Public Policy

HM15 Presenters: Roy Sittig MD SFHM, Jeffrey Frank MD MBA, Jodi Braun

Summation: Speakers covered timely topics regarding the Accountable Care Act, namely Medicaid Expansion and Bundled Payment arrangements; and reviewed the seminal paper on “Key Principals and Characteristics of an Effective Hospitalist Medicine Group” and lessons learned in implementing those 10 Key Principles.

Medicaid Expansion: EDs serving the 29 Medicaid expansion states are reporting higher volumes, likely due to 11.4million new lives now insured under the ACA. While the ACA does provide for higher Medicaid payment rates thus far, only 34% of providers accept Medicaid, a 21% drop since the ACA went into effect.

Bundled Payment Arrangements:

• Bundled Payment Care Initiative (BPCI) lexicon:

  • Model 2-Episode Anchor (anchor admission) AND 90days post d/c; Medicare pays 98% of usual cost
  • Model 3-90days post d/c AFTER anchor admission; Medicare pays 97% of usual cost
  • Convener-entity that brings providers together and enters into CMS agreement to bear risk for bundles
  • Awardee (entity having agreement with Medicare to assume risk and receive payment via BPCI) and Convener own the Bundle
  • Episode initiator (EI) triggers “bundle period”
  • Bundles based on DRG

10-Key Principles of an Effective Hospitalist Medicine Group:

1. Effective Leadership
2. Engaged Hospitalists
3. Adequate Resources
4. Planning and Management Infrastructure
5. Alignment with Hospital/Health System
6. Care Coordination Across Settings
7. Leadership in Key Clinical Issues in the Hospital/Health System
8. Thoughtful Approach to Scope of Activity
9. Patient/Family-Centered, Team-Based Care; Effective Communication
10. Recruiting/Retaining Qualified Clinicians

Key Points/HM Takeaways:

Medicaid Expansion- many of the 11.4M newly insured lives under the ACA have moved into Medicaid. Only about 1/3 of providers now accept Medicaid- 1 in 5 covered persons now have Medicaid, nearly 20% increase since 2013.

Bundled Payments- Majority of savings opportunity lies in Post-Acute Care. Awardee and Convener make profit is total cost is less than 98% of Target Price. In gainsharing agreements individuals can be reimbursed up to 150% usual Medicare rate. Pay occurs in usual Medicare fashion but is reconciled 60-90 days after end of bundle. For more information: http://innovation.cms.gov/initiatives/bundled-payments/

Effective HM Groups- Three important areas for focus when beginning to address group performance are: engaged hospitalists, planning and management infrastructure, care coordination across settings. These three topics have broad reaching implications into the hospitalist practice and patient care. [Cawley P, et al. Journal of Hospital Medicine 2014; 9(2):123-128]

HM15 Presenters: Roy Sittig MD SFHM, Jeffrey Frank MD MBA, Jodi Braun

Summation: Speakers covered timely topics regarding the Accountable Care Act, namely Medicaid Expansion and Bundled Payment arrangements; and reviewed the seminal paper on “Key Principals and Characteristics of an Effective Hospitalist Medicine Group” and lessons learned in implementing those 10 Key Principles.

Medicaid Expansion: EDs serving the 29 Medicaid expansion states are reporting higher volumes, likely due to 11.4million new lives now insured under the ACA. While the ACA does provide for higher Medicaid payment rates thus far, only 34% of providers accept Medicaid, a 21% drop since the ACA went into effect.

Bundled Payment Arrangements:

• Bundled Payment Care Initiative (BPCI) lexicon:

  • Model 2-Episode Anchor (anchor admission) AND 90days post d/c; Medicare pays 98% of usual cost
  • Model 3-90days post d/c AFTER anchor admission; Medicare pays 97% of usual cost
  • Convener-entity that brings providers together and enters into CMS agreement to bear risk for bundles
  • Awardee (entity having agreement with Medicare to assume risk and receive payment via BPCI) and Convener own the Bundle
  • Episode initiator (EI) triggers “bundle period”
  • Bundles based on DRG

10-Key Principles of an Effective Hospitalist Medicine Group:

1. Effective Leadership
2. Engaged Hospitalists
3. Adequate Resources
4. Planning and Management Infrastructure
5. Alignment with Hospital/Health System
6. Care Coordination Across Settings
7. Leadership in Key Clinical Issues in the Hospital/Health System
8. Thoughtful Approach to Scope of Activity
9. Patient/Family-Centered, Team-Based Care; Effective Communication
10. Recruiting/Retaining Qualified Clinicians

Key Points/HM Takeaways:

Medicaid Expansion- many of the 11.4M newly insured lives under the ACA have moved into Medicaid. Only about 1/3 of providers now accept Medicaid- 1 in 5 covered persons now have Medicaid, nearly 20% increase since 2013.

Bundled Payments- Majority of savings opportunity lies in Post-Acute Care. Awardee and Convener make profit is total cost is less than 98% of Target Price. In gainsharing agreements individuals can be reimbursed up to 150% usual Medicare rate. Pay occurs in usual Medicare fashion but is reconciled 60-90 days after end of bundle. For more information: http://innovation.cms.gov/initiatives/bundled-payments/

Effective HM Groups- Three important areas for focus when beginning to address group performance are: engaged hospitalists, planning and management infrastructure, care coordination across settings. These three topics have broad reaching implications into the hospitalist practice and patient care. [Cawley P, et al. Journal of Hospital Medicine 2014; 9(2):123-128]

HM15 Presenters: Roy Sittig MD SFHM, Jeffrey Frank MD MBA, Jodi Braun

Summation: Speakers covered timely topics regarding the Accountable Care Act, namely Medicaid Expansion and Bundled Payment arrangements; and reviewed the seminal paper on “Key Principals and Characteristics of an Effective Hospitalist Medicine Group” and lessons learned in implementing those 10 Key Principles.

Medicaid Expansion: EDs serving the 29 Medicaid expansion states are reporting higher volumes, likely due to 11.4million new lives now insured under the ACA. While the ACA does provide for higher Medicaid payment rates thus far, only 34% of providers accept Medicaid, a 21% drop since the ACA went into effect.

Bundled Payment Arrangements:

• Bundled Payment Care Initiative (BPCI) lexicon:

  • Model 2-Episode Anchor (anchor admission) AND 90days post d/c; Medicare pays 98% of usual cost
  • Model 3-90days post d/c AFTER anchor admission; Medicare pays 97% of usual cost
  • Convener-entity that brings providers together and enters into CMS agreement to bear risk for bundles
  • Awardee (entity having agreement with Medicare to assume risk and receive payment via BPCI) and Convener own the Bundle
  • Episode initiator (EI) triggers “bundle period”
  • Bundles based on DRG

10-Key Principles of an Effective Hospitalist Medicine Group:

1. Effective Leadership
2. Engaged Hospitalists
3. Adequate Resources
4. Planning and Management Infrastructure
5. Alignment with Hospital/Health System
6. Care Coordination Across Settings
7. Leadership in Key Clinical Issues in the Hospital/Health System
8. Thoughtful Approach to Scope of Activity
9. Patient/Family-Centered, Team-Based Care; Effective Communication
10. Recruiting/Retaining Qualified Clinicians

Key Points/HM Takeaways:

Medicaid Expansion- many of the 11.4M newly insured lives under the ACA have moved into Medicaid. Only about 1/3 of providers now accept Medicaid- 1 in 5 covered persons now have Medicaid, nearly 20% increase since 2013.

Bundled Payments- Majority of savings opportunity lies in Post-Acute Care. Awardee and Convener make profit is total cost is less than 98% of Target Price. In gainsharing agreements individuals can be reimbursed up to 150% usual Medicare rate. Pay occurs in usual Medicare fashion but is reconciled 60-90 days after end of bundle. For more information: http://innovation.cms.gov/initiatives/bundled-payments/

Effective HM Groups- Three important areas for focus when beginning to address group performance are: engaged hospitalists, planning and management infrastructure, care coordination across settings. These three topics have broad reaching implications into the hospitalist practice and patient care. [Cawley P, et al. Journal of Hospital Medicine 2014; 9(2):123-128]

In the article “Common Coding Mistakes Hospitalists Should Avoid” in the August 2014 issue of The Hospitalist, the author states:

“For inpatient care, an established problem is defined as one in which a care plan has been generated by the physician (or same specialty group practice member) during the current hospitalization.”

This definition contradicts what I have been told in other coding courses regarding new vs. established problems relative to the examiner. It has been my understanding that when [I am] rotating on service and I have not seen that particular patient during the current admission, all of the current problems are new to me, even if previously identified by another member of my group. This [situation] results in a higher complexity of medical decision-making, which is reflective of the increased time spent learning a new patient when coming on service. I would appreciate clarification from the author.

–Matt George, MD,

medical director, MBHS Hospitalists

Billing and coding expert Carol Pohlig, BSN, RN, CPC, ACS, explains:

Be mindful when attending coding courses that are not contractor sponsored, as they may not validate the geographical interpretations of the rules for providers. There are several factors to consider when crediting the physician with “new” or “established” problems.

CMS documentation guidelines state: “Decision making with respect to a diagnosed problem is easier than that for an identified but undiagnosed problem.¹

• For a presenting problem with an established diagnosis, the record should reflect whether the problem is:

  • Improved, well-controlled, resolving, or resolved or
  • Inadequately controlled, worsening, or failing to change as expected.

• For a presenting problem without an established diagnosis, the assessment or clinical impression may be stated in the form of differential diagnoses or as a “possible,” “probable,” or “rule out” diagnosis.

