Joshua Boswell

In 2014, the Society of Hospital Medicine endorsed the Interstate Medical Licensure Compact as a way to address divergent physician licensing requirements among states. The thrust of SHM’s reasoning was that differing licensing policies across state lines not only hinder the ability of hospitalists to quickly adjust staffing to meet the needs of hospitals and patients but also create extensive, costly, and often redundant administrative hurdles for individual hospitalists and hospital medicine groups. For hospitalists looking to relocate to another state, practice in multiple states, provide telemedicine services, or even take on some per diem work, the Interstate Medical Licensure Compact should be of great help.

To briefly summarize, states participating in the compact agree to share information with one another and work together in streamlining the licensing process. For example, the compact aims to reduce redundant licensing requirements by creating one place where physicians submit basic information such as their education credentials. The compact does not establish a national license; a license to practice medicine will still be issued by individual state medical boards. Physicians will still need to be licensed in the state where the patient is located, but the difference is that the process of obtaining a license will be streamlined significantly.

To join the Interstate Medical Licensure Compact, state legislatures must enact the compact into state law. Two years in, the compact is now being implemented in 12 states: Alabama, Idaho, Illinois, Iowa, Minnesota, Montana, Nevada, South Dakota, Utah, West Virginia, Wisconsin, and Wyoming. States where it has been introduced but not yet adopted include Alaska, Arizona, Colorado, Kansas, Maryland, Michigan, Mississippi, Nebraska, New Hampshire, Oklahoma, Pennsylvania, Rhode Island, Vermont, and Washington.

Licenses via the compact process are not currently being issued, but representatives from the 12 participating states have begun to formally meet and are working out the administrative procedures needed to begin expedited licensure processes. With a core group of states adopting and implementing the compact, it will be important for state officials to hear why adoption of the compact is important to physicians.

This presents an opportunity for hospitalists residing in holdout states to participate in some advocacy work at the state level—on their own, as a group, or even within one of SHM’s many state chapters. To find your local chapter and get involved, visit www.hospitalmedicine.org/chapters.

To assist, detailed information on the Interstate Medical Licensure Compact can be found at www.licenseportability.org, and SHM advocacy staff is available to address questions members may have about getting started. You can reach them via email at [email protected]. TH

Josh Boswell is SHM’s director of government affairs.

In 2014, the Society of Hospital Medicine endorsed the Interstate Medical Licensure Compact as a way to address divergent physician licensing requirements among states. The thrust of SHM’s reasoning was that differing licensing policies across state lines not only hinder the ability of hospitalists to quickly adjust staffing to meet the needs of hospitals and patients but also create extensive, costly, and often redundant administrative hurdles for individual hospitalists and hospital medicine groups. For hospitalists looking to relocate to another state, practice in multiple states, provide telemedicine services, or even take on some per diem work, the Interstate Medical Licensure Compact should be of great help.

To briefly summarize, states participating in the compact agree to share information with one another and work together in streamlining the licensing process. For example, the compact aims to reduce redundant licensing requirements by creating one place where physicians submit basic information such as their education credentials. The compact does not establish a national license; a license to practice medicine will still be issued by individual state medical boards. Physicians will still need to be licensed in the state where the patient is located, but the difference is that the process of obtaining a license will be streamlined significantly.

To join the Interstate Medical Licensure Compact, state legislatures must enact the compact into state law. Two years in, the compact is now being implemented in 12 states: Alabama, Idaho, Illinois, Iowa, Minnesota, Montana, Nevada, South Dakota, Utah, West Virginia, Wisconsin, and Wyoming. States where it has been introduced but not yet adopted include Alaska, Arizona, Colorado, Kansas, Maryland, Michigan, Mississippi, Nebraska, New Hampshire, Oklahoma, Pennsylvania, Rhode Island, Vermont, and Washington.

Licenses via the compact process are not currently being issued, but representatives from the 12 participating states have begun to formally meet and are working out the administrative procedures needed to begin expedited licensure processes. With a core group of states adopting and implementing the compact, it will be important for state officials to hear why adoption of the compact is important to physicians.

