Hospital Medicine’s Role in Healthcare System Under Affordable Care Act Takes Shape
David Longworth, MD, Cleveland Clinic, speaks during a breakout session called “Accountable Care Organizations and Hospital Medicine.”
LAS VEGAS—As America’s favorite pastime began a new season, hospitalists from all parts of the country engaged in a variety of healthcare policy discussions at HM14. That’s why the baseball analogy that SHM advocacy guru Ron Greeno, MD, MHM, used to describe how far along the industry is in implementing the Affordable Care Act (ACA) was particularly fitting: “We’re in the first inning,” he said.
So, while hospitalists are dealing with myriad policy issues stemming from the generational healthcare reform legislation colloquially referred to as “Obamacare,” policy experts at HM14 noted that hospitalists can help control how changes will be incorporated into day-to-day care delivery.
“I want to decrease people’s fear about the role of hospitalists in the healthcare system of the future,” said Dr. Greeno, chief medical officer of Cogent Healthcare in Brentwood, Tenn., and chair of SHM’s Public Policy Committee. “They should feel just the opposite of fear. There is unbelievable opportunity for hospitalists in the realigned healthcare system.”
At a base level, the ACA is codifying and prodding healthcare’s move away from fee-for-service payments to compensation based on the health of a given population. Over time, that shift will reward value, not simply pay up for procedures and tests, Dr. Greeno said.
As an example, he explained, “If we prevent a readmission in a fee-for-service world, there are hospitals that tell us that that actually hurts them; they need that admission. In a population health environment … if you prevent a readmission, that’s wonderful thing. That’s a hospitalization that did not occur. That creates tremendous value.”
SHM CEO Larry Wellikson, MD, SFHM, said hospitalists not only provide that value on the ground, but also have a strong voice in Washington, D.C. That is especially true with hospitalist Patrick Conway, MD, MSc, FAAP, MHM, who serves as chief medical officer for the Centers for Medicare & Medicaid Services (CMS). Dr. Conway is the former chair of SHM’s Public Policy Committee.
“We’re a young organization with no budget and no power, and we get to have a face-to-face conversation with the guy that’s running Medicare,” Dr. Wellikson said. “Five or six hospitalists from SHM sit on our Public Policy Committee and think about how to fix the observation unit, and the next thing you know it becomes [part] of the regulations and changes things. We’re not your ordinary society.”
Robert Wachter, MD, MHM, also noted that the specialty is waiting to see if the U.S. Senate will approve President Obama’s nomination of Boston hospitalist Vivek Murthy, MD, MBA, as surgeon general of the United States. Dr. Murthy has been a strong supporter of the ACA, but a vote on his approval is being held up by Congress members who are concerned he will use the position as a bully pulpit against gun control, a claim he has denied.
Dr. Wachter explains why Congress might hold up hospitalist Vivek Murthy’s nomination to be next U.S. Surgeon General.
Dr. Wellikson added that when lobbying for continued changes to healthcare rules, SHM tries to focus on providing assistance, not asking for handouts. That will likely be a big focus next year, as the annual meeting returns to a suburb of Washington, D.C., with an expectation that hundreds of hospitalists will participate in the “Hospitalists on the Hill” advocacy event.
“We never go to Washington and ask for more power for hospitals or more money for hospitalists,” Dr. Wellikson said. “When we go to Washington, we say, ‘Things are changing in the system. How can we be a part of that change?’
