A few months ago SHM received an e-mail from SHM member Jennifer Bellino, MD, a hospitalist at William Backus Hospital in Norwich, Conn. She had gotten wind of a proposal flowing through the Public Health Committee at the Connecticut State Legislature that would mandate the frequency of communications between hospitalists and primary care physicians (PCPs). From her short e-mail SHM’s advocacy enterprise sprung into action.
Bill 5721 was being introduced to the Public Health Committee in the Connecticut Legislature, and it required the development of state regulations that would have governed the timing and frequency of communications between hospitalists and PCPs.
Laura Allendorf, SHM’s head of Governmental Affairs, engaged SHM’s Public Policy Committee to better understand the issues involved in this bill and to get a sense of whether this was a unique bill for Connecticut or whether it was being introduced in other state legislatures.
While the bill appeared to be isolated to Connecticut, the Public Policy Committee thought the issue was threatening enough to the practice of hospital medicine that local aggressive action was necessary.
Allendorf contacted the Connecticut State Medical Society and spoke to Ken Ferrucci, director of government relations, who was already aware of Bill 5721. The Connecticut State Medical Society (CSMS) was opposed to the bill as well, and Ferrucci proposed that SHM find a Connecticut hospitalist who could come to Hartford to speak against Bill 5721 at the Public Health Committee, which would hear testimony in just a few days.
Unfortunately, no one on the Public Policy Committee was from Connecticut. Fortunately, SHM was familiar with Bill Rifkin, MD, from Yale (New Haven) and Waterbury Hospital, who is active at SHM as a member of our Education Committee. Allendorf contacted Dr. Rifkin and explained the situation. He dropped everything on his calendar and changed his appointments and agreed to come to Hartford to fly the SHM banner and testify before the Public Health Committee.
Working together Allendorf, Eric Siegal, the Public Policy committee chair, and Dr. Rifkin crafted the testimony necessary to explain to the legislators just what hospital medicine is and what hospitalists do. In addition, they emphasized that hospitalists are working hard to be the experts in transitions of care and that mandates and regulations were not needed and, in fact, could be detrimental to the fundamental relationship between PCPs and hospitalists.
SHM then coordinated our approach with that of the Connecticut State Medical Society to create a unified front for maximum effectiveness. In the end Dr. Rifkin carried the day.
After Dr. Rifkin’s testimony, as well as testimony from the Connecticut State Medical Society, the bill died a quiet death. Eventually, a watered down amendment was made to another public health bill, which contained language that basically said hospitalists and PCPs should talk to each other. This amendment asked that the Quality of Care Advisory Committee, which advises the Department of Public Health, make recommendations to the department concerning best practices with respect to communications between a patient’s PCP and other providers involved in a patient’s care, including hospitalists and specialists.
Thanks to CSMS’ and SHM’s efforts, no regulations or mandates are currently planned in Connecticut.
It is unfortunate that some states, driven by a small vocal group of consumers or sometimes by just one legislator, can single out hospitalists for scrutiny and regulation. Dr. Rifkin found out how important and necessary it is to provide education to the involved legislators, as some professed knowing few of the details of the hospital medicine movement.
While you might be sitting in Texas or Minnesota or California and wondering what all of this has to do with you, know that a wildfire can start from a smoldering ember. SHM must vigilantly monitor the actions of local legislatures and regulators so that in their misunderstanding of hospital medicine or in their concerns for changes in the healthcare system they do not attempt to use the state or federal legislatures for their remedies.
Hospital medicine is new, and we are challenging the status quo. While we are driven by a goal of creating a more efficient healthcare system, driven by accountability and data, some will see the turbulence of change and attempt to rein this in. While some places have seen significant improvements, hospital medicine is still very much in its growth and evolutionary phase. This is the time to have the ability for flexibility and even experimentation in the best sense of the word. It is important not to be stifled by overregulation. At the same time, hospitalists need to be aware that we are no longer a boutique specialty off on the margins of healthcare. Hospital medicine is front and center at more than 2,000 hospitals and with 15,000 hospitalists nationwide too large to be ignored.
Expect more attempts to legislate how hospitalists practice. One SHM member’s e-mail brought the full strength of SHM to quash the wrong bill in Connecticut. We need your local eyes to let us know what is happening out in the real world. In the meantime SHM will work hard to develop the bench strength to be able to rise to your challenges. TH
Dr. Wellikson has been CEO of SHM since 2000.