Hospitalists Brace for Challenges of Health Care Reform

The health care reform law signed by President Obama last month clears the way for about 32 million previously uninsured Americans to get coverage in coming years, but the changes will bring new challenges for hospitalists, physicians told

“We have long supported efforts to expand health care coverage to all Americans, and in that respect, this legislation is a step in the right direction,” said Dr. Eric M. Siegal, chair of the Society of Hospital Medicine's public policy committee. “One cannot bring 30-plus million Americans into the system and expect costs to decrease if one doesn't also address the inefficiencies and perverse incentives that are driving health care costs ever higher.”

Dr. Alpesh Amin, executive director of the hospitalist program at University of California, Irvine, agreed. “It's going to make the hospitalists much busier,” he said in an interview. “Volume is going to go up,” and that could pose a problem for a specialty facing a shortage of physicians available to fill existing positions.

Although health care reform includes a Medicare payment incentive designed to bolster the supply of primary care physicians, hospitalists will not be eligible for those bonuses, Dr. Siegal noted. Only services rendered in the ambulatory and nursing home setting will qualify.

Another concern: The new law does not address the sustainable growth rate formula that is used to adjust physician Medicare payments and that many physicians see as flawed. Under the formula, Medicare physicians' fees were cut 21% on April 1 as Congress—which has postponed but not eliminated the cuts for several years—adjourned for a spring recess without acting on the SGR. At press time, the Centers for Medicare and Medicaid Services (CMS) was holding Medicare claims for 10 business days until Congress could reconvene and address the issue, probably on a temporary basis.

“This is simply unacceptable,” Dr. Siegal said. “If the government expects physicians to dramatically alter the way that we practice to deliver better health care, the absolute minimum that we should expect in return is a stable and predictable reimbursement methodology.”

Hospitalists could benefit from continuation of the Physician Quality Reporting Initiative. PQRI participants stand to receive incentive payments of 1% in 2011 and 0.5% from 2012 to 2014. Physicians who don't participate will be penalized starting in 2015. “The PQRI looks like it is here to stay,” Dr. Siegal said. “We know that less than 20% of physicians currently participate, and hospitalists will obviously need to gear up to participate if they want to avoid being penalized.”

Other benefits of the reform law relate to the discharge process, Dr. Amin said. “As a hospitalist, I'm discharging patients out of the hospital who may not have any good follow-up,” he said. “And when they don't have good follow-up because they don't have insurance, there's a higher chance of readmission.”

Discharge without follow-up could become much less likely once an additional 32 million Americans get health insurance, he said. “If there's follow-up available, that's a wonderful thing. We'll be able to feel comfortable about putting patients back out in their community.”

Dr. Patrick Conway, director of hospital medicine at Cincinnati Children's Hospital, agreed. “Decreasing the number of uninsured will benefit most hospitals and hospitalists,” said Dr. Conway, a former chief medical officer at the Department of Health and Human Services (HHS).

Hospitalists will see more hospital-based demonstration projects focusing on quality, value, and comparative effectiveness research, he predicted. Also, a new Center for Medicare and Medicaid Innovation within CMS will test novel payment methodologies aimed at improving quality and reducing costs. “Hospitalists will play key roles in many of these programs,” Dr. Conway said.

The health care reform law also aims to bring transparency to relationships between pharmaceutical companies and physicians and hospitals. Under the incorporated Physician Payments Sunshine Act, sponsored by Sen. Chuck Grassley (R-Iowa) and Sen. Herb Kohl (D-Wis.), makers of medical supplies, pharmaceuticals, biologics, and devices must report any payments or transfers worth more than $100 a year that go to physicians and hospitals, starting in 2013. Manufacturers also will have to report any and all physician ownership stakes. The HHS will be required to make this information available to the public.

Also, starting in 2012, manufacturers will have to report to the HHS all drug samples given to physicians, if the drugs are covered by Medicare or Medicaid.

Finally, the reforms establish an Independent Payment Advisory Board, which will recommend Medicare spending reductions whenever annual spending on Medicare exceeds a yet-to-be determined rate. Precise details about how this board will function remain to be addressed via federal regulation.

According to Dr. Siegal, that's no surprise. “A lot of the implementation of these bills is subject to interpretation by CMS,” he noted. “The next 12-18 months will be phenomenally busy as CMS struggles to turn 2,000-plus pages of legislation into actionable statutes.”

He added that “it will be absolutely critical for hospital medicine to be represented in this process, and for us to lend our expertise to ensure that we get the outcomes that are intended. Only then will we really know if the bills are likely to deliver.”