Although Medicare contractors utilize the Marshfield Clinic Scoring Tool when reviewing evaluation and management (E/M) services, a tool that historically refers to the “examiner” when considering the patient’s diagnoses, not all accept this tool-inspired standard, particularly in the advent of electronic health record accessibility and the idea that same-specialty physicians in a group practice are viewed as an individual physician.^2,3

Reviewing information and familiarization of patients is often considered pre-service work and factored into the payment for E/M services. More importantly, the feasibility of an auditor being able to distinguish new vs. established problems at the level of the “examiner” is decreased when auditing a single date of service. Non-Medicare payers who audit E/M services do not necessarily follow contractor-specific guidelines but, rather, general CMS guidelines.

Therefore, without knowing the insurer or their interpretation at the time of service or visit level selection, the CMS-developed standard is the most practical application when considering the complexity of the encounter.

References

1. Centers for Medicare and Medicaid Services. Department of Health and Human Services. Evaluation and management services guide. Available at: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads//eval_mgmt_serv_guide-ICN006764.pdf. Accessed November 13, 2014.
2. National Government Services. Evaluation and management documentation training too. Available at: http://www.ngsmedicare.com/ngs/wcm/connect/3632a905-b697-4266-8fc0-2aa2a84fedb2/1074_0514_EM_Documentation_Training_Tool_508.pdf?MOD=AJPERES. Accessed November 13, 2014.
3. Centers for Medicare and Medicaid Services. Medicare Claims Processing Manual. Chapter 12 – Physicians/nonphysician practitioners. Available at: http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf. Accessed November 13, 2014.

In the article “Common Coding Mistakes Hospitalists Should Avoid” in the August 2014 issue of The Hospitalist, the author states:

“For inpatient care, an established problem is defined as one in which a care plan has been generated by the physician (or same specialty group practice member) during the current hospitalization.”

This definition contradicts what I have been told in other coding courses regarding new vs. established problems relative to the examiner. It has been my understanding that when [I am] rotating on service and I have not seen that particular patient during the current admission, all of the current problems are new to me, even if previously identified by another member of my group. This [situation] results in a higher complexity of medical decision-making, which is reflective of the increased time spent learning a new patient when coming on service. I would appreciate clarification from the author.

–Matt George, MD,

medical director, MBHS Hospitalists

Billing and coding expert Carol Pohlig, BSN, RN, CPC, ACS, explains:

Be mindful when attending coding courses that are not contractor sponsored, as they may not validate the geographical interpretations of the rules for providers. There are several factors to consider when crediting the physician with “new” or “established” problems.

CMS documentation guidelines state: “Decision making with respect to a diagnosed problem is easier than that for an identified but undiagnosed problem.¹

• For a presenting problem with an established diagnosis, the record should reflect whether the problem is:

  • Improved, well-controlled, resolving, or resolved or
  • Inadequately controlled, worsening, or failing to change as expected.

• For a presenting problem without an established diagnosis, the assessment or clinical impression may be stated in the form of differential diagnoses or as a “possible,” “probable,” or “rule out” diagnosis.

Although Medicare contractors utilize the Marshfield Clinic Scoring Tool when reviewing evaluation and management (E/M) services, a tool that historically refers to the “examiner” when considering the patient’s diagnoses, not all accept this tool-inspired standard, particularly in the advent of electronic health record accessibility and the idea that same-specialty physicians in a group practice are viewed as an individual physician.^2,3

Reviewing information and familiarization of patients is often considered pre-service work and factored into the payment for E/M services. More importantly, the feasibility of an auditor being able to distinguish new vs. established problems at the level of the “examiner” is decreased when auditing a single date of service. Non-Medicare payers who audit E/M services do not necessarily follow contractor-specific guidelines but, rather, general CMS guidelines.

Therefore, without knowing the insurer or their interpretation at the time of service or visit level selection, the CMS-developed standard is the most practical application when considering the complexity of the encounter.

References

1. Centers for Medicare and Medicaid Services. Department of Health and Human Services. Evaluation and management services guide. Available at: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads//eval_mgmt_serv_guide-ICN006764.pdf. Accessed November 13, 2014.
2. National Government Services. Evaluation and management documentation training too. Available at: http://www.ngsmedicare.com/ngs/wcm/connect/3632a905-b697-4266-8fc0-2aa2a84fedb2/1074_0514_EM_Documentation_Training_Tool_508.pdf?MOD=AJPERES. Accessed November 13, 2014.
3. Centers for Medicare and Medicaid Services. Medicare Claims Processing Manual. Chapter 12 – Physicians/nonphysician practitioners. Available at: http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf. Accessed November 13, 2014.

In the article “Common Coding Mistakes Hospitalists Should Avoid” in the August 2014 issue of The Hospitalist, the author states:

“For inpatient care, an established problem is defined as one in which a care plan has been generated by the physician (or same specialty group practice member) during the current hospitalization.”

This definition contradicts what I have been told in other coding courses regarding new vs. established problems relative to the examiner. It has been my understanding that when [I am] rotating on service and I have not seen that particular patient during the current admission, all of the current problems are new to me, even if previously identified by another member of my group. This [situation] results in a higher complexity of medical decision-making, which is reflective of the increased time spent learning a new patient when coming on service. I would appreciate clarification from the author.

–Matt George, MD,

medical director, MBHS Hospitalists

Billing and coding expert Carol Pohlig, BSN, RN, CPC, ACS, explains:

Be mindful when attending coding courses that are not contractor sponsored, as they may not validate the geographical interpretations of the rules for providers. There are several factors to consider when crediting the physician with “new” or “established” problems.

CMS documentation guidelines state: “Decision making with respect to a diagnosed problem is easier than that for an identified but undiagnosed problem.¹

• For a presenting problem with an established diagnosis, the record should reflect whether the problem is:

  • Improved, well-controlled, resolving, or resolved or
  • Inadequately controlled, worsening, or failing to change as expected.

• For a presenting problem without an established diagnosis, the assessment or clinical impression may be stated in the form of differential diagnoses or as a “possible,” “probable,” or “rule out” diagnosis.

Although Medicare contractors utilize the Marshfield Clinic Scoring Tool when reviewing evaluation and management (E/M) services, a tool that historically refers to the “examiner” when considering the patient’s diagnoses, not all accept this tool-inspired standard, particularly in the advent of electronic health record accessibility and the idea that same-specialty physicians in a group practice are viewed as an individual physician.^2,3

Reviewing information and familiarization of patients is often considered pre-service work and factored into the payment for E/M services. More importantly, the feasibility of an auditor being able to distinguish new vs. established problems at the level of the “examiner” is decreased when auditing a single date of service. Non-Medicare payers who audit E/M services do not necessarily follow contractor-specific guidelines but, rather, general CMS guidelines.

Therefore, without knowing the insurer or their interpretation at the time of service or visit level selection, the CMS-developed standard is the most practical application when considering the complexity of the encounter.

References

1. Centers for Medicare and Medicaid Services. Department of Health and Human Services. Evaluation and management services guide. Available at: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads//eval_mgmt_serv_guide-ICN006764.pdf. Accessed November 13, 2014.
2. National Government Services. Evaluation and management documentation training too. Available at: http://www.ngsmedicare.com/ngs/wcm/connect/3632a905-b697-4266-8fc0-2aa2a84fedb2/1074_0514_EM_Documentation_Training_Tool_508.pdf?MOD=AJPERES. Accessed November 13, 2014.
3. Centers for Medicare and Medicaid Services. Medicare Claims Processing Manual. Chapter 12 – Physicians/nonphysician practitioners. Available at: http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c12.pdf. Accessed November 13, 2014.

Editor’s note: First of a two-part series examining bundled payments and hospital medicine. Additionally, Dr. Whitcomb works for a company that is an Awardee Convener in the CMS Bundled Payments for Care Improvement (BPCI) Initiative.

The Centers for Medicare and Medicaid Services’ (CMS) bundled payment initiative was announced in August 2011 and has been “live” since October 2013, when a handful of healthcare systems launched bundled payment programs. In 2014, the CMS initiative grew substantially as a result of large-scale interest on the part of hospitals, physician groups, skilled nursing facilities (SNFs), and others in testing the model, which can be described as a single payment for an episode of care.

The BPCI initiative will be a large-scale program by July 1; it starts with an April 1 cohort launch and will result in the program’s presence in all 50 states, with hundreds of physician practices and hospitals participating. The 2015 cohort will involve a large number of hospitalist practices, participating as “episode initiators” that bear clinical and economic responsibility for the bundle, or as “gainsharers” who are eligible to receive incentive payments if they can reduce costs while maintaining measurable quality for an episode of care.

How Does Bundled Payment Work?

The BPCI initiative is a large-scale, three- to five-year demonstration to test bundled payment in patients with fee-for-service Medicare. The most common model, referred to as Model 2, involves an inpatient hospitalization for one of 48 defined episodes, which include both medical and surgical conditions, followed by a recovery period lasting 30, 60, or 90 days.

Each hospital or physician practice that is considering entering the BPCI program receives prices for all 48 episodes based on a 2009-2012 historical average of Medicare part A and B claims associated with that hospital or physician group. After analyzing those prices, the hospital or physician practice may elect to choose the bundles that have a good chance of being successful—where actual spending comes in under the historical target price—based on care improvement expectations in their local system. In Model 2, CMS takes 2% off the target price for 90-day episodes and 3% off the target price for 30- and 60-day episodes, making it all the more important to choose bundles that demonstrate a high likelihood of success.

The revenue cycle for hospitals and physicians in the program does not change. They submit claims for their services and receive reimbursement as they always have; however, after the end of each quarter, when the majority of part A and B claims have been processed, a “look back” at actual spending for all participating episodes is reconciled against the baseline price derived from 2009-2012. If there is a net savings compared to the baseline, monies can be distributed to the participating providers—the hospital or physician practice—and those providers may further share some of the savings with other physicians/providers who have signed a gainsharing contract.