This presents an opportunity for hospitalists residing in holdout states to participate in some advocacy work at the state level—on their own, as a group, or even within one of SHM’s many state chapters. To find your local chapter and get involved, visit www.hospitalmedicine.org/chapters.

To assist, detailed information on the Interstate Medical Licensure Compact can be found at www.licenseportability.org, and SHM advocacy staff is available to address questions members may have about getting started. You can reach them via email at [email protected]. TH

Josh Boswell is SHM’s director of government affairs.

In 2014, the Society of Hospital Medicine endorsed the Interstate Medical Licensure Compact as a way to address divergent physician licensing requirements among states. The thrust of SHM’s reasoning was that differing licensing policies across state lines not only hinder the ability of hospitalists to quickly adjust staffing to meet the needs of hospitals and patients but also create extensive, costly, and often redundant administrative hurdles for individual hospitalists and hospital medicine groups. For hospitalists looking to relocate to another state, practice in multiple states, provide telemedicine services, or even take on some per diem work, the Interstate Medical Licensure Compact should be of great help.

To briefly summarize, states participating in the compact agree to share information with one another and work together in streamlining the licensing process. For example, the compact aims to reduce redundant licensing requirements by creating one place where physicians submit basic information such as their education credentials. The compact does not establish a national license; a license to practice medicine will still be issued by individual state medical boards. Physicians will still need to be licensed in the state where the patient is located, but the difference is that the process of obtaining a license will be streamlined significantly.

To join the Interstate Medical Licensure Compact, state legislatures must enact the compact into state law. Two years in, the compact is now being implemented in 12 states: Alabama, Idaho, Illinois, Iowa, Minnesota, Montana, Nevada, South Dakota, Utah, West Virginia, Wisconsin, and Wyoming. States where it has been introduced but not yet adopted include Alaska, Arizona, Colorado, Kansas, Maryland, Michigan, Mississippi, Nebraska, New Hampshire, Oklahoma, Pennsylvania, Rhode Island, Vermont, and Washington.

Licenses via the compact process are not currently being issued, but representatives from the 12 participating states have begun to formally meet and are working out the administrative procedures needed to begin expedited licensure processes. With a core group of states adopting and implementing the compact, it will be important for state officials to hear why adoption of the compact is important to physicians.

This presents an opportunity for hospitalists residing in holdout states to participate in some advocacy work at the state level—on their own, as a group, or even within one of SHM’s many state chapters. To find your local chapter and get involved, visit www.hospitalmedicine.org/chapters.

To assist, detailed information on the Interstate Medical Licensure Compact can be found at www.licenseportability.org, and SHM advocacy staff is available to address questions members may have about getting started. You can reach them via email at [email protected]. TH

Josh Boswell is SHM’s director of government affairs.

There is little dispute in the potential for cost savings when gainsharing arrangements incentivize things like product standardization, substitution of lower-cost products, and, most notably for hospitalists, medically appropriate decreases in length of stay. However, well-meaning but overly inclusive federal law makes the legal risk of establishing these arrangements so great that providers recoil at the prospect.

This doesn’t mean that gainsharing isn’t occurring. Currently, Medicare accountable-care organizations (ACOs) have been granted official waivers to establish such arrangements; smaller-scale pilot projects implemented by Medicare also have been granted similar waivers in the past. As availability is limited to participants within officially sanctioned programs, most providers are not able to tap into these cost-saving efforts, though this has not been for lack of trying.

Hospitals and physicians are engaging in a number of clinical joint ventures that have spurred them to seek their own gainsharing waivers by approaching the Office of the Inspector General (OIG). The OIG is the arm of the U.S. Department of Health and Human Services charged with enforcing the applicable laws affecting gainsharing. The OIG responded by cautioning that gainsharing arrangements violate the Social Security Act’s “Civil Monetary Penalty” prohibition against limitation of services to publicly insured patients, in addition to violating the federal Anti-Kickback Law and possibly the “Stark” law. Nonetheless, the OIG concluded it would not impose sanctions for the violations. In short, the OIG declared the proposals illegal but gave the go-ahead. The caveat, of course, is that these opinions are nonbinding, so providers remain understandably timid.

