Although the bungled rollout of health exchange websites has dominated healthcare-related headlines in the last months of 2013, hospitalist leaders say the policy landscape for 2014 features bigger issues.
To set the table, The Hospitalist reached out to four hospitalists who keep a close eye on the policy sphere. Those interviewed agree that the continued shift from fee-for-service to pay-for-performance will dominate policy discussions. In tow with that are the expected quality improvements the payment model is supposed to beget.
“Pay-for-performance and quality measures will be major issues for hospitalists moving forward,” says SHM Public Policy Committee member Joshua Lenchus, DO, RPh, FACP, SFHM. “But, I am not very optimistic that these processes will lead to their desired outcomes. At the end of the day, personal patient responsibility will need to be accounted for if a real change in healthcare outcomes is to be recognized.”
Other pressing policy issues the panel will pay attention to this year include:
1. Value-Based Purchasing
Further refinement and development of just how physician value-based purchasing will be implemented. More specifically, Josh Boswell, SHM’s senior manager of government relations, is watching to see how that will be incorporated into a possible long-term fix for the sustainable growth rate (SGR) formula.
“As the costs associated with noncompliance increase, hospitals will increasingly look to hospitalists to drive better performance,” says former SHM Public Policy Committee member Eric Siegal, MD, SFHM, director, Aurora Critical Care Service, St Luke’s Medical Center, Milwaukee, and clinical associate professor of medicine, University of Wisconsin School of Medicine and Public Health. “The good news: This is job security for many hospitalists. The bad news: Increasing amounts of human capital will be dedicated to meeting Medicare’s mandates, irrespective of whether this represents the most productive or effective use of those resources.”
Continued monitoring of accountable-care organizations (ACOs) as the first waves of data emerge on claims and performance. Along with managing health populations, expect consolidation of healthcare systems from nearly 700 to what some experts think could be as few as 50 to 70 mega-providers.
3. Observation Status
The rollout of the new two-midnight rule, which the Centers for Medicare & Medicaid Services (CMS) recently changed to allow physicians to admit a patient if they reasonably expect and document in the medical record that a beneficiary will need to stay in the hospital for more than two midnights. Such admissions will be presumed to be appropriate for Medicare Part A payment. CMS cited concerns about the growing trend of longer observation stays to support this change. Connected with this issue is SHM’s continued backing of the Improving Access to Medicare Coverage Act of 2013 (H.R. 1179, S. 569), which would solve the conundrum 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.
SHM Public Policy Committee chair Ron Greeno, MD, FCCP, MHM, says that while insurance reform is one of the three legs of the Affordable Care Act, hospitalists need to be focused just as vigilantly on expanding healthcare access for more patients and reforming the delivery system.
“That’s where we’re supposedly going to get the resources to do these other things,” says Dr. Greeno, chief medical officer for Cogent HMG of Brentwood, Tenn. “Hospitalists are right in the middle of those discussions—and they should be.”