Hospitalists and BPCI

Hospitalist practices participate in the CMS program either as episode initiators or gainsharers. As episode initiators, they “own” the bundle, which means they bear economic risk for the program. In this capacity, overall savings will mean the hospitalist practice has a new revenue stream, which could be substantial; however, the practice is also responsible for any losses.

Other hospitalist practices have become gainsharers in the program, which means they have signed an agreement enabling them to receive payments in addition to professional fee revenues for activities that reduce costs while maintaining or improving quality. Such activities are referred to as “care redesign” in the program. Gainsharers do not bear financial risk.

Where Will Savings Come From?

Perhaps ironically for hospitalists, the main source of savings in the BPCI program comes from post-acute care and readmissions. For example, for common conditions like heart failure, COPD, and pneumonia, Medicare spends almost as much on post-acute care and readmissions in the first 30 days after discharge as it does on the index hospitalization.¹ As a result, the BPCI program adds further emphasis on preventing readmissions when added to existing pressures, and there is a new premium placed on “right-sizing” the usage of SNF and other post-acute facilities, such as inpatient rehabilitation and long-term acute care hospitals. For hospitalists, this means that new rigor is needed to connect to the post-acute setting, such as determining why a patient is being discharged to a skilled facility.

Another savings pool, called “internal cost savings,” is available to reward decreasing inpatient utilization from, for example, testing, imaging, and implantable devices.

Conclusion

Bundled payment might be the biggest thing to come along for hospitalists since the patient safety movement launched some 16 years ago. Why? Although accountable care organizations have largely focused on ambulatory practice, bundled payment has a major focus on hospital care and on the post-acute care decisions that are made during the hospitalization. If bundled payment proves to be an effective way to pay for—and organize—care, hospitalists will play a central role in the success of this innovation.

In part two of this series, I will explore specific roles hospitalists play in successful bundled payment programs.

Reference

1. Mechanic R. Post-acute care: the next frontier for controlling Medicare spending. N Engl J Med. 2014;370(8):692-694.

Editor’s note: First of a two-part series examining bundled payments and hospital medicine. Additionally, Dr. Whitcomb works for a company that is an Awardee Convener in the CMS Bundled Payments for Care Improvement (BPCI) Initiative.

The Centers for Medicare and Medicaid Services’ (CMS) bundled payment initiative was announced in August 2011 and has been “live” since October 2013, when a handful of healthcare systems launched bundled payment programs. In 2014, the CMS initiative grew substantially as a result of large-scale interest on the part of hospitals, physician groups, skilled nursing facilities (SNFs), and others in testing the model, which can be described as a single payment for an episode of care.

The BPCI initiative will be a large-scale program by July 1; it starts with an April 1 cohort launch and will result in the program’s presence in all 50 states, with hundreds of physician practices and hospitals participating. The 2015 cohort will involve a large number of hospitalist practices, participating as “episode initiators” that bear clinical and economic responsibility for the bundle, or as “gainsharers” who are eligible to receive incentive payments if they can reduce costs while maintaining measurable quality for an episode of care.

How Does Bundled Payment Work?

The BPCI initiative is a large-scale, three- to five-year demonstration to test bundled payment in patients with fee-for-service Medicare. The most common model, referred to as Model 2, involves an inpatient hospitalization for one of 48 defined episodes, which include both medical and surgical conditions, followed by a recovery period lasting 30, 60, or 90 days.

Each hospital or physician practice that is considering entering the BPCI program receives prices for all 48 episodes based on a 2009-2012 historical average of Medicare part A and B claims associated with that hospital or physician group. After analyzing those prices, the hospital or physician practice may elect to choose the bundles that have a good chance of being successful—where actual spending comes in under the historical target price—based on care improvement expectations in their local system. In Model 2, CMS takes 2% off the target price for 90-day episodes and 3% off the target price for 30- and 60-day episodes, making it all the more important to choose bundles that demonstrate a high likelihood of success.

The revenue cycle for hospitals and physicians in the program does not change. They submit claims for their services and receive reimbursement as they always have; however, after the end of each quarter, when the majority of part A and B claims have been processed, a “look back” at actual spending for all participating episodes is reconciled against the baseline price derived from 2009-2012. If there is a net savings compared to the baseline, monies can be distributed to the participating providers—the hospital or physician practice—and those providers may further share some of the savings with other physicians/providers who have signed a gainsharing contract.

Hospitalists and BPCI

Hospitalist practices participate in the CMS program either as episode initiators or gainsharers. As episode initiators, they “own” the bundle, which means they bear economic risk for the program. In this capacity, overall savings will mean the hospitalist practice has a new revenue stream, which could be substantial; however, the practice is also responsible for any losses.

Other hospitalist practices have become gainsharers in the program, which means they have signed an agreement enabling them to receive payments in addition to professional fee revenues for activities that reduce costs while maintaining or improving quality. Such activities are referred to as “care redesign” in the program. Gainsharers do not bear financial risk.

Where Will Savings Come From?

Perhaps ironically for hospitalists, the main source of savings in the BPCI program comes from post-acute care and readmissions. For example, for common conditions like heart failure, COPD, and pneumonia, Medicare spends almost as much on post-acute care and readmissions in the first 30 days after discharge as it does on the index hospitalization.¹ As a result, the BPCI program adds further emphasis on preventing readmissions when added to existing pressures, and there is a new premium placed on “right-sizing” the usage of SNF and other post-acute facilities, such as inpatient rehabilitation and long-term acute care hospitals. For hospitalists, this means that new rigor is needed to connect to the post-acute setting, such as determining why a patient is being discharged to a skilled facility.

Another savings pool, called “internal cost savings,” is available to reward decreasing inpatient utilization from, for example, testing, imaging, and implantable devices.

Conclusion

Bundled payment might be the biggest thing to come along for hospitalists since the patient safety movement launched some 16 years ago. Why? Although accountable care organizations have largely focused on ambulatory practice, bundled payment has a major focus on hospital care and on the post-acute care decisions that are made during the hospitalization. If bundled payment proves to be an effective way to pay for—and organize—care, hospitalists will play a central role in the success of this innovation.

In part two of this series, I will explore specific roles hospitalists play in successful bundled payment programs.

Reference

1. Mechanic R. Post-acute care: the next frontier for controlling Medicare spending. N Engl J Med. 2014;370(8):692-694.

Editor’s note: First of a two-part series examining bundled payments and hospital medicine. Additionally, Dr. Whitcomb works for a company that is an Awardee Convener in the CMS Bundled Payments for Care Improvement (BPCI) Initiative.

The Centers for Medicare and Medicaid Services’ (CMS) bundled payment initiative was announced in August 2011 and has been “live” since October 2013, when a handful of healthcare systems launched bundled payment programs. In 2014, the CMS initiative grew substantially as a result of large-scale interest on the part of hospitals, physician groups, skilled nursing facilities (SNFs), and others in testing the model, which can be described as a single payment for an episode of care.

The BPCI initiative will be a large-scale program by July 1; it starts with an April 1 cohort launch and will result in the program’s presence in all 50 states, with hundreds of physician practices and hospitals participating. The 2015 cohort will involve a large number of hospitalist practices, participating as “episode initiators” that bear clinical and economic responsibility for the bundle, or as “gainsharers” who are eligible to receive incentive payments if they can reduce costs while maintaining measurable quality for an episode of care.

How Does Bundled Payment Work?

The BPCI initiative is a large-scale, three- to five-year demonstration to test bundled payment in patients with fee-for-service Medicare. The most common model, referred to as Model 2, involves an inpatient hospitalization for one of 48 defined episodes, which include both medical and surgical conditions, followed by a recovery period lasting 30, 60, or 90 days.

Each hospital or physician practice that is considering entering the BPCI program receives prices for all 48 episodes based on a 2009-2012 historical average of Medicare part A and B claims associated with that hospital or physician group. After analyzing those prices, the hospital or physician practice may elect to choose the bundles that have a good chance of being successful—where actual spending comes in under the historical target price—based on care improvement expectations in their local system. In Model 2, CMS takes 2% off the target price for 90-day episodes and 3% off the target price for 30- and 60-day episodes, making it all the more important to choose bundles that demonstrate a high likelihood of success.

The revenue cycle for hospitals and physicians in the program does not change. They submit claims for their services and receive reimbursement as they always have; however, after the end of each quarter, when the majority of part A and B claims have been processed, a “look back” at actual spending for all participating episodes is reconciled against the baseline price derived from 2009-2012. If there is a net savings compared to the baseline, monies can be distributed to the participating providers—the hospital or physician practice—and those providers may further share some of the savings with other physicians/providers who have signed a gainsharing contract.

Hospitalists and BPCI

Hospitalist practices participate in the CMS program either as episode initiators or gainsharers. As episode initiators, they “own” the bundle, which means they bear economic risk for the program. In this capacity, overall savings will mean the hospitalist practice has a new revenue stream, which could be substantial; however, the practice is also responsible for any losses.

Other hospitalist practices have become gainsharers in the program, which means they have signed an agreement enabling them to receive payments in addition to professional fee revenues for activities that reduce costs while maintaining or improving quality. Such activities are referred to as “care redesign” in the program. Gainsharers do not bear financial risk.

Where Will Savings Come From?

Perhaps ironically for hospitalists, the main source of savings in the BPCI program comes from post-acute care and readmissions. For example, for common conditions like heart failure, COPD, and pneumonia, Medicare spends almost as much on post-acute care and readmissions in the first 30 days after discharge as it does on the index hospitalization.¹ As a result, the BPCI program adds further emphasis on preventing readmissions when added to existing pressures, and there is a new premium placed on “right-sizing” the usage of SNF and other post-acute facilities, such as inpatient rehabilitation and long-term acute care hospitals. For hospitalists, this means that new rigor is needed to connect to the post-acute setting, such as determining why a patient is being discharged to a skilled facility.

