Medicolegal Issues

At Work in Washington


SHM’s 20-member Public Policy Committee, headed by Eric Siegal, MD, had a busy 2008 addressing the many legislative and regulatory issues affecting hospitalists. As a result of our efforts, SHM’s visibility with key lawmakers, the Medicare Payment Advisory Commission (MedPAC), and the Centers for Medicare and Medicaid Services (CMS) has increased significantly, and policymakers now routinely turn to us for advice and expertise. Here is an update on how the committee represents hospital medicine—and your interests—in our nation’s capital.

Medicare Payment Cuts Prevented

Earlier this year, SHM’s Public Policy Committee (PPC) worked tirelessly to secure passage of H.R. 6331, the Medicare Improvements for Patients and Providers Act (MIPPA). It blocked the 10.6% physician payment cut, which was scheduled to go into effect July 1, 2008, and extended current payment rates through Dec. 31, 2009 Thanks in part to concerted advocacy by SHM and its members, Congress voted overwhelmingly July 15 to override President Bush’s veto of this measure. The new law (P.L. 110-275) includes 18 months of relief from scheduled cuts in Part B Medicare payments, other increases in reimbursement for inpatient evaluation and management services, and several SHM-supported quality improvement initiatives.

HM Group Staff Growth

Beginning Jan. 1, hospitalists will see a 1.1% increase in Part B payments, instead of a projected 5.4% cut. SHM strongly supported provisions of the bill, which requires CMS to apply budget-neutral adjustments for 2007 and 2008 to the conversion factor. This change will result in an estimated average gain of another 3% in total Medicare payments for hospitalists.

SHM also supported continued funding of the Physician Quality Reporting Initiative (PQRI) and other quality provisions contained in MIPPA. Under the new Medicare act, hospitalists who successfully report quality measures are eligible for a bonus payment in 2009 and 2010 of 2% (up from 1.5%) of their total Medicare allowed charges. The new law also requires the U.S. Secretary of Health and Human Services (HHS) to develop a plan to transition to a value-based purchasing program for physician services.

SHM took multiple steps to influence MIPPA’s successful passage. Here are a few of those steps:

  • When Sen. Max Baucus (D-Montana), chair of the Senate Finance Committee, announced he was working on legislation to reverse the pending cuts in Medicare payments, the PPC immediately commended his efforts and offered our assistance with the bill, specifically focusing on quality improvement provisions.
  • Sen. Baucus introduced S. 3101, which formed the basis of the final Medicare bill, H.R. 6331, in June. On June 9, the PPC sent a letter to Sen. Baucus, formally supporting his efforts to address the pending payment reductions and praising other provisions in the bill promoting quality reporting, including continuation of the PQRI program; a requirement that measures be endorsed by a consensus-based, standard-setting entity such as the National Quality Forum, which CMS posts on its Web site the list of providers who participate in the PQRI; and that HHS provide confidential feedback to providers regarding their resource use.
  • In a July 10 letter, we urged President Bush to immediately sign H.R. 6331 into law, stating, “This legislation, passed by bipartisan margins in both the House and Senate, contains many positive elements for hospitalists and their patients, and deserves your support.”
  • As part of our advocacy efforts, the PPC launched a comprehensive, grassroots campaign to pass MIPPA, sending an unprecedented number of communications to inform and mobilize SHM members. In the month leading up to final passage of H.R. 6331, we sent 12 legislative e-mail updates to SHM members, urging each member to contact his or her lawmakers via our legislation action center. As a result of this outreach, hospitalists generated a total of 1,269 messages to members of Congress, urging policy makers to stop the Medicare cuts to physician payments. We thank all of you who visited the action center and contacted your lawmakers. Your efforts were vital to the success of SHM’s campaign to stop the cuts and passage of H.R. 6331.

Chapter Updates

New Jersey

The New Jersey Chapter had its bi-annual meeting Sept. 18 at the Grand Summit Hotel in Summit. Twenty-one SHM members representing seven hospital medicine groups attended the meeting. Donnet Brown, MSN, MBA, WCC, and Alan Levin, MSN, MBA, CPHQ, gave presentations in patient safety and the first domain of quality healthcare. The meeting was sponsored by Ortho-McNeil.

Lake Erie

The Lake Erie Chapter meeting was Aug. 20 at the Mallorca Restaurant in Cleveland. Fourteen SHM members representing four HM groups attended. Christian Nasr, MD, endocrinologist at the Cleveland Clinic, gave a presentation on inpatient management of diabetes. The evidence-based presentation was followed by lively discussion from the attendees. The meeting was sponsored by sanofi-aventis US, LLC.

Charlotte, N.C.

The Charlotte Chapter’s Sept. 25 meeting was entitled: “SHM Web-Based Resources: Tools to Improve the Quality Gap in Heart Failure.” The meeting, at Ruth’s Chris Steakhouse in Charlotte, was attended by nine SHM members from six HM groups. Nurcan Ilksoy, MD, hospitalist at Wellstar Windy Hill Hospital, Marietta, Ga., gave the heart failure presentation, which included new clinical information and a review of the basic information on the subject. SCIOS, Inc. sponsored the meeting.


The Indiana Chapter’s Aug. 20 meeting took place at Sullivan’s Steakhouse in Indianapolis. Twenty SHM members representing eight HM groups learned about “Billing, Coding, and Documentation of Consultations/Co-management of Patients” from Robin Stickney, MD, JD, a senior consultant with St. Vincent Health, a division of Ascension Health, in Indianapolis. UCB Pharmaceuticals sponsored the meeting.