The health care reform law signed by President Obama last month clears the way for about 32 million previously uninsured Americans to get coverage in coming years, but the changes will bring new challenges for hospitalists, physicians told

“We have long supported efforts to expand health care coverage to all Americans, and in that respect, this legislation is a step in the right direction,” said Dr. Eric M. Siegal, chair of the Society of Hospital Medicine's public policy committee. “One cannot bring 30-plus million Americans into the system and expect costs to decrease if one doesn't also address the inefficiencies and perverse incentives that are driving health care costs ever higher.”

Dr. Alpesh Amin, executive director of the hospitalist program at University of California, Irvine, agreed. “It's going to make the hospitalists much busier,” he said in an interview. “Volume is going to go up,” and that could pose a problem for a specialty facing a shortage of physicians available to fill existing positions.

Although health care reform includes a Medicare payment incentive designed to bolster the supply of primary care physicians, hospitalists will not be eligible for those bonuses, Dr. Siegal noted. Only services rendered in the ambulatory and nursing home setting will qualify.

Another concern: The new law does not address the sustainable growth rate formula that is used to adjust physician Medicare payments and that many physicians see as flawed. Under the formula, Medicare physicians' fees were cut 21% on April 1 as Congress—which has postponed but not eliminated the cuts for several years—adjourned for a spring recess without acting on the SGR. At press time, the Centers for Medicare and Medicaid Services (CMS) was holding Medicare claims for 10 business days until Congress could reconvene and address the issue, probably on a temporary basis.

“This is simply unacceptable,” Dr. Siegal said. “If the government expects physicians to dramatically alter the way that we practice to deliver better health care, the absolute minimum that we should expect in return is a stable and predictable reimbursement methodology.”

Hospitalists could benefit from continuation of the Physician Quality Reporting Initiative. PQRI participants stand to receive incentive payments of 1% in 2011 and 0.5% from 2012 to 2014. Physicians who don't participate will be penalized starting in 2015. “The PQRI looks like it is here to stay,” Dr. Siegal said. “We know that less than 20% of physicians currently participate, and hospitalists will obviously need to gear up to participate if they want to avoid being penalized.”

Other benefits of the reform law relate to the discharge process, Dr. Amin said. “As a hospitalist, I'm discharging patients out of the hospital who may not have any good follow-up,” he said. “And when they don't have good follow-up because they don't have insurance, there's a higher chance of readmission.”

Discharge without follow-up could become much less likely once an additional 32 million Americans get health insurance, he said. “If there's follow-up available, that's a wonderful thing. We'll be able to feel comfortable about putting patients back out in their community.”

Dr. Patrick Conway, director of hospital medicine at Cincinnati Children's Hospital, agreed. “Decreasing the number of uninsured will benefit most hospitals and hospitalists,” said Dr. Conway, a former chief medical officer at the Department of Health and Human Services (HHS).

Hospitalists will see more hospital-based demonstration projects focusing on quality, value, and comparative effectiveness research, he predicted. Also, a new Center for Medicare and Medicaid Innovation within CMS will test novel payment methodologies aimed at improving quality and reducing costs. “Hospitalists will play key roles in many of these programs,” Dr. Conway said.

The health care reform law also aims to bring transparency to relationships between pharmaceutical companies and physicians and hospitals. Under the incorporated Physician Payments Sunshine Act, sponsored by Sen. Chuck Grassley (R-Iowa) and Sen. Herb Kohl (D-Wis.), makers of medical supplies, pharmaceuticals, biologics, and devices must report any payments or transfers worth more than $100 a year that go to physicians and hospitals, starting in 2013. Manufacturers also will have to report any and all physician ownership stakes. The HHS will be required to make this information available to the public.

Also, starting in 2012, manufacturers will have to report to the HHS all drug samples given to physicians, if the drugs are covered by Medicare or Medicaid.

Finally, the reforms establish an Independent Payment Advisory Board, which will recommend Medicare spending reductions whenever annual spending on Medicare exceeds a yet-to-be determined rate. Precise details about how this board will function remain to be addressed via federal regulation.

According to Dr. Siegal, that's no surprise. “A lot of the implementation of these bills is subject to interpretation by CMS,” he noted. “The next 12-18 months will be phenomenally busy as CMS struggles to turn 2,000-plus pages of legislation into actionable statutes.”

He added that “it will be absolutely critical for hospital medicine to be represented in this process, and for us to lend our expertise to ensure that we get the outcomes that are intended. Only then will we really know if the bills are likely to deliver.”