Another savings pool, called “internal cost savings,” is available to reward decreasing inpatient utilization from, for example, testing, imaging, and implantable devices.

Conclusion

Bundled payment might be the biggest thing to come along for hospitalists since the patient safety movement launched some 16 years ago. Why? Although accountable care organizations have largely focused on ambulatory practice, bundled payment has a major focus on hospital care and on the post-acute care decisions that are made during the hospitalization. If bundled payment proves to be an effective way to pay for—and organize—care, hospitalists will play a central role in the success of this innovation.

In part two of this series, I will explore specific roles hospitalists play in successful bundled payment programs.

Reference

1. Mechanic R. Post-acute care: the next frontier for controlling Medicare spending. N Engl J Med. 2014;370(8):692-694.

In late January, the Centers for Medicare and Medicaid Services (CMS) released the early results of two multi-year innovation projects focused on the creation of patient-centered medical homes (PCMHs).

Although PCMH models have been lauded as a way to achieve CMS’ triple aim —better quality patient care and improved health at a lower cost—little evidence currently backs up this claim. The latest reports show that PCMH interventions hold promise, but the jury is still out.

“I think, two to three years from now, we will be in a totally different position, in terms of a sound evidence base for policy,” says Mark Friedberg, MD, MPP, a practicing general internist and senior natural scientist for the RAND Corporation. “We know these very large CMS demonstrations are just starting to trickle in with year one results.”

Both the Comprehensive Primary Care (CPC) Initiative and the Multi-payer Advanced Primary Care Practice (MAPCP) are large, multi-year CMS demonstrations launched in 2012 and 2011, respectively, and the reports cover just their first 12 months. Although different in numerous ways, both projects aim to create better coordinated care that will in turn lower hospital admissions and ED visits, reduce duplications, enhance patient health through prevention, improve chronic disease management, and move away from a fee-for-service approach. They are just two of many experiments supported by the 10-year, $10 billion CMS Innovation Center.

In its first 12 months, the CPC focused on improving the care of high-risk patients in four states plus three separate regions of the U.S. It served 345,000 Medicare beneficiaries and roughly 2.5 million patients overall among nearly 500 primary care practices identified as likely to achieve meaningful results.

The evaluation, performed by policy research firm Mathematica, found that CPC cut hospital admissions by 2% and saw a 3% reduction in ED visits relative to similar practices not participating in the initiative, contributing to an overall $168 savings per Medicare beneficiary. It generated more than $70,000 in additional revenue per median practice clinician.¹

However, the Department of Health and Human Services (HHS) paid practices $240 per patient to cover the costs of establishing the medical home, including hiring nurses, improving electronic health records, and setting up 24-hour call lines. Thus, the initiative failed to offset its costs. Even so, Mathematica called the findings “promising” and “more favorable” than expected for the first year of the initiative, though it advised caution in interpreting the findings at this stage.

The MAPCP involved primary care initiatives in eight states, encompassing 3,800 providers across 700 practices; it touched 400,000 Medicare beneficiaries in its first year (today, it serves practices in just six states). Private payers and Medicaid also took part, leading to an estimated savings of $4.2 million, according to the initiative’s evaluators, RTI International and The Urban Institute.²

The demonstration realized a reduction in fee-for-service Medicare growth in Vermont and Michigan, largely resulting from lower inpatient expenditures, but did little to reduce hospitalizations, readmissions, or ED visits. Data collection and utilization were recurring challenges.

Dr. Friedberg says these first reports are akin to seeing the first few ships of the armada break the horizon. Last year, he was first author of a Journal of the American Medical Association study of a three-year PCMH intervention in Pennsylvania, Southeastern Pennsylvania’s Chronic Care Initiative, which also showed mixed results.³ He currently is part of a team evaluating the CMS Federally Qualified Health Center Advanced Primary Care Practice Demonstration, which concluded last October.

Although he has not yet seen an evaluation of a PCMH intervention involving hospitalists, Dr. Friedberg says it would be interesting to see the results of a rigorously studied pilot that involves such an evaluation. A 2012 article in The Hospitalist highlighted one project in Wisconsin and laid out ways in which hospitalists could be involved in PCMH initiatives—among them, being part of hospital admissions decision making and maintaining open lines of communication.⁴ Leaders of that project declined to comment at this time.

“The patient-centered medical home really is an outpatient strategy more than it is an inpatient strategy,” says Robert Centor, MD, MACP, an academic hospitalist at the University of Alabama Huntsville and chair of the Board of Regents of the American College of Physicians, yet he sees a role for hospitalists.

“If we start getting good results with patient-centered medical homes and more people go to the model, a relationship between the PCMH on the outpatient side and a cadre of people who know how to work the inpatient side is going to be critical to success,” Dr. Centor says.

Indeed, Dr. Friedberg says hospitalists’ involvement could be one of the “missing ingredients” that might contribute to the success of any given PCMH intervention, and he’s careful to emphasize there is no such thing as “the medical home.” Rather, there are “many medical homes,” he says.

Dr. Centor says hospitalists could serve as conduits between care inside the hospital and follow-up care, which could reduce length of stay for some patients and smooth the transition from discharge to primary care. A well-versed hospitalist with the PCMH might also assist in reducing repeat tests and procedures.

“I think it comes down to relationships more than anything else,” Dr. Centor says. “The challenge is, given all of the busyness of outpatient practice and inpatient care, how do we best communicate?”

Kelly April Tyrrell is a freelance writer in Madison, Wis.

References

1. Mathematica Policy Research. Evaluation of the Comprehensive Primary Care Initiative: first annual report. Reference number 40102.R14. Available at: http://innovation.cms.gov/Files/reports/CPCI-EvalRpt1.pdf. Accessed March 4, 2015.
2. RTI International. Evaluation of the multi-payer advanced primary care practice (MAPCP) demonstration: first annual report. RTI Project Number 0212790.005.001.001. Available at: http://innovation.cms.gov/Files/reports/MAPCP-EvalRpt1.pdf. Accessed March 4, 2015.
3. Friedberg MW, Schneider EC, Rosenthal MB, Volpp KG, Werner RM. Association between participation in a multipayer medical home intervention and changes in quality, utilization, and costs of care. JAMA. 2014;311(8):815-825.
4. Collins T. Patients should prepare for the patient-centered medical home. The Hospitalist. July 3, 2012. Available at: http://www.the-hospitalist.org/article/hospitalists-should-prepare-for-the-patient-centered-medical-home/. Accessed March 4, 2015.

In late January, the Centers for Medicare and Medicaid Services (CMS) released the early results of two multi-year innovation projects focused on the creation of patient-centered medical homes (PCMHs).

Although PCMH models have been lauded as a way to achieve CMS’ triple aim —better quality patient care and improved health at a lower cost—little evidence currently backs up this claim. The latest reports show that PCMH interventions hold promise, but the jury is still out.

“I think, two to three years from now, we will be in a totally different position, in terms of a sound evidence base for policy,” says Mark Friedberg, MD, MPP, a practicing general internist and senior natural scientist for the RAND Corporation. “We know these very large CMS demonstrations are just starting to trickle in with year one results.”

Both the Comprehensive Primary Care (CPC) Initiative and the Multi-payer Advanced Primary Care Practice (MAPCP) are large, multi-year CMS demonstrations launched in 2012 and 2011, respectively, and the reports cover just their first 12 months. Although different in numerous ways, both projects aim to create better coordinated care that will in turn lower hospital admissions and ED visits, reduce duplications, enhance patient health through prevention, improve chronic disease management, and move away from a fee-for-service approach. They are just two of many experiments supported by the 10-year, $10 billion CMS Innovation Center.

In its first 12 months, the CPC focused on improving the care of high-risk patients in four states plus three separate regions of the U.S. It served 345,000 Medicare beneficiaries and roughly 2.5 million patients overall among nearly 500 primary care practices identified as likely to achieve meaningful results.

The evaluation, performed by policy research firm Mathematica, found that CPC cut hospital admissions by 2% and saw a 3% reduction in ED visits relative to similar practices not participating in the initiative, contributing to an overall $168 savings per Medicare beneficiary. It generated more than $70,000 in additional revenue per median practice clinician.¹

However, the Department of Health and Human Services (HHS) paid practices $240 per patient to cover the costs of establishing the medical home, including hiring nurses, improving electronic health records, and setting up 24-hour call lines. Thus, the initiative failed to offset its costs. Even so, Mathematica called the findings “promising” and “more favorable” than expected for the first year of the initiative, though it advised caution in interpreting the findings at this stage.

The MAPCP involved primary care initiatives in eight states, encompassing 3,800 providers across 700 practices; it touched 400,000 Medicare beneficiaries in its first year (today, it serves practices in just six states). Private payers and Medicaid also took part, leading to an estimated savings of $4.2 million, according to the initiative’s evaluators, RTI International and The Urban Institute.²

The demonstration realized a reduction in fee-for-service Medicare growth in Vermont and Michigan, largely resulting from lower inpatient expenditures, but did little to reduce hospitalizations, readmissions, or ED visits. Data collection and utilization were recurring challenges.

Dr. Friedberg says these first reports are akin to seeing the first few ships of the armada break the horizon. Last year, he was first author of a Journal of the American Medical Association study of a three-year PCMH intervention in Pennsylvania, Southeastern Pennsylvania’s Chronic Care Initiative, which also showed mixed results.³ He currently is part of a team evaluating the CMS Federally Qualified Health Center Advanced Primary Care Practice Demonstration, which concluded last October.