As a result, gainsharing currently remains more or less out of reach for those not participating in a Medicare ACO. This makes little sense at a time when Medicare and the entire health-care system are focusing on how to deliver high-quality, cost-conscious care. For example, if hospitalists are capable of reducing length of stay without detriment to the patient, they should not be legally prohibited from sharing any of the resulting cost savings. Fortunately, U.S. Rep. Jim McDermott (D-Wash.) agrees with this sentiment and has introduced legislation to address the problem.

McDermott introduced the Improved Health Care at Lower Cost Act of 2013 (H.R. 1487) in April. It seeks to exempt monetary incentive payments made by hospitals to physicians from federal anti-kickback and other sanctions. Such exemptions, or safe harbors, would be automatically granted to gainsharing arrangements that meet a pre-determined set of requirements. This means no formal application process or participation in a specific federal program would be required.

Passage of the bill would be a major step in the right direction for providers lacking the resources to navigate legal minefields or establish a full-scale ACO. If well-implemented, it could also generate significant cost savings for Medicare.

It is for these reasons that SHM supports H.R. 1487 and looks forward to working with McDermott in securing its passage.

In the coming months, members of SHM’s Grassroots Network will be encouraging Congress to make this important change to facilitate practice arrangements that provide high-value coordinated care for patients. Stay informed and take action when SHM issues Legislative Action Alerts by signing up for the Grassroots Network at www.hospitalmedicine.org/grassroots.

Josh Boswell is SHM’s senior manager of government relations.

There is little dispute in the potential for cost savings when gainsharing arrangements incentivize things like product standardization, substitution of lower-cost products, and, most notably for hospitalists, medically appropriate decreases in length of stay. However, well-meaning but overly inclusive federal law makes the legal risk of establishing these arrangements so great that providers recoil at the prospect.

This doesn’t mean that gainsharing isn’t occurring. Currently, Medicare accountable-care organizations (ACOs) have been granted official waivers to establish such arrangements; smaller-scale pilot projects implemented by Medicare also have been granted similar waivers in the past. As availability is limited to participants within officially sanctioned programs, most providers are not able to tap into these cost-saving efforts, though this has not been for lack of trying.

Hospitals and physicians are engaging in a number of clinical joint ventures that have spurred them to seek their own gainsharing waivers by approaching the Office of the Inspector General (OIG). The OIG is the arm of the U.S. Department of Health and Human Services charged with enforcing the applicable laws affecting gainsharing. The OIG responded by cautioning that gainsharing arrangements violate the Social Security Act’s “Civil Monetary Penalty” prohibition against limitation of services to publicly insured patients, in addition to violating the federal Anti-Kickback Law and possibly the “Stark” law. Nonetheless, the OIG concluded it would not impose sanctions for the violations. In short, the OIG declared the proposals illegal but gave the go-ahead. The caveat, of course, is that these opinions are nonbinding, so providers remain understandably timid.

As a result, gainsharing currently remains more or less out of reach for those not participating in a Medicare ACO. This makes little sense at a time when Medicare and the entire health-care system are focusing on how to deliver high-quality, cost-conscious care. For example, if hospitalists are capable of reducing length of stay without detriment to the patient, they should not be legally prohibited from sharing any of the resulting cost savings. Fortunately, U.S. Rep. Jim McDermott (D-Wash.) agrees with this sentiment and has introduced legislation to address the problem.

McDermott introduced the Improved Health Care at Lower Cost Act of 2013 (H.R. 1487) in April. It seeks to exempt monetary incentive payments made by hospitals to physicians from federal anti-kickback and other sanctions. Such exemptions, or safe harbors, would be automatically granted to gainsharing arrangements that meet a pre-determined set of requirements. This means no formal application process or participation in a specific federal program would be required.

Passage of the bill would be a major step in the right direction for providers lacking the resources to navigate legal minefields or establish a full-scale ACO. If well-implemented, it could also generate significant cost savings for Medicare.

It is for these reasons that SHM supports H.R. 1487 and looks forward to working with McDermott in securing its passage.