The health care reform law signed by President Obama last month clears the way for about 32 million previously uninsured Americans to get coverage in coming years, but the changes will bring new challenges for hospitalists, physicians told

“We have long supported efforts to expand health care coverage to all Americans, and in that respect, this legislation is a step in the right direction,” said Dr. Eric M. Siegal, chair of the Society of Hospital Medicine's public policy committee. “One cannot bring 30-plus million Americans into the system and expect costs to decrease if one doesn't also address the inefficiencies and perverse incentives that are driving health care costs ever higher.”

Dr. Alpesh Amin, executive director of the hospitalist program at University of California, Irvine, agreed. “It's going to make the hospitalists much busier,” he said in an interview. “Volume is going to go up,” and that could pose a problem for a specialty facing a shortage of physicians available to fill existing positions.

Although health care reform includes a Medicare payment incentive designed to bolster the supply of primary care physicians, hospitalists will not be eligible for those bonuses, Dr. Siegal noted. Only services rendered in the ambulatory and nursing home setting will qualify.

Another concern: The new law does not address the sustainable growth rate formula that is used to adjust physician Medicare payments and that many physicians see as flawed. Under the formula, Medicare physicians' fees were cut 21% on April 1 as Congress—which has postponed but not eliminated the cuts for several years—adjourned for a spring recess without acting on the SGR. At press time, the Centers for Medicare and Medicaid Services (CMS) was holding Medicare claims for 10 business days until Congress could reconvene and address the issue, probably on a temporary basis.

“This is simply unacceptable,” Dr. Siegal said. “If the government expects physicians to dramatically alter the way that we practice to deliver better health care, the absolute minimum that we should expect in return is a stable and predictable reimbursement methodology.”

Hospitalists could benefit from continuation of the Physician Quality Reporting Initiative. PQRI participants stand to receive incentive payments of 1% in 2011 and 0.5% from 2012 to 2014. Physicians who don't participate will be penalized starting in 2015. “The PQRI looks like it is here to stay,” Dr. Siegal said. “We know that less than 20% of physicians currently participate, and hospitalists will obviously need to gear up to participate if they want to avoid being penalized.”

Other benefits of the reform law relate to the discharge process, Dr. Amin said. “As a hospitalist, I'm discharging patients out of the hospital who may not have any good follow-up,” he said. “And when they don't have good follow-up because they don't have insurance, there's a higher chance of readmission.”

Discharge without follow-up could become much less likely once an additional 32 million Americans get health insurance, he said. “If there's follow-up available, that's a wonderful thing. We'll be able to feel comfortable about putting patients back out in their community.”

Dr. Patrick Conway, director of hospital medicine at Cincinnati Children's Hospital, agreed. “Decreasing the number of uninsured will benefit most hospitals and hospitalists,” said Dr. Conway, a former chief medical officer at the Department of Health and Human Services (HHS).

Hospitalists will see more hospital-based demonstration projects focusing on quality, value, and comparative effectiveness research, he predicted. Also, a new Center for Medicare and Medicaid Innovation within CMS will test novel payment methodologies aimed at improving quality and reducing costs. “Hospitalists will play key roles in many of these programs,” Dr. Conway said.

The health care reform law also aims to bring transparency to relationships between pharmaceutical companies and physicians and hospitals. Under the incorporated Physician Payments Sunshine Act, sponsored by Sen. Chuck Grassley (R-Iowa) and Sen. Herb Kohl (D-Wis.), makers of medical supplies, pharmaceuticals, biologics, and devices must report any payments or transfers worth more than $100 a year that go to physicians and hospitals, starting in 2013. Manufacturers also will have to report any and all physician ownership stakes. The HHS will be required to make this information available to the public.

Also, starting in 2012, manufacturers will have to report to the HHS all drug samples given to physicians, if the drugs are covered by Medicare or Medicaid.

Finally, the reforms establish an Independent Payment Advisory Board, which will recommend Medicare spending reductions whenever annual spending on Medicare exceeds a yet-to-be determined rate. Precise details about how this board will function remain to be addressed via federal regulation.

According to Dr. Siegal, that's no surprise. “A lot of the implementation of these bills is subject to interpretation by CMS,” he noted. “The next 12-18 months will be phenomenally busy as CMS struggles to turn 2,000-plus pages of legislation into actionable statutes.”

He added that “it will be absolutely critical for hospital medicine to be represented in this process, and for us to lend our expertise to ensure that we get the outcomes that are intended. Only then will we really know if the bills are likely to deliver.”