The Chicago Chapter met Oct. 29 at Joe’s Seafood, Prime Steak & Stone Crab in Chicago. The guest speaker was Tamara Vokes, MD, associate professor of medicine, the Department of Endocrinology at the University of Chicago. Dr. Vokes made a presentation and led discussion on “The Treatment of Osteoporosis.”

Election results were announced and the new chapter officers are: Ana Nowell, MD, president, hospitalist at Advocate Health Centers; Joanna Maurice, MD, University of Illinois-Chicago, vice-president; Aziz Ansari, DO, hospitalist and assistant program director at Loyola University Medical Center in Chicago, secretary.

Dr. Nowell thanked the outgoing officers for their tremendous efforts and announced plans for 2009. Nearly 50 hospitalists attended the meeting, which was sponsored by Novartis.

Nashville/Middle Tennessee

The Nashville/Middle Tennessee Chapter met Sept. 11 at Morton’s Steakhouse in Nashville. Twenty-six attendees participated in a question-and-answer presentation on “Hospital-Inquired Infections: Diagnosis and Treatment Considerations for the Hospitalist” by Michael Gelfand, MD, FACP, professor of medicine at the University of Tennessee Health Science Center, Memphis. The meeting was sponsored by Ortho-McNeil Pharmaceuticals.

Payment Advisory Commission Interaction

The PPC has made SHM’s engagement with the influential Medicare Payment Advisory Commission a top priority. An independent Congressional agency established by the Balanced Budget Act of 1997, MedPAC advises Congress on issues affecting the Medicare program. Our efforts to educate the commission and staff about hospital medicine are paying off. Through attendance at MedPAC meetings, as well as conference calls and face-to-face meetings with staff, SHM has educated the commission about the positive contributions hospitalists are making throughout the country.

PPC members attended MedPAC’s March 5, 2008, meeting and addressed the commission during the public comment period. The PPC offered to further educate the commission regarding the role hospital medicine can play in Medicare reform. In June, key SHM leaders met with MedPAC staff, including executive director Mark Miller, in Washington to discuss hospital medicine and SHM’s quality improvement initiatives, including Project BOOST. At MedPAC’s request, the PPC has worked to develop a “starter set” of metrics to define high-performing hospitalist programs. It might form a basis for future value-based purchasing initiatives.

Also in June, MedPAC released its report to Congress on “Reforming the Delivery System,” which contained extensive information and feedback from SHM.

The PPC continues to monitor MedPAC’s work, particularly its recommendations for changes in Medicare payment for care provided around a hospitalization to encourage care coordination and efficiency. To reduce hospital readmissions, the commission’s June report to Congress recommended, among other things, that CMS conduct a voluntary pilot program to test bundled payment for all services around a hospitalization for select conditions.

Value-Based Purchasing

Together with SHM’s Performance and Standards Committee, the PPC continues to monitor and comment on CMS’s value-based purchasing (VBP) initiatives, as well as educate SHM members on what the initiatives mean for hospitalists. On June 11, SHM hosted a teleconference on VBP. It featured Thomas Valuck, MD, JD, medical officer and senior adviser, Center for Medicare Management, CMS. In his presentation, Dr. Valuck acknowledged the unique role hospitalists play in VBP programs, and he commended SHM for its proactive stance and constructive engagement with CMS.

On Aug. 29, the PPC submitted comments on CMS’s proposed FY 2009 physician payment rule. This rule proposed additional improvements to the PQRI; discussed CMS’s interest in developing a “Physician Compare” Web site to report quality of care and value for services provided by physicians; solicited comments on CMS’s proposed preventable hospital-acquired conditions; and proposed a new, targeted exception to the physician self-referral statute for programs using economic incentives to foster high quality, cost-effective care. Visit Menu/AdvocacyPolicy/LegislativeRegulatoryUpdates/Legislative_Regulato.htm for a summary of the final rule.

Increased AHRQ Appropriations

Through its participation in the Friends of Agency for Healthcare Research and Quality (AHRQ) coalition, visits to Congressional offices by members and staff, and grassroots advocacy via our legislative action center, SHM continues to advocate for increased funding for this important agency. Last fall, President Bush signed a continuing resolution, P.L. 110-329, which funds government agencies, including AHRQ, at current levels through March 6. The resolution was necessary because none of the 12 individual FY 2009 appropriations bills, including the Labor Department-Health and Human Services-Education Department measure, which contains funding for AHRQ and the National Institutes of Health, had been enacted into law. Early this year lawmakers are expected to attempt to pass the remaining appropriations bills and forward them to President-elect Obama.

What’s Ahead?

This year promises to be busy on the healthcare policy front. SHM is poised to make major contributions to the debate, given its advocacy on key issues over the past year and the goodwill it has generated among policymakers. The PPC will devote considerable time to crafting hospital medicine-specific recommendations on health reform, including bundling and its implications for hospitalists; and providing input to CMS’s value-based purchasing initiatives, including the agency’s report to Congress, which is due May 2010. We also will continue to pursue a separate CMS specialty billing code for hospitalists.

The PPC strives to keep SHM members informed about legislative and regulatory activities through monthly updates posted to the advocacy section of the SHM Web site, articles in The Hospitalist, and items in the new SHM e-Wire. Letters to Congress and CMS are located on the Web site, as well.

When an important issue arises, you likely will receive an e-mail urging you to visit our legislative action center ( and contact your members of Congress. We depend on your involvement in the legislative process in order to be effective in Washington. TH

Laura Allendorf is senior advisor for advocacy and government affairs for the Society of Hospital Medicine. Contact her at [email protected]

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