In the coming months, members of SHM’s Grassroots Network will be encouraging Congress to make this important change to facilitate practice arrangements that provide high-value coordinated care for patients. Stay informed and take action when SHM issues Legislative Action Alerts by signing up for the Grassroots Network at www.hospitalmedicine.org/grassroots.

Josh Boswell is SHM’s senior manager of government relations.

There is little dispute in the potential for cost savings when gainsharing arrangements incentivize things like product standardization, substitution of lower-cost products, and, most notably for hospitalists, medically appropriate decreases in length of stay. However, well-meaning but overly inclusive federal law makes the legal risk of establishing these arrangements so great that providers recoil at the prospect.

This doesn’t mean that gainsharing isn’t occurring. Currently, Medicare accountable-care organizations (ACOs) have been granted official waivers to establish such arrangements; smaller-scale pilot projects implemented by Medicare also have been granted similar waivers in the past. As availability is limited to participants within officially sanctioned programs, most providers are not able to tap into these cost-saving efforts, though this has not been for lack of trying.

Hospitals and physicians are engaging in a number of clinical joint ventures that have spurred them to seek their own gainsharing waivers by approaching the Office of the Inspector General (OIG). The OIG is the arm of the U.S. Department of Health and Human Services charged with enforcing the applicable laws affecting gainsharing. The OIG responded by cautioning that gainsharing arrangements violate the Social Security Act’s “Civil Monetary Penalty” prohibition against limitation of services to publicly insured patients, in addition to violating the federal Anti-Kickback Law and possibly the “Stark” law. Nonetheless, the OIG concluded it would not impose sanctions for the violations. In short, the OIG declared the proposals illegal but gave the go-ahead. The caveat, of course, is that these opinions are nonbinding, so providers remain understandably timid.

As a result, gainsharing currently remains more or less out of reach for those not participating in a Medicare ACO. This makes little sense at a time when Medicare and the entire health-care system are focusing on how to deliver high-quality, cost-conscious care. For example, if hospitalists are capable of reducing length of stay without detriment to the patient, they should not be legally prohibited from sharing any of the resulting cost savings. Fortunately, U.S. Rep. Jim McDermott (D-Wash.) agrees with this sentiment and has introduced legislation to address the problem.

McDermott introduced the Improved Health Care at Lower Cost Act of 2013 (H.R. 1487) in April. It seeks to exempt monetary incentive payments made by hospitals to physicians from federal anti-kickback and other sanctions. Such exemptions, or safe harbors, would be automatically granted to gainsharing arrangements that meet a pre-determined set of requirements. This means no formal application process or participation in a specific federal program would be required.

Passage of the bill would be a major step in the right direction for providers lacking the resources to navigate legal minefields or establish a full-scale ACO. If well-implemented, it could also generate significant cost savings for Medicare.

It is for these reasons that SHM supports H.R. 1487 and looks forward to working with McDermott in securing its passage.

In the coming months, members of SHM’s Grassroots Network will be encouraging Congress to make this important change to facilitate practice arrangements that provide high-value coordinated care for patients. Stay informed and take action when SHM issues Legislative Action Alerts by signing up for the Grassroots Network at www.hospitalmedicine.org/grassroots.

Josh Boswell is SHM’s senior manager of government relations.

The tiresome cycle of the sustainable growth rate (SGR) continues and, as a result, providers are facing a pay cut of approximately 25% at the end of 2013. With virtually universal agreement that something must be done to permanently repeal the SGR, the insurmountable barrier to a solution has been the cost, which is estimated at $245 billion.

However, a bright spot has emerged.

Several months ago, the Congressional Budget Office produced an anomalous, revised SGR repeal estimate of $138 billion. At nearly half the cost of previous estimates, this is a much less daunting budgetary hole to fill. Needless to say, this revised estimate has breathed new life into the potential to permanently fix the SGR this year. The only catch is that this low estimate is unlikely to persist, so a flurry of activity is expected to last throughout the summer months before the window of opportunity closes.

One of the earliest proposals to move away from fee-for-service to a payment system rooted in quality and value came from the reintroduction of legislation by U.S. Reps. Allyson Schwartz (D-Pa.) and Joe Heck (R-Nev.). SHM is actively supporting this legislation and will continue to do so, but it will give the same attention to other reasonable plans designed to move away from the SGR by incorporating the concepts of quality and value as laid out by Schwartz and Heck.