Although he has not yet seen an evaluation of a PCMH intervention involving hospitalists, Dr. Friedberg says it would be interesting to see the results of a rigorously studied pilot that involves such an evaluation. A 2012 article in The Hospitalist highlighted one project in Wisconsin and laid out ways in which hospitalists could be involved in PCMH initiatives—among them, being part of hospital admissions decision making and maintaining open lines of communication.⁴ Leaders of that project declined to comment at this time.

“The patient-centered medical home really is an outpatient strategy more than it is an inpatient strategy,” says Robert Centor, MD, MACP, an academic hospitalist at the University of Alabama Huntsville and chair of the Board of Regents of the American College of Physicians, yet he sees a role for hospitalists.

“If we start getting good results with patient-centered medical homes and more people go to the model, a relationship between the PCMH on the outpatient side and a cadre of people who know how to work the inpatient side is going to be critical to success,” Dr. Centor says.

Indeed, Dr. Friedberg says hospitalists’ involvement could be one of the “missing ingredients” that might contribute to the success of any given PCMH intervention, and he’s careful to emphasize there is no such thing as “the medical home.” Rather, there are “many medical homes,” he says.

Dr. Centor says hospitalists could serve as conduits between care inside the hospital and follow-up care, which could reduce length of stay for some patients and smooth the transition from discharge to primary care. A well-versed hospitalist with the PCMH might also assist in reducing repeat tests and procedures.

“I think it comes down to relationships more than anything else,” Dr. Centor says. “The challenge is, given all of the busyness of outpatient practice and inpatient care, how do we best communicate?”

Kelly April Tyrrell is a freelance writer in Madison, Wis.

References

1. Mathematica Policy Research. Evaluation of the Comprehensive Primary Care Initiative: first annual report. Reference number 40102.R14. Available at: http://innovation.cms.gov/Files/reports/CPCI-EvalRpt1.pdf. Accessed March 4, 2015.
2. RTI International. Evaluation of the multi-payer advanced primary care practice (MAPCP) demonstration: first annual report. RTI Project Number 0212790.005.001.001. Available at: http://innovation.cms.gov/Files/reports/MAPCP-EvalRpt1.pdf. Accessed March 4, 2015.
3. Friedberg MW, Schneider EC, Rosenthal MB, Volpp KG, Werner RM. Association between participation in a multipayer medical home intervention and changes in quality, utilization, and costs of care. JAMA. 2014;311(8):815-825.
4. Collins T. Patients should prepare for the patient-centered medical home. The Hospitalist. July 3, 2012. Available at: http://www.the-hospitalist.org/article/hospitalists-should-prepare-for-the-patient-centered-medical-home/. Accessed March 4, 2015.

In late January, the Centers for Medicare and Medicaid Services (CMS) released the early results of two multi-year innovation projects focused on the creation of patient-centered medical homes (PCMHs).

Although PCMH models have been lauded as a way to achieve CMS’ triple aim —better quality patient care and improved health at a lower cost—little evidence currently backs up this claim. The latest reports show that PCMH interventions hold promise, but the jury is still out.

“I think, two to three years from now, we will be in a totally different position, in terms of a sound evidence base for policy,” says Mark Friedberg, MD, MPP, a practicing general internist and senior natural scientist for the RAND Corporation. “We know these very large CMS demonstrations are just starting to trickle in with year one results.”

Both the Comprehensive Primary Care (CPC) Initiative and the Multi-payer Advanced Primary Care Practice (MAPCP) are large, multi-year CMS demonstrations launched in 2012 and 2011, respectively, and the reports cover just their first 12 months. Although different in numerous ways, both projects aim to create better coordinated care that will in turn lower hospital admissions and ED visits, reduce duplications, enhance patient health through prevention, improve chronic disease management, and move away from a fee-for-service approach. They are just two of many experiments supported by the 10-year, $10 billion CMS Innovation Center.

In its first 12 months, the CPC focused on improving the care of high-risk patients in four states plus three separate regions of the U.S. It served 345,000 Medicare beneficiaries and roughly 2.5 million patients overall among nearly 500 primary care practices identified as likely to achieve meaningful results.

The evaluation, performed by policy research firm Mathematica, found that CPC cut hospital admissions by 2% and saw a 3% reduction in ED visits relative to similar practices not participating in the initiative, contributing to an overall $168 savings per Medicare beneficiary. It generated more than $70,000 in additional revenue per median practice clinician.¹

However, the Department of Health and Human Services (HHS) paid practices $240 per patient to cover the costs of establishing the medical home, including hiring nurses, improving electronic health records, and setting up 24-hour call lines. Thus, the initiative failed to offset its costs. Even so, Mathematica called the findings “promising” and “more favorable” than expected for the first year of the initiative, though it advised caution in interpreting the findings at this stage.

The MAPCP involved primary care initiatives in eight states, encompassing 3,800 providers across 700 practices; it touched 400,000 Medicare beneficiaries in its first year (today, it serves practices in just six states). Private payers and Medicaid also took part, leading to an estimated savings of $4.2 million, according to the initiative’s evaluators, RTI International and The Urban Institute.²

The demonstration realized a reduction in fee-for-service Medicare growth in Vermont and Michigan, largely resulting from lower inpatient expenditures, but did little to reduce hospitalizations, readmissions, or ED visits. Data collection and utilization were recurring challenges.

Dr. Friedberg says these first reports are akin to seeing the first few ships of the armada break the horizon. Last year, he was first author of a Journal of the American Medical Association study of a three-year PCMH intervention in Pennsylvania, Southeastern Pennsylvania’s Chronic Care Initiative, which also showed mixed results.³ He currently is part of a team evaluating the CMS Federally Qualified Health Center Advanced Primary Care Practice Demonstration, which concluded last October.

Although he has not yet seen an evaluation of a PCMH intervention involving hospitalists, Dr. Friedberg says it would be interesting to see the results of a rigorously studied pilot that involves such an evaluation. A 2012 article in The Hospitalist highlighted one project in Wisconsin and laid out ways in which hospitalists could be involved in PCMH initiatives—among them, being part of hospital admissions decision making and maintaining open lines of communication.⁴ Leaders of that project declined to comment at this time.

“The patient-centered medical home really is an outpatient strategy more than it is an inpatient strategy,” says Robert Centor, MD, MACP, an academic hospitalist at the University of Alabama Huntsville and chair of the Board of Regents of the American College of Physicians, yet he sees a role for hospitalists.

“If we start getting good results with patient-centered medical homes and more people go to the model, a relationship between the PCMH on the outpatient side and a cadre of people who know how to work the inpatient side is going to be critical to success,” Dr. Centor says.

Indeed, Dr. Friedberg says hospitalists’ involvement could be one of the “missing ingredients” that might contribute to the success of any given PCMH intervention, and he’s careful to emphasize there is no such thing as “the medical home.” Rather, there are “many medical homes,” he says.

Dr. Centor says hospitalists could serve as conduits between care inside the hospital and follow-up care, which could reduce length of stay for some patients and smooth the transition from discharge to primary care. A well-versed hospitalist with the PCMH might also assist in reducing repeat tests and procedures.

“I think it comes down to relationships more than anything else,” Dr. Centor says. “The challenge is, given all of the busyness of outpatient practice and inpatient care, how do we best communicate?”

Kelly April Tyrrell is a freelance writer in Madison, Wis.

References

1. Mathematica Policy Research. Evaluation of the Comprehensive Primary Care Initiative: first annual report. Reference number 40102.R14. Available at: http://innovation.cms.gov/Files/reports/CPCI-EvalRpt1.pdf. Accessed March 4, 2015.
2. RTI International. Evaluation of the multi-payer advanced primary care practice (MAPCP) demonstration: first annual report. RTI Project Number 0212790.005.001.001. Available at: http://innovation.cms.gov/Files/reports/MAPCP-EvalRpt1.pdf. Accessed March 4, 2015.
3. Friedberg MW, Schneider EC, Rosenthal MB, Volpp KG, Werner RM. Association between participation in a multipayer medical home intervention and changes in quality, utilization, and costs of care. JAMA. 2014;311(8):815-825.
4. Collins T. Patients should prepare for the patient-centered medical home. The Hospitalist. July 3, 2012. Available at: http://www.the-hospitalist.org/article/hospitalists-should-prepare-for-the-patient-centered-medical-home/. Accessed March 4, 2015.

For hospitalists who want to relocate to another state, practice in multiple states, provide telemedicine services, or take on some per diem work, this should be of interest. As part of the feasibility study on an Interstate Medical Licensure Compact, the Federation of State Medical Boards (FSMB) “allied in common purpose to develop a comprehensive process that complements the existing licensing and regulatory authority of state medical boards” and, therefore, to provide physicians with an efficient process to become licensed in multiple states.

Put simply, FSMB intends to work with the states to simplify and expedite state licensure.

The compact boasts of positively impacting physician shortage areas, leveraging the portability of care and expertise, and, in the end, not just making licensure much easier, but also favorably influencing patient safety. In a press release, the CEO of FSMB, Humayun Chaudhry, DO, MS, MACP, FACOI, stated that the compact “offers an effective solution to the question of how best to balance patient safety and quality care with the needs of a growing and changing healthcare market.” The compact promises to systematize the ability of physicians to obtain licensure in multiple states.

From a hospitalist’s perspective, the compact has a lot to offer. Hospitalists do not have a “panel” of patients that we will follow indefinitely. This allows for an enormous amount of flexibility to consider additional work, to take on per diem opportunities, and also to practice telemedicine as a “telehospitalist” in multiple states. Such flexibility would invariably mean getting licensed in several states. Getting a license in a newer state (one that takes part in the compact) should become easier once all of your credentials have been duly verified and are readily accessible. Essentially, there will be a repository of verified credentials and any disciplinary actions that will be promptly available, simplifying the process quite a bit for the applicant, as well as for the state boards. At the end of the day, the jurisdiction, execution, and authority to issue the license will always belong to the state medical boards, maintaining the integrity of the Medical Practice Act. From a physician’s perceptive, participation is entirely voluntary.

