Public Policy

Hospitalists’ Capitol Hill Advocacy Effort Produces Results


Talking Points

This year’s Hospitalists on the Hill advocacy day in Washington, D.C., was the largest SHM has ever sponsored. It highlighted three topics important both to HM and the health-care system:

  1. Repealing the sustainable growth rate (SGR) formula for Medicare payments, specifically via the proposed Medicare Physician Payment Innovation Act of 2013 (H.R. 574);
  2. Solving the quagmire of observation status time not counting toward the required three consecutive overnights an inpatient needs to qualify for Medicare benefits at a skilled nursing facility, by supporting the Improving Access to Medicare Coverage Act of 2013 (H.R. 1179, S. 569); and
  3. Getting the federal government to commit to providing $434 million in funding for the Agency for Healthcare Research and Quality (AHRQ) in fiscal 2014.

—Richard Quinn

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.

Observation Legislation

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.”

Political Networking

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.).

Dr. Ramenofsky sat with two of McDermott’s staffers, one of whom sounded knowledgeable and enthused about health-care-policy issues. Although the congressman couldn’t sit in on the meeting, he knew Dr. Ramenofsky’s name and took the time to say hello.

“It was really interesting to me that these staffers wanted to hear what I had to say and learn about my experience,” Dr. Ramenofsky adds. “My views may affect how they work with their bosses to make policy changes. It was surprising to me how much my opinions mattered to them.”

After the meeting and another briefing SHM arranged with another local hospitalist, McDermott reached out to SHM. He asked for support for his proposed bill to expand protections from anti-kickback laws and regulations, to provide safe harbor protection for gainsharing, and other incentive-payment systems.

SHM responded in July with a letter of support that thanked the congressman for his efforts.2

“We look forward to working with you,” the letter ended.

Dr. Ramenofsky says he’s proud his efforts led to a working relationship between his professional society and his local legislator. He says he’s looking forward to participating in future Hill Day activities and acting as a local liaison for SHM.

He laments that he has not received much post-meeting feedback from his discussions with the senators’ offices, but says he understands how busy politicians are. And a 1-for-3 showing is pretty good, given his status as a political novice.

“Given overall public perception of Congress, I’m amazed that my visits caused one of three offices to engage in further policy discussions with SHM,” he says. “I’m encouraged to remain engaged in political activities through SHM.”

Richard Quinn is a freelance writer in New Jersey.


  1. Society of Hospital Medicine. Letter to Congress members. Society of Hospital Medicine website. Available at: Regulatory_Agencies&Template=/CM/ContentDisplay.cfm&ContentID=33169. Accessed July 15, 2013.
  2. Society of Hospital Medicine. Letter to Congressman Jim McDermott. Society of Hospital Medicine website. Available at: Accessed July 15, 2013.

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