Along these lines, a joint effort by House Energy and Commerce Committee chairman

Fred Upton (R-Mich.) and House Ways and Means Committee chairman Dave Camp (R-Mich.) would repeal the SGR and replace it with a more sustainable payment system. The plan is being developed iteratively, with opportunities for specialty societies, such as SHM, to provide input along the way. Clear details have yet to emerge because the plan is still in its early stages, but broadly, it will repeal the SGR, replacing it with quality and resource use metrics coupled with value-based payment, and somehow incorporate alternative payment models, such as accountable-care organizations (ACOs). This may sound familiar

because much of it is.

The Centers for Medicare & Medicaid Services (CMS) is developing programs, guided by the Affordable Care Act (ACA), to meet many of these systemic needs in the absence of a repeal of the SGR. The Physician Quality Reporting System (PQRS) is transitioning into a mandatory program, and it’s coupling with Quality and Resource Use Reports (QRURs) brings value into the equation. Both of these programs are a part of the ACA-mandated Physician Value-Based Payment Modifier (VBPM), which implements a level of value-based payment to all physicians by 2017. Additionally, the Center for Medicare & Medicaid Innovation, along with Medicare itself, is developing and testing many alternative models, such as ACOs, bundled payments, and patient-centered medical homes, to name a few.

Upton and Camp have expressed that their goal is to not only repeal the SGR, but also to establish a system that pays for value and is less piecemeal and confusing than what is currently being implemented. For example, they are looking at ways to potentially unify the often disparate yet overlapping reporting requirements placed on physicians through such programs as PQRS, Meaningful Use, and VBPM. This is a great opportunity to take the knowledge and experience hospitalists have with these current CMS programs and advocate for aligning programs, ensuring the usefulness of quality measurement, and reducing administrative barriers and burdens.

Ultimately, the repeal of the SGR will take much thought and legislative will to accomplish. With a broad framework in place, the process has at least begun. It remains to be seen whether Congress will act now on the SGR “sale” and help the health-care system transition into something more sustainable and stable.

Josh Boswell is SHM’s senior manager of government relations

The tiresome cycle of the sustainable growth rate (SGR) continues and, as a result, providers are facing a pay cut of approximately 25% at the end of 2013. With virtually universal agreement that something must be done to permanently repeal the SGR, the insurmountable barrier to a solution has been the cost, which is estimated at $245 billion.

However, a bright spot has emerged.

Several months ago, the Congressional Budget Office produced an anomalous, revised SGR repeal estimate of $138 billion. At nearly half the cost of previous estimates, this is a much less daunting budgetary hole to fill. Needless to say, this revised estimate has breathed new life into the potential to permanently fix the SGR this year. The only catch is that this low estimate is unlikely to persist, so a flurry of activity is expected to last throughout the summer months before the window of opportunity closes.

One of the earliest proposals to move away from fee-for-service to a payment system rooted in quality and value came from the reintroduction of legislation by U.S. Reps. Allyson Schwartz (D-Pa.) and Joe Heck (R-Nev.). SHM is actively supporting this legislation and will continue to do so, but it will give the same attention to other reasonable plans designed to move away from the SGR by incorporating the concepts of quality and value as laid out by Schwartz and Heck.

Along these lines, a joint effort by House Energy and Commerce Committee chairman

Fred Upton (R-Mich.) and House Ways and Means Committee chairman Dave Camp (R-Mich.) would repeal the SGR and replace it with a more sustainable payment system. The plan is being developed iteratively, with opportunities for specialty societies, such as SHM, to provide input along the way. Clear details have yet to emerge because the plan is still in its early stages, but broadly, it will repeal the SGR, replacing it with quality and resource use metrics coupled with value-based payment, and somehow incorporate alternative payment models, such as accountable-care organizations (ACOs). This may sound familiar

because much of it is.