At the time of writing this, upwards of 25 states have shown enthusiasm towards this compact, 15 states have introduced a bill for the compact, including Alabama, Idaho, Illinois, Iowa, Maryland, Minnesota, Montana, Nebraska, Nevada, Oklahoma, Rhode Island, South Dakota, Texas, Utah, Vermont, West Virginia, and Wyoming, and the support continues to grow. The compact already has cleared legislative houses in Wyoming and South Dakota, and are now awaiting the governor’s signature.

For example, some argue that the high licensing fees on initial issuance and reissuance by the state medical boards may be hard to justify once a simplified licensing mechanism is in place; despite this concern, momentum and enthusiasm for the compact continue to grow. SHM, having applauded the FSMB’s efforts in its letter of support, will also likely be calling upon local chapters to promote these initiatives. Generally speaking, the interstate compact would be beneficial, offering a multistate licensure process that would be exponentially quicker than the one we currently have. I applaud the FSMB’s efforts in spearheading this endeavor.

Want to further discuss the Interstate Medical Licensure Compact? Add to my discussion on HMX.

For more information, visit the FSMB website.

Dr. Deepak Asudani, MD, MPH, FHM, is an academic hospitalist at the University of California San Diego, and is a member of the SHM Public Policy Committee. At UCSD Hospital Medicine, he directs Global Health Initiatives and is involved in developing educational programs for international students including their clinical training and simulation experiences.

For hospitalists who want to relocate to another state, practice in multiple states, provide telemedicine services, or take on some per diem work, this should be of interest. As part of the feasibility study on an Interstate Medical Licensure Compact, the Federation of State Medical Boards (FSMB) “allied in common purpose to develop a comprehensive process that complements the existing licensing and regulatory authority of state medical boards” and, therefore, to provide physicians with an efficient process to become licensed in multiple states.

Put simply, FSMB intends to work with the states to simplify and expedite state licensure.

The compact boasts of positively impacting physician shortage areas, leveraging the portability of care and expertise, and, in the end, not just making licensure much easier, but also favorably influencing patient safety. In a press release, the CEO of FSMB, Humayun Chaudhry, DO, MS, MACP, FACOI, stated that the compact “offers an effective solution to the question of how best to balance patient safety and quality care with the needs of a growing and changing healthcare market.” The compact promises to systematize the ability of physicians to obtain licensure in multiple states.

From a hospitalist’s perspective, the compact has a lot to offer. Hospitalists do not have a “panel” of patients that we will follow indefinitely. This allows for an enormous amount of flexibility to consider additional work, to take on per diem opportunities, and also to practice telemedicine as a “telehospitalist” in multiple states. Such flexibility would invariably mean getting licensed in several states. Getting a license in a newer state (one that takes part in the compact) should become easier once all of your credentials have been duly verified and are readily accessible. Essentially, there will be a repository of verified credentials and any disciplinary actions that will be promptly available, simplifying the process quite a bit for the applicant, as well as for the state boards. At the end of the day, the jurisdiction, execution, and authority to issue the license will always belong to the state medical boards, maintaining the integrity of the Medical Practice Act. From a physician’s perceptive, participation is entirely voluntary.

At the time of writing this, upwards of 25 states have shown enthusiasm towards this compact, 15 states have introduced a bill for the compact, including Alabama, Idaho, Illinois, Iowa, Maryland, Minnesota, Montana, Nebraska, Nevada, Oklahoma, Rhode Island, South Dakota, Texas, Utah, Vermont, West Virginia, and Wyoming, and the support continues to grow. The compact already has cleared legislative houses in Wyoming and South Dakota, and are now awaiting the governor’s signature.

For example, some argue that the high licensing fees on initial issuance and reissuance by the state medical boards may be hard to justify once a simplified licensing mechanism is in place; despite this concern, momentum and enthusiasm for the compact continue to grow. SHM, having applauded the FSMB’s efforts in its letter of support, will also likely be calling upon local chapters to promote these initiatives. Generally speaking, the interstate compact would be beneficial, offering a multistate licensure process that would be exponentially quicker than the one we currently have. I applaud the FSMB’s efforts in spearheading this endeavor.

Want to further discuss the Interstate Medical Licensure Compact? Add to my discussion on HMX.

For more information, visit the FSMB website.

Dr. Deepak Asudani, MD, MPH, FHM, is an academic hospitalist at the University of California San Diego, and is a member of the SHM Public Policy Committee. At UCSD Hospital Medicine, he directs Global Health Initiatives and is involved in developing educational programs for international students including their clinical training and simulation experiences.

For hospitalists who want to relocate to another state, practice in multiple states, provide telemedicine services, or take on some per diem work, this should be of interest. As part of the feasibility study on an Interstate Medical Licensure Compact, the Federation of State Medical Boards (FSMB) “allied in common purpose to develop a comprehensive process that complements the existing licensing and regulatory authority of state medical boards” and, therefore, to provide physicians with an efficient process to become licensed in multiple states.

Put simply, FSMB intends to work with the states to simplify and expedite state licensure.

The compact boasts of positively impacting physician shortage areas, leveraging the portability of care and expertise, and, in the end, not just making licensure much easier, but also favorably influencing patient safety. In a press release, the CEO of FSMB, Humayun Chaudhry, DO, MS, MACP, FACOI, stated that the compact “offers an effective solution to the question of how best to balance patient safety and quality care with the needs of a growing and changing healthcare market.” The compact promises to systematize the ability of physicians to obtain licensure in multiple states.

From a hospitalist’s perspective, the compact has a lot to offer. Hospitalists do not have a “panel” of patients that we will follow indefinitely. This allows for an enormous amount of flexibility to consider additional work, to take on per diem opportunities, and also to practice telemedicine as a “telehospitalist” in multiple states. Such flexibility would invariably mean getting licensed in several states. Getting a license in a newer state (one that takes part in the compact) should become easier once all of your credentials have been duly verified and are readily accessible. Essentially, there will be a repository of verified credentials and any disciplinary actions that will be promptly available, simplifying the process quite a bit for the applicant, as well as for the state boards. At the end of the day, the jurisdiction, execution, and authority to issue the license will always belong to the state medical boards, maintaining the integrity of the Medical Practice Act. From a physician’s perceptive, participation is entirely voluntary.

At the time of writing this, upwards of 25 states have shown enthusiasm towards this compact, 15 states have introduced a bill for the compact, including Alabama, Idaho, Illinois, Iowa, Maryland, Minnesota, Montana, Nebraska, Nevada, Oklahoma, Rhode Island, South Dakota, Texas, Utah, Vermont, West Virginia, and Wyoming, and the support continues to grow. The compact already has cleared legislative houses in Wyoming and South Dakota, and are now awaiting the governor’s signature.

For example, some argue that the high licensing fees on initial issuance and reissuance by the state medical boards may be hard to justify once a simplified licensing mechanism is in place; despite this concern, momentum and enthusiasm for the compact continue to grow. SHM, having applauded the FSMB’s efforts in its letter of support, will also likely be calling upon local chapters to promote these initiatives. Generally speaking, the interstate compact would be beneficial, offering a multistate licensure process that would be exponentially quicker than the one we currently have. I applaud the FSMB’s efforts in spearheading this endeavor.

Want to further discuss the Interstate Medical Licensure Compact? Add to my discussion on HMX.

For more information, visit the FSMB website.

Dr. Deepak Asudani, MD, MPH, FHM, is an academic hospitalist at the University of California San Diego, and is a member of the SHM Public Policy Committee. At UCSD Hospital Medicine, he directs Global Health Initiatives and is involved in developing educational programs for international students including their clinical training and simulation experiences.

In December, the Altarum Institute’s Center for Elder Care and Advanced Illness released data showing that while San Diego County hospitals do better than national averages in reducing readmissions rates, nearly all of the eligible hospitals are being penalized by Medicare’s hospital readmissions penalty program because their discharges are being reduced through best practices at about the same rate as their reductions in readmissions.

The American Hospital Association and America’s Essential Hospitals (representing public hospitals) have both provided evidence to press their claims that the government’s Hospital Readmissions Reduction Program is unfair for refusing to adjust readmissions penalties and other hospital quality measures based on socioeconomic factors that influence readmission risk. A recent JAMA Viewpoint discusses an expert panel’s review of the National Quality Forum’s long-standing policy of not adjusting quality measures for sociodemographic risk factors out of a concern that it could create lower standards of care for disadvantaged patients. The panel concluded that this policy needed to be revisited.

Larry Beresford is a freelance writer in Alameda, Calif.

In December, the Altarum Institute’s Center for Elder Care and Advanced Illness released data showing that while San Diego County hospitals do better than national averages in reducing readmissions rates, nearly all of the eligible hospitals are being penalized by Medicare’s hospital readmissions penalty program because their discharges are being reduced through best practices at about the same rate as their reductions in readmissions.

The American Hospital Association and America’s Essential Hospitals (representing public hospitals) have both provided evidence to press their claims that the government’s Hospital Readmissions Reduction Program is unfair for refusing to adjust readmissions penalties and other hospital quality measures based on socioeconomic factors that influence readmission risk. A recent JAMA Viewpoint discusses an expert panel’s review of the National Quality Forum’s long-standing policy of not adjusting quality measures for sociodemographic risk factors out of a concern that it could create lower standards of care for disadvantaged patients. The panel concluded that this policy needed to be revisited.

Larry Beresford is a freelance writer in Alameda, Calif.

In December, the Altarum Institute’s Center for Elder Care and Advanced Illness released data showing that while San Diego County hospitals do better than national averages in reducing readmissions rates, nearly all of the eligible hospitals are being penalized by Medicare’s hospital readmissions penalty program because their discharges are being reduced through best practices at about the same rate as their reductions in readmissions.

