SHM: BEHIND THE SCENES

Your Legislative Advisor Speaks Out

By Laura L. Allendorf

Advocating for our members while promoting the value of hospital medicine to legislators and policymakers is an important priority for SHM. As SHM’s senior advisor for Advocacy and Government Affairs, I am responsible for monitoring federal legislation and regulations affecting hospital medicine and recommending appropriate action by SHM. In effect, I am your eyes and ears in our nation’s capital, where more than 34,000 of my fellow lobbyists live and work. Given the fast-paced and often unpredictable nature of legislative affairs, my job is never dull!

The opportunity to represent SHM in Washington, D.C., has been very rewarding. I am fortunate to work with SHM’s Public Policy Committee (PPC), an enthusiastic and hardworking group of 16 hospitalists committed to expanding SHM’s ability to influence healthcare policy in Washington. Under the able leadership of Eric Siegal, MD, from Madison, Wis., the PPC spends countless hours working on your behalf, providing me with valuable clinical insight and guidance on how proposed legislation and regulations would affect hospitalists and their patients, and crafting recommendations to the SHM board on an appropriate response.

In Washington, SHM works both independently and through coalitions with like-minded organizations in pursuit of its policy objectives. We analyze legislation and send letters to Capitol Hill in support of particular bills that are consistent with SHM’s guiding principles. For example, we recently wrote to sponsors of the “Health Partnership Act” (S. 2772) in support of their legislation, which aims to expand health insurance coverage for all Americans by making grants available to state and local governments so they can test various options for improving access.

On the regulatory side, the PPC reviews proposed regulations and coding changes affecting hospitalists. These are brought to our attention by our members, after which we provide input to the Centers for Medicare and Medicaid Services (CMS). Together with SHM’s Performance and Standards Task Force, we are analyzing CMS’ Physician Voluntary Reporting Program, launched in January 2006 and widely viewed as the foundation for a future physician quality reporting program; at the same time, we are educating SHM members about its implications for hospital medicine and providing feedback to CMS on how the program could be expanded to better reflect the services provided by hospitalists. Congress and CMS want to develop a system that ensures appropriate payments for providers while also promoting the highest quality of care, a goal shared by SHM.

We also ally ourselves with a variety of partners in coalitions, depending on the issue. We worked very closely with the American College of Physicians, for example, in support of proposed changes to work relative value units that should result in significant payment increases for hospitalists next year. We have joined with other physician groups, including the AMA, to block the projected cut in the Medicare physician update of 4.6% that will take place in 2007 unless Congress acts, and with the American Hospital Association on issues of mutual interest. Through the Friends of the Agency for Healthcare Research and Quality (AHRQ) coalition, SHM has advocated for increased funding for the AHRQ, the lead federal agency charged with supporting research designed to improve the quality of healthcare in this country.

I have always felt that politically active members are an organization’s best resource when it comes to influencing healthcare policy on Capitol Hill. It is not enough for me, as your Washington representative, to communicate SHM’s positions to members of Congress and their staffs. Lawmakers need to hear from their hospitalist constituents—by phone, by mail, or during a personal visit—concerning why they should take the actions we request. It is time well spent. The personal relationships you develop with your legislators can help influence how decisions on healthcare issues are made.

Recognizing that grassroots involvement by SHM members is critical to the organization’s success on Capitol Hill, PPC organized SHM’s first-ever Legislative Advocacy Day on May 3, in conjunction with the annual meeting. Armed with fact sheets describing hospital medicine and our positions on issues pending before Congress, 72 hospitalists representing 29 states met with their lawmakers and staff and began to develop what we hope will be long-term relationships with those congressional offices. More than 130 appointments were scheduled—many with members of Congress who sit on key health committees with jurisdiction over Medicare, as well as with those who sit on committees responsible for determining funding levels for the National Institutes of Health, the CDC, and the AHRQ.

The consensus from those who participated: Advocacy Day was a valuable opportunity to personally educate lawmakers about hospital medicine and about SHM’s proposals to improve the quality of care in our nation’s hospitals. The PPC hopes to keep the momentum and enthusiasm from Advocacy Day going and is exploring other ways to expand SHM’s grassroots capabilities.

We strive to keep you informed about our legislative and regulatory activities through monthly updates posted to the Advocacy and Policy section of the SHM Web site, the “Public Policy” department in The Hospitalist, and items in SHM’s E-newsletter. SHM’s letters to Congress and CMS are located on the SHM Web site as well. Depending on the issue, you might also receive an e-mail urging you to take action with CMS or Congress.

As SHM continues to expand its presence in Washington, we will call on you to help us get our message across in the halls of Congress and before the regulatory agencies. Your participation in the political process is integral to our ability to shape healthcare policy in Washington. In the words of former congresswoman Barbara Jordan: “The stakes are too high for government to be a spectator sport.”

The PPC and I appreciate your feedback. You may reach me at [email protected]. Check back with us next month when you will hear from Tina Budnitz, MPH, SHM’s senior advisor for Quality Initiatives.

Allendorf is SHM’s senior advisor for Advocacy and Government Affairs.