways to treat severe battlefield injuries, Hekel said. It also led to a Clinic-Army Reserve program that gives reservists priority for jobs at the Clinic, as well as millions in research grant dollars dealing with traumatic brain injuries, he said.

The Clinic also spends a large portion of its time monitoring and commenting on rules in the Centers for Medicare & Medicaid Services, Henkel said.

University Hospitals Case Medical Center spent $290,000(pdf) lobbying on issues including trying to get a special Medicare exception for its Ireland Cancer Center, funding for the Cleveland-based National Center for Regenerative Medicine, and funding the State Children’s Health Insurance Program (SCHIP), said Heidi Gartland, UH’s vice president for governmental relations.

Nationwide Children’s Hospital in Columbus spent more than $427,000(pdf) lobbying Congress in 2008, records show. That hospital focused, in part, on Defense Department appropriations bills and autism research.

Morna Smith, director of federal relations and health policy at Nationwide, said those efforts have helped Nationwide win $3 million in federal research funding for autism research over the last two years.

But Smith said Nationwide focuses more of its efforts on national issues, like maintaining Medicare payments for children’s procedures or winning drug reimbursements for children’s hospitals that adult facilities already get.

Issues like Medicare “far overshadow earmarked dollars,” Smith said.

Compared to those of large organizations, hospital lobbies are like raindrops in a pond. For instance, the American Medical Association spent more than $19 million lobbying the federal government last year, according to its disclosure forms.

But hospital systems are often more powerful than large trade groups because of their combined lobbying dollars and voters in Congressional districts, Heaney said.

No Ohio hospital said it plans to increase its lobbying budget for 2009. In fact, Henkel said the Clinic is planning to spend less.

But President Obama has proposed to increase federal research funding by millions of dollars, which is exactly the kind of funding a hospital would pursue on its own.

Heaney reviewed the Clinic’s disclosure forms and described its approach as a sophisticated approach that has become standard in the health-care industry. The Clinic spends a large portion of its lobbying money through firms and couples it with some personal efforts.

• Fredrick H. Graeff: $150,000
• Cohen Group: $30,000
• The Nickles Group: $246,000
• Van Scoyoc Associates: $180,000

But Heaney said that the Clinic is not a “big player” in lobbying. “If they were big players, they’d move to D.C.,” Heaney said.

For all the good lobbying might do for individual hospitals, this lobbying also helps fuel some of the problems in health care, said Dylan Roby, assistant professor in UCLA School of Public Health and a research scientist at the school’s Center for Health Policy Research. Roby said hospitals often lobby to fund medical specialties and specific research, and such efforts likely contribute to declining doctor interest in primary care practices.

Henkel and Gartland disagreed. Gartland said she regularly lobbies for graduate education at Rainbow Babies and Children’s Hospital from which many pediatric fellows go on to practice primary-care medicine.

“We think health care is important to the state and the region,” Gartland said. “We want to make sure we promote medical education so the next generation of doctors and nurses can practice cutting-edge medical care.”