The American Hospital Association and America’s Essential Hospitals (representing public hospitals) have both provided evidence to press their claims that the government’s Hospital Readmissions Reduction Program is unfair for refusing to adjust readmissions penalties and other hospital quality measures based on socioeconomic factors that influence readmission risk. A recent JAMA Viewpoint discusses an expert panel’s review of the National Quality Forum’s long-standing policy of not adjusting quality measures for sociodemographic risk factors out of a concern that it could create lower standards of care for disadvantaged patients. The panel concluded that this policy needed to be revisited.

Larry Beresford is a freelance writer in Alameda, Calif.

A widely cited statistic in the national readmissions debate holds that one in five acute hospital discharges will lead to a readmission within 30 days.¹ Associated costs are estimated at $17.5 billion, although that figure encapsulates significant variation across diagnoses, regions, and hospital models.¹ Analyses by CMS and others suggest that average 30-day readmission rates have been falling, albeit slowly, to 17.8% during the fourth quarter of 2012 after averaging 19% over the previous five years, according to Congressional testimony by Medicare Director Jonathan Blum in February 2013.²

CMS calculates “excessive readmissions rates” for subsequent hospital admissions to the same or a different hospital for specific diagnoses within 30 days of discharge, risk-adjusted for planned and unrelated readmissions using methodology endorsed by the National Quality Forum. Based on the hospital’s rate of actual to expected readmissions, HRRP penalties are applied to all Medicare-based diagnosis-related group (DRG) payments to the hospital for the fiscal year in question, to a maximum of 3% of Medicare payments. The list of conditions now includes heart failure, acute myocardial infarction, pneumonia, acute exacerbation of COPD, other lung ailments such as chronic bronchitis, and admissions for elective total hip and total knee arthroplasty.

Aggregate average penalty in FY2015 for 2,610 hospitals paying penalties, or three-fourths of those subject to the program, will be 0.63% of total base hospital DRG reimbursement, or approximately $428 million in total readmissions penalties. Thirty-nine hospitals are paying the full 3% penalty, based on their posted readmissions between July 2010 and June 2013.³ If a hospital has fewer than 25 discharges for a given condition, then CMS does not calculate its excess readmissions penalty for that condition.

In its June 2013 report to Congress, the Medicare Payment Advisory Commission (MedPAC), which first proposed readmissions payment incentives in 2008, recommended steps to refine the computation of penalties, all with “the goal that any policy change should maintain a hospital’s incentive to reduce readmissions.”⁴ CMS has stated that it is continuing to revise its algorithms for excluding planned and unrelated readmissions from the penalty calculation.⁵

MedPAC found that the rate of “potentially preventable readmissions” (PPR) was 12.3% in 2011, according to the “3M Algorithm” developed by 3M Health Information Systems, which uses administrative data to identify hospital readmissions that may indicate problems with quality of care. The PPR logic determines whether the reason for readmission is clinically related to a prior admission and therefore potentially preventable.⁶

Others define preventable readmissions in terms of quality problems, medical errors through actions taken or omitted during the initial hospital stay that could lead to patient harm.

Larry Beresford is a freelance writer in Alameda, Calif.

References

1. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009;360(14):1418-1428.
2. Blum J. Statement of Jonathan Blum on delivery system reform: progress report from CMS before the U.S. Senate Finance Committee. February 28, 2013. Available at: http://www.finance.senate.gov/imo/media/doc/CMS%20Delivery%20System%20Reform%20Testimony%202.28.13%20(J.%20Blum).pdf. Accessed March 12, 2015.
3. Rau J. Medicare Fines 2,610 Hospitals in Third Round of Readmissions Penalties. Kaiser Health News. October 2, 2014. Available at: http://kaiserhealthnews.org/news/medicare-readmissions-penalties-2015/. Accessed March 12, 2015.
4. Medicare Payment Advisory Commission. Report to the Congress: Medicare and the health care delivery system. Chapter 4: refining the hospital readmissions reduction program. June 2013. Available at: http://www.medpac.gov/documents/reports/jun13_entirereport.pdf. Accessed March 12, 2015.
5. Rodak S. CMS responds to 6 major critiques of readmissions measures. Becker’s Infection Control and Clinical Quality. August 7, 2013. Available at: http://www.beckershospitalreview.com/quality/cms-responds-to-6-major-critiques-of-readmission-measure.html. Accessed March 12 2015.
6. Goldfield NI, McCullough EC, Hughes JS, et al. Identifying potentially preventable readmissions. Healthcare Financing Review. Available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/HealthCareFinancingReview/downloads/08Fallpg75.pdf. Accessed March 12, 2015.

A widely cited statistic in the national readmissions debate holds that one in five acute hospital discharges will lead to a readmission within 30 days.¹ Associated costs are estimated at $17.5 billion, although that figure encapsulates significant variation across diagnoses, regions, and hospital models.¹ Analyses by CMS and others suggest that average 30-day readmission rates have been falling, albeit slowly, to 17.8% during the fourth quarter of 2012 after averaging 19% over the previous five years, according to Congressional testimony by Medicare Director Jonathan Blum in February 2013.²

CMS calculates “excessive readmissions rates” for subsequent hospital admissions to the same or a different hospital for specific diagnoses within 30 days of discharge, risk-adjusted for planned and unrelated readmissions using methodology endorsed by the National Quality Forum. Based on the hospital’s rate of actual to expected readmissions, HRRP penalties are applied to all Medicare-based diagnosis-related group (DRG) payments to the hospital for the fiscal year in question, to a maximum of 3% of Medicare payments. The list of conditions now includes heart failure, acute myocardial infarction, pneumonia, acute exacerbation of COPD, other lung ailments such as chronic bronchitis, and admissions for elective total hip and total knee arthroplasty.

Aggregate average penalty in FY2015 for 2,610 hospitals paying penalties, or three-fourths of those subject to the program, will be 0.63% of total base hospital DRG reimbursement, or approximately $428 million in total readmissions penalties. Thirty-nine hospitals are paying the full 3% penalty, based on their posted readmissions between July 2010 and June 2013.³ If a hospital has fewer than 25 discharges for a given condition, then CMS does not calculate its excess readmissions penalty for that condition.

In its June 2013 report to Congress, the Medicare Payment Advisory Commission (MedPAC), which first proposed readmissions payment incentives in 2008, recommended steps to refine the computation of penalties, all with “the goal that any policy change should maintain a hospital’s incentive to reduce readmissions.”⁴ CMS has stated that it is continuing to revise its algorithms for excluding planned and unrelated readmissions from the penalty calculation.⁵

MedPAC found that the rate of “potentially preventable readmissions” (PPR) was 12.3% in 2011, according to the “3M Algorithm” developed by 3M Health Information Systems, which uses administrative data to identify hospital readmissions that may indicate problems with quality of care. The PPR logic determines whether the reason for readmission is clinically related to a prior admission and therefore potentially preventable.⁶

Others define preventable readmissions in terms of quality problems, medical errors through actions taken or omitted during the initial hospital stay that could lead to patient harm.

Larry Beresford is a freelance writer in Alameda, Calif.

References

1. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009;360(14):1418-1428.
2. Blum J. Statement of Jonathan Blum on delivery system reform: progress report from CMS before the U.S. Senate Finance Committee. February 28, 2013. Available at: http://www.finance.senate.gov/imo/media/doc/CMS%20Delivery%20System%20Reform%20Testimony%202.28.13%20(J.%20Blum).pdf. Accessed March 12, 2015.
3. Rau J. Medicare Fines 2,610 Hospitals in Third Round of Readmissions Penalties. Kaiser Health News. October 2, 2014. Available at: http://kaiserhealthnews.org/news/medicare-readmissions-penalties-2015/. Accessed March 12, 2015.
4. Medicare Payment Advisory Commission. Report to the Congress: Medicare and the health care delivery system. Chapter 4: refining the hospital readmissions reduction program. June 2013. Available at: http://www.medpac.gov/documents/reports/jun13_entirereport.pdf. Accessed March 12, 2015.
5. Rodak S. CMS responds to 6 major critiques of readmissions measures. Becker’s Infection Control and Clinical Quality. August 7, 2013. Available at: http://www.beckershospitalreview.com/quality/cms-responds-to-6-major-critiques-of-readmission-measure.html. Accessed March 12 2015.
6. Goldfield NI, McCullough EC, Hughes JS, et al. Identifying potentially preventable readmissions. Healthcare Financing Review. Available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/HealthCareFinancingReview/downloads/08Fallpg75.pdf. Accessed March 12, 2015.

A widely cited statistic in the national readmissions debate holds that one in five acute hospital discharges will lead to a readmission within 30 days.¹ Associated costs are estimated at $17.5 billion, although that figure encapsulates significant variation across diagnoses, regions, and hospital models.¹ Analyses by CMS and others suggest that average 30-day readmission rates have been falling, albeit slowly, to 17.8% during the fourth quarter of 2012 after averaging 19% over the previous five years, according to Congressional testimony by Medicare Director Jonathan Blum in February 2013.²

CMS calculates “excessive readmissions rates” for subsequent hospital admissions to the same or a different hospital for specific diagnoses within 30 days of discharge, risk-adjusted for planned and unrelated readmissions using methodology endorsed by the National Quality Forum. Based on the hospital’s rate of actual to expected readmissions, HRRP penalties are applied to all Medicare-based diagnosis-related group (DRG) payments to the hospital for the fiscal year in question, to a maximum of 3% of Medicare payments. The list of conditions now includes heart failure, acute myocardial infarction, pneumonia, acute exacerbation of COPD, other lung ailments such as chronic bronchitis, and admissions for elective total hip and total knee arthroplasty.

