Medicolegal Issues

Capitol Gains


Nine members of SHM’s Public Policy Committee (PPC), accompanied by several SHM staff members, paid a visit to Capitol Hill early this year.

The group spent Feb. 28 calling on senators, representatives, and congressional staff, as they participated in meetings similar to those included in SHM’s Legislative Advocacy Day, held during the 2006 Annual Meeting. In fact, many of the PPC members had second meetings with legislative staff they had met last May.

“We had already broken some ground with Legislative Day, so some people were familiar with us,” says Ron Angus, MD, Department of Medicine, Presbyterian Hospital of Dallas. “We had a little more time to talk about the issues.”

During their meetings, “We emphasized the different roles that SHM can play, and we tried to get a feel for what it means to have a Democrat-led Congress,” says Jack Percelay, MD, MPH, FAAP, Virtua Health, Ridgewood, N.J.

SHM’s senior adviser for advocacy and government affairs, Laura Allendorf, pronounces it “a very productive day.”

Back row from left to right: Chris Skinner, Eric Siegal, Felix Aguirre, Jack Percelay, Stephanie Jackson. Bottom row from left to right:  Laura Allendorf, Rep. Shelley Berkley, D-Nev., Ron Greeno, Ryan Genzink.

Back row from left to right: Chris Skinner, Eric Siegal, Felix Aguirre, Jack Percelay, Stephanie Jackson. Bottom row from left to right: Laura Allendorf, Rep. Shelley Berkley, D-Nev., Ron Greeno, Ryan Genzink.

Building on a Foundation

The PPC visits were successful partly because this was the second time SHM had visited representatives, allowing the hospitalists to build on their introductory meetings and spend more time discussing issues and offering help. The committee hopes to continue this trend.

“In the long term, we want to see if we can meet with the same people more frequently,” explains Dr. Angus. Allendorf agrees, saying, “The more often we’re up there, the better.”

There may be many more visits or communications. “I think we’re building something long-term, and it’s going to take a while to do that,” says Dr. Angus. “As we get more comfortable talking to these folks, we’ll work on getting them to contact us when issues first come up. Our goal is to be there at the beginning of the process, rather than the end, when it’s too late to have much impact.”

Another reason the February visits were deemed a success involves whom the PPC met with.

Policy Points

CMS Posts Information on the Physician Quality Reporting Initiative

Details on the 2007 Physician Quality Reporting Initiative (PQRI) are available online. In this program, eligible physicians who successfully report a designated set of quality measures on claims from July 1 to Dec. 31 can earn a cash bonus of 1.5% of total allowed charges for covered Medicare physician fee schedule services.

The 74 quality measures to be used in the program are now listed on the Web, along with 50 frequently asked questions and other information, at

SHM has been working with the Centers for Medicare and Medicaid Services (CMS) and the AMA’s Physician Consortium for Performance Improvement to ensure that measures are included that can be reported by hospitalists who decide to participate in this voluntary program. Pre-enrollment is not necessary to participate.

CMS/Premier P4P Project Gets 3 More Years

CMS has given the green light to a three-year extension of its first successful pay-for-performance (P4P) trial, the CMS/Premier Hospital Quality Incentive Demonstration.

The extension of the demonstration project will test new incentive models, including hospitals achieving a defined level of quality or quality threshold and hospitals making the most improvement in quality that also achieve the quality threshold.

The extension will continue to track hospital performance in the clinical areas of pneumonia, heart bypass, acute myocardial infarction, heart failure, and hip and knee replacement, with the flexibility to add quality measures and clinical conditions in the fifth and sixth years. New mortality and patient-safety measures are among those that may be included.

“These meetings were more productive because we were meeting with key staff, people on key committees,” recounts Allendorf. “And [participants] had more visits during the day—each had between five and eight. We made a point to meet with committee staff, staff for key committees, including the House Ways and Means Health Subcommittee, the Senate Finance Committee, the Senate Committee on Appropriations, and the Senate Committee on Health, Education, Labor, and Pensions. We met with committee aides hired to handle special issues like Medicare Part B.”

Targeting these influential offices—particularly the powerful Ways and Means Committee—should have greater impact on healthcare legislation and funding.

Making Inroads with Ways and Means

The entire group ended the day in a meeting with Rep. Shelley Berkley, D-Nev., and her health legislative aide Jeff Davis. Berkley serves on the House Ways and Means Committee and is perceived as “physician-friendly.” Her husband is a nephrologist, and Allendorf describes the lawmaker as “very knowledgeable about the issues” in healthcare. “She’s now in a position to do something; she’ll be a major player,” predicts Allendorf.

“We met with Berkley for five or 10 minutes, then had a roundtable with Jeff Davis from her office,” says Dr. Angus. “We talked about increased funding for AHRQ [Agency for Healthcare Research and Quality] and coordinating quality initiatives being brought to bear in hospitals. We tried to emphasize that when you talk about quality in hospitals, you’re talking about hospitalists.”

With her majority role on a key committee, Berkley is one example of the newly empowered Democrats in office—Democrats who may make a difference in pushing through SHM-sponsored legislation.

Democratic Differences?

Did the PPC members notice a difference since May, with the change of majority party in Congress?

“I could feel it,” says Dr. Angus. “There’s been a huge sea change. Those who felt unempowered last year now feel that there’s a clean slate.”

Dr. Percelay saw a difference in priorities among healthcare issues. “In general, the access issue is much more prominent,” he says. “There’s a sense that we need to do something about healthcare expenses and access for everyone. There’s a recognition of big-picture issues—by both Democrats and Republicans—that we aren’t providing coverage for everyone, and we’re spending too much on it.”

Future Advocacy

The PPC counts its Capitol Hill visit a success. Members want to broaden the influence of SHM and hospitalists by enlisting the help of others.

“We want to identify members who are interested in public policy who live in key areas—areas served by legislators on key committees,” explains Dr. Percelay, “so that they can lobby from a local perspective.” Dr. Angus adds, “Ideally, they’ll interact with their national officials when they’re in their local offices. Also, we’d like members to keep an eye on state and local issues.”

Allendorf points out that these members can be identified and reached though SHM’s online Legislative Action Center at If you receive an e-mail asking you to contact one of your representatives regarding a specific issue, you can take part in the advocacy efforts.

In other plans, says Dr. Angus, “We hope to construct some body of resources that hospitalists who go to D.C. on their own can use to go up to the Hill with information in hand and talk to their Congress people.”

PPC members understand they have their work cut out for them when it comes to increasing awareness of SHM and hospitalists on Capitol Hill.

“This is a long-term investment process,” Dr. Percelay says. “We’re learning as an organization how to conduct our public policy efforts. We’re at the beginning stages of meeting with these people and letting them know what hospitalists can do.” TH

Jane Jerrard writes “Public Policy” for The Hospitalist.

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