While President Obama made a splash last week with his first stump speeches for healthcare reform, SHM policy leaders want to hear more—a lot more. Those hospitalists say HM advocates need to stay on top of the details that will emerge in coming months about “accountable healthcare,” the bundling of Medicare reimbursement payments, and other sensitive issues.

"Reform is going to happen," says Eric Siegal, MD, FHM, a critical-care fellow at the University of Wisconsin School of Medicine and Public Health in Madison and the chair of SHM’s Public Policy Committee. “The scope of what it is remains to be seen. ... The devil is absolutely in the details."

Dr. Siegal resisted focusing on Obama's opposition to cap malpractice awards. "While tort reform is important and should be addressed, medical malpractice is not the root cause of our dysfunctional healthcare system." Dr. Siegal agrees "conceptually" with the administration’s plans to bundle payments, encourage more medical students to enter primary care, and hold healthcare organizations accountable. But he and other SHM leaders want pilot programs to test the efficacy of such initiatives before any broad changes are implemented.

Some policy wonks wonder how fast HM leaders might see the impact of Obama’s proposal to cut $600 billion from Medicare and Medicaid by 2019. SHM policy committee member Bradley Flansbaum, DO, MPH, said if cuts are implemented quickly, then hospitalists could see hospital subsidies to their programs reduced, or could simply be competing with other specialists for a shrinking fiscal pie.

“Short-term, I would be concerned,” says Dr. Flansbaum, chief of hospitalist services at Lenox Hill Hospital in New York City. “What he’s proposing is more or less ... a haircut. Depending on how quickly the system is worked out, there could be a lot of pain on the hospital medicine side.”

For more public policy information, visit SHM’s Advocacy Website.

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