Aggregate average penalty in FY2015 for 2,610 hospitals paying penalties, or three-fourths of those subject to the program, will be 0.63% of total base hospital DRG reimbursement, or approximately $428 million in total readmissions penalties. Thirty-nine hospitals are paying the full 3% penalty, based on their posted readmissions between July 2010 and June 2013.³ If a hospital has fewer than 25 discharges for a given condition, then CMS does not calculate its excess readmissions penalty for that condition.

In its June 2013 report to Congress, the Medicare Payment Advisory Commission (MedPAC), which first proposed readmissions payment incentives in 2008, recommended steps to refine the computation of penalties, all with “the goal that any policy change should maintain a hospital’s incentive to reduce readmissions.”⁴ CMS has stated that it is continuing to revise its algorithms for excluding planned and unrelated readmissions from the penalty calculation.⁵

MedPAC found that the rate of “potentially preventable readmissions” (PPR) was 12.3% in 2011, according to the “3M Algorithm” developed by 3M Health Information Systems, which uses administrative data to identify hospital readmissions that may indicate problems with quality of care. The PPR logic determines whether the reason for readmission is clinically related to a prior admission and therefore potentially preventable.⁶

Others define preventable readmissions in terms of quality problems, medical errors through actions taken or omitted during the initial hospital stay that could lead to patient harm.

Larry Beresford is a freelance writer in Alameda, Calif.

References

1. Jencks SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. N Engl J Med. 2009;360(14):1418-1428.
2. Blum J. Statement of Jonathan Blum on delivery system reform: progress report from CMS before the U.S. Senate Finance Committee. February 28, 2013. Available at: http://www.finance.senate.gov/imo/media/doc/CMS%20Delivery%20System%20Reform%20Testimony%202.28.13%20(J.%20Blum).pdf. Accessed March 12, 2015.
3. Rau J. Medicare Fines 2,610 Hospitals in Third Round of Readmissions Penalties. Kaiser Health News. October 2, 2014. Available at: http://kaiserhealthnews.org/news/medicare-readmissions-penalties-2015/. Accessed March 12, 2015.
4. Medicare Payment Advisory Commission. Report to the Congress: Medicare and the health care delivery system. Chapter 4: refining the hospital readmissions reduction program. June 2013. Available at: http://www.medpac.gov/documents/reports/jun13_entirereport.pdf. Accessed March 12, 2015.
5. Rodak S. CMS responds to 6 major critiques of readmissions measures. Becker’s Infection Control and Clinical Quality. August 7, 2013. Available at: http://www.beckershospitalreview.com/quality/cms-responds-to-6-major-critiques-of-readmission-measure.html. Accessed March 12 2015.
6. Goldfield NI, McCullough EC, Hughes JS, et al. Identifying potentially preventable readmissions. Healthcare Financing Review. Available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/HealthCareFinancingReview/downloads/08Fallpg75.pdf. Accessed March 12, 2015.

Day Four highlights from HM15, the Society of Hospital Medicine’s (SHM) annual meeting in National Harbor, Md., just outside Washington, D.C.

Day Four highlights from HM15, the Society of Hospital Medicine’s (SHM) annual meeting in National Harbor, Md., just outside Washington, D.C.

Day Four highlights from HM15, the Society of Hospital Medicine’s (SHM) annual meeting in National Harbor, Md., just outside Washington, D.C.

There are so many ways to advocate for your patients, for your profession, for the future of hospital medicine. The easiest way? Getting involved.

We know how important it is to you that your patients receive the best care possible. We know that you do your absolute best as their provider but that sometimes there are hurdles that can hinder your capabilities until some kind of legislative change is enacted. SHM does its best to foresee these obstacles and works rigorously to achieve positive legislative outcomes, but often there are details we cannot fathom without your input and expertise. That’s why we need you, our hospitalist members, to fill in the gaps.

On April 1, the final day of Hospital Medicine 2015, SHM is hosting another “Hospitalists on the Hill” in Washington, D.C. We are so excited to join members on Capitol Hill again. Discussing healthcare issues that impact your patients and the specialty by meeting personally with legislators and their staff is an opportunity to share your experiences as a frontline hospitalist and directly impact key policy issues.

Want to learn more about how you can impact the process prior to heading to the Hill? Unable to attend Hill Day, but still want a better understanding of the legislative process and how SHM gets involved? Come to our “Policy Basics 101” session March 31 at HM15, where you’ll hear from SHM’s Government Relations team and from members of the Public Policy Committee. You will not only learn about the legislative and regulatory processes, but you can also discover where hospitalists can take part and exert influence along the way.

If you find that you’re unable to attend the face-to-face meetings on April 1, or even if you are, make sure that you are a member of SHM’s Grassroots Network. SHM uses this venue to keep you informed of the healthcare policy decisions on the horizon and asks you to take only a few minutes to reach out to your representatives via e-mail to take action on the issues most important to hospital medicine.

The Grassroots Network has grown substantially over the past few years, but we are always looking for more hospitalists to take up the cause. Strength in numbers is the most effective way to tell Congress where change is needed. Sign up directly.

Whether you do it in person on Capitol Hill or through periodic e-mails to legislators, advocating for patients and the specialty of hospital medicine is important work, and we hope you’ll continue to help us in even greater numbers in the future. Hospitalists have a unique voice in the healthcare system—one that needs to be shared and engaged in critical policy discussions. We hope you’ll join us in the movement to advocate for hospitalists, for your patients, and for hospital medicine.

Ellen Boyer is SHM’s government relations project coordinator.

There are so many ways to advocate for your patients, for your profession, for the future of hospital medicine. The easiest way? Getting involved.

We know how important it is to you that your patients receive the best care possible. We know that you do your absolute best as their provider but that sometimes there are hurdles that can hinder your capabilities until some kind of legislative change is enacted. SHM does its best to foresee these obstacles and works rigorously to achieve positive legislative outcomes, but often there are details we cannot fathom without your input and expertise. That’s why we need you, our hospitalist members, to fill in the gaps.

On April 1, the final day of Hospital Medicine 2015, SHM is hosting another “Hospitalists on the Hill” in Washington, D.C. We are so excited to join members on Capitol Hill again. Discussing healthcare issues that impact your patients and the specialty by meeting personally with legislators and their staff is an opportunity to share your experiences as a frontline hospitalist and directly impact key policy issues.

Want to learn more about how you can impact the process prior to heading to the Hill? Unable to attend Hill Day, but still want a better understanding of the legislative process and how SHM gets involved? Come to our “Policy Basics 101” session March 31 at HM15, where you’ll hear from SHM’s Government Relations team and from members of the Public Policy Committee. You will not only learn about the legislative and regulatory processes, but you can also discover where hospitalists can take part and exert influence along the way.

If you find that you’re unable to attend the face-to-face meetings on April 1, or even if you are, make sure that you are a member of SHM’s Grassroots Network. SHM uses this venue to keep you informed of the healthcare policy decisions on the horizon and asks you to take only a few minutes to reach out to your representatives via e-mail to take action on the issues most important to hospital medicine.

The Grassroots Network has grown substantially over the past few years, but we are always looking for more hospitalists to take up the cause. Strength in numbers is the most effective way to tell Congress where change is needed. Sign up directly.

Whether you do it in person on Capitol Hill or through periodic e-mails to legislators, advocating for patients and the specialty of hospital medicine is important work, and we hope you’ll continue to help us in even greater numbers in the future. Hospitalists have a unique voice in the healthcare system—one that needs to be shared and engaged in critical policy discussions. We hope you’ll join us in the movement to advocate for hospitalists, for your patients, and for hospital medicine.

Ellen Boyer is SHM’s government relations project coordinator.

There are so many ways to advocate for your patients, for your profession, for the future of hospital medicine. The easiest way? Getting involved.

We know how important it is to you that your patients receive the best care possible. We know that you do your absolute best as their provider but that sometimes there are hurdles that can hinder your capabilities until some kind of legislative change is enacted. SHM does its best to foresee these obstacles and works rigorously to achieve positive legislative outcomes, but often there are details we cannot fathom without your input and expertise. That’s why we need you, our hospitalist members, to fill in the gaps.

On April 1, the final day of Hospital Medicine 2015, SHM is hosting another “Hospitalists on the Hill” in Washington, D.C. We are so excited to join members on Capitol Hill again. Discussing healthcare issues that impact your patients and the specialty by meeting personally with legislators and their staff is an opportunity to share your experiences as a frontline hospitalist and directly impact key policy issues.

Want to learn more about how you can impact the process prior to heading to the Hill? Unable to attend Hill Day, but still want a better understanding of the legislative process and how SHM gets involved? Come to our “Policy Basics 101” session March 31 at HM15, where you’ll hear from SHM’s Government Relations team and from members of the Public Policy Committee. You will not only learn about the legislative and regulatory processes, but you can also discover where hospitalists can take part and exert influence along the way.

If you find that you’re unable to attend the face-to-face meetings on April 1, or even if you are, make sure that you are a member of SHM’s Grassroots Network. SHM uses this venue to keep you informed of the healthcare policy decisions on the horizon and asks you to take only a few minutes to reach out to your representatives via e-mail to take action on the issues most important to hospital medicine.

The Grassroots Network has grown substantially over the past few years, but we are always looking for more hospitalists to take up the cause. Strength in numbers is the most effective way to tell Congress where change is needed. Sign up directly.

Whether you do it in person on Capitol Hill or through periodic e-mails to legislators, advocating for patients and the specialty of hospital medicine is important work, and we hope you’ll continue to help us in even greater numbers in the future. Hospitalists have a unique voice in the healthcare system—one that needs to be shared and engaged in critical policy discussions. We hope you’ll join us in the movement to advocate for hospitalists, for your patients, and for hospital medicine.

Ellen Boyer is SHM’s government relations project coordinator.