There’s a familiar pattern to fall — the days grow shorter, the weather grows colder and Congress returns to confront a series of fiscal crises of their own making.

This year, Congress faces three fiscal deadlines. The fiscal year began Oct. 1; as I wrote this, a stop-gap funding bill was being drafted. By the time you read this, Congress, hopefully, will have passed the bill, thereby avoiding another government shutdown. The next cliff occurs Dec. 31 when a temporary increase in physicians’ Medicaid payments for primary care mandated by the Affordable Care Act expires. The third deadline — April 1 — looms even larger. That’s when the latest “doc fix” expires and physicians’ Medicare payments will plummet by more than 20 percent if Congress fails to take action. At the same time, several programs important to small and rural hospitals will expire. In addition, the debt limit is projected to expire at about that time. Given that Medicare and Medicaid account for more than 20 percent of federal spending, this puts hospital payments in the spotlight.

Congress only acts when it’s facing a crisis or a deadline, and with an election in November, not much work will be done this fall. With that in mind, the American Hospital Association is laying the groundwork now to ensure that hospitals’ concerns are front and center when Congress is ready to act. Specifically, we’re working in four areas.

Demanding responsible regulation: Out-of-control contractors, such as Medicare’s recovery audit contractors, and well-intentioned but burdensome requirements, such as the government’s standards for demonstrating “meaningful use” of health information technology, are diverting precious resources from patient care. In an effort to bring clarity, Medicare released new regulations, such as the two-midnight rule and a recent rule to add some flexibility for meeting meaningful use in 2014. But they have only further confused the situation. What’s needed is responsible, commonsense regulation that puts patients — and patient care — first. And we’re pushing Congress to act if the agencies won’t.

Protecting vulnerable populations: Hospitals offer a lifeline to our nation’s most vulnerable populations — the uninsured, the poor, the elderly and the disabled. But mounting cuts and regulations are threatening hospitals’ ability to continue to provide the essential services these populations rely on. We’re fighting for relief from cuts to programs like the Medicare disproportionate share hospital program that support treatment for vulnerable patient populations. And we’re seeking changes to programs that unfairly penalize hospitals for socioeconomic forces outside of their control, like the Hospital Readmissions Reduction Program.

Ensuring access to care in rural communities: Approximately 46 million Americans live in rural areas and depend upon the hospital’s serving their community as an important and, often, only source of care. These hospitals need regulations that recognize their challenges and support patient care, not make it more difficult. That’s why we support the extension of vital programs like the low-volume adjustment and Medicare-dependent hospital program, as well as legislation to remove burdensome requirements such as the 96-hour rule and direct supervision for outpatient therapeutic services.

NEED FOR BUDGET PREDICTABILITY. In the past four years alone, Medicare and Medicaid payments for hospital services have been slashed by more than $121.9 billion. Hospitals simply cannot continue to do more with less. They need a predictable revenue stream, not greater uncertainty. That’s why we continue to urge Congress to reject cuts to payments for hospital care as it looks for ways to offset the costs of other spending.

Rick Pollack is the AHA’s executive vice president, advocacy and public policy.

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