The Centers for Medicare & Medicaid Services (CMS) is developing programs, guided by the Affordable Care Act (ACA), to meet many of these systemic needs in the absence of a repeal of the SGR. The Physician Quality Reporting System (PQRS) is transitioning into a mandatory program, and it’s coupling with Quality and Resource Use Reports (QRURs) brings value into the equation. Both of these programs are a part of the ACA-mandated Physician Value-Based Payment Modifier (VBPM), which implements a level of value-based payment to all physicians by 2017. Additionally, the Center for Medicare & Medicaid Innovation, along with Medicare itself, is developing and testing many alternative models, such as ACOs, bundled payments, and patient-centered medical homes, to name a few.

Upton and Camp have expressed that their goal is to not only repeal the SGR, but also to establish a system that pays for value and is less piecemeal and confusing than what is currently being implemented. For example, they are looking at ways to potentially unify the often disparate yet overlapping reporting requirements placed on physicians through such programs as PQRS, Meaningful Use, and VBPM. This is a great opportunity to take the knowledge and experience hospitalists have with these current CMS programs and advocate for aligning programs, ensuring the usefulness of quality measurement, and reducing administrative barriers and burdens.

Ultimately, the repeal of the SGR will take much thought and legislative will to accomplish. With a broad framework in place, the process has at least begun. It remains to be seen whether Congress will act now on the SGR “sale” and help the health-care system transition into something more sustainable and stable.

Josh Boswell is SHM’s senior manager of government relations

The tiresome cycle of the sustainable growth rate (SGR) continues and, as a result, providers are facing a pay cut of approximately 25% at the end of 2013. With virtually universal agreement that something must be done to permanently repeal the SGR, the insurmountable barrier to a solution has been the cost, which is estimated at $245 billion.

However, a bright spot has emerged.

Several months ago, the Congressional Budget Office produced an anomalous, revised SGR repeal estimate of $138 billion. At nearly half the cost of previous estimates, this is a much less daunting budgetary hole to fill. Needless to say, this revised estimate has breathed new life into the potential to permanently fix the SGR this year. The only catch is that this low estimate is unlikely to persist, so a flurry of activity is expected to last throughout the summer months before the window of opportunity closes.

One of the earliest proposals to move away from fee-for-service to a payment system rooted in quality and value came from the reintroduction of legislation by U.S. Reps. Allyson Schwartz (D-Pa.) and Joe Heck (R-Nev.). SHM is actively supporting this legislation and will continue to do so, but it will give the same attention to other reasonable plans designed to move away from the SGR by incorporating the concepts of quality and value as laid out by Schwartz and Heck.

Along these lines, a joint effort by House Energy and Commerce Committee chairman

Fred Upton (R-Mich.) and House Ways and Means Committee chairman Dave Camp (R-Mich.) would repeal the SGR and replace it with a more sustainable payment system. The plan is being developed iteratively, with opportunities for specialty societies, such as SHM, to provide input along the way. Clear details have yet to emerge because the plan is still in its early stages, but broadly, it will repeal the SGR, replacing it with quality and resource use metrics coupled with value-based payment, and somehow incorporate alternative payment models, such as accountable-care organizations (ACOs). This may sound familiar

because much of it is.

The Centers for Medicare & Medicaid Services (CMS) is developing programs, guided by the Affordable Care Act (ACA), to meet many of these systemic needs in the absence of a repeal of the SGR. The Physician Quality Reporting System (PQRS) is transitioning into a mandatory program, and it’s coupling with Quality and Resource Use Reports (QRURs) brings value into the equation. Both of these programs are a part of the ACA-mandated Physician Value-Based Payment Modifier (VBPM), which implements a level of value-based payment to all physicians by 2017. Additionally, the Center for Medicare & Medicaid Innovation, along with Medicare itself, is developing and testing many alternative models, such as ACOs, bundled payments, and patient-centered medical homes, to name a few.

Upton and Camp have expressed that their goal is to not only repeal the SGR, but also to establish a system that pays for value and is less piecemeal and confusing than what is currently being implemented. For example, they are looking at ways to potentially unify the often disparate yet overlapping reporting requirements placed on physicians through such programs as PQRS, Meaningful Use, and VBPM. This is a great opportunity to take the knowledge and experience hospitalists have with these current CