On May 12, 113 hospitalists descended on Capitol Hill for “Hospitalists on the Hill 2013,” the public-advocacy highlight of SHM’s annual meeting. Hospitalists from all parts of the country engaged with congressional representatives in a daylong series of meet-and-greets that may seem to some people useless in the face of political obstinacy in Washington. But the trip worked.
Josh Boswell, SHM’s senior manager of government relations, reports many Hill Day objectives were achieved:
- The number of legislators co-sponsoring a bill regarding the “three-day observation rule” more than tripled in the House of Representatives and doubled in the Senate. SHM officials note that the added support has come from both political parties.
- A Congressional Budget Office (CBO) review of the bill has been formally requested by those legislators.
- A congressman from Washington state asked for—and received—a letter of support for a proposed measure, the Improved Health Care at a Lower Cost Act of 2013 (H.R. 1487).
- Multiple reports of continued dialogue between congressional staffers and SHM members nationwide. When planning the advocacy day, SHM officials noted that one of the most valuable results is creating relationships at the local level.
One of the three talking points hospitalists took into their legislative meetings was solving the dilemmas surrounding observation status. Currently, time spent on observation status does not count toward the required three consecutive overnights an inpatient needs to qualify for Medicare benefits at a skilled nursing facility (SNF).
Hospitalists have been pushing to change that rule, in large part by supporting the Improving Access to Medicare Coverage Act of 2013 (H.R. 1179, S. 569), sponsored by Rep. Joe Courtney (D-Conn.), Rep. Tom Latham (R-Iowa), and Sen. Sherrod Brown (D-Ohio).1 In addition to the status reclassification, the proposal would establish a 90-day appeal period for those who have been denied the benefit.
The issue is important to hospitalists because of the penalties hospitals face for readmissions—and also in part because hospitalists increasingly are providing care at SNFs and other post-acute-care facilities. SHM says that after the Hill visits—and the ensuing follow-up communications—the number of co-sponsors in the House jumped to 70 from 22. The Senate version doubled its list of co-sponsors.
And, perhaps more important, a CBO analysis has been requested for the observation bills. That review, known as a CBO score, weighs the financial impacts of proposed laws and is considered a necessary precursor to successfully passing any legislation.
All in all, SHM was pleased with the progress on the observation-status bill and will continue to push for its passage, whether it is in this congressional session or the next.
“Rep. Courtney’s bill is now getting significant traction,” Boswell says. “Hospitalists should be proud to know this is in no small part due to their advocacy efforts.”
Hospitalist David Ramenofsky, MD, who works at Northwest Hospital and Medical Center in Seattle, wasn’t sure how much traction he was going to be able to generate at his first Hill Day. SHM had arranged meetings with the offices of three local politicians: Rep. Jim McDermott (D-Wash.), Sen. Patty Murray (D-Wash.), and Sen. Maria Cantwell (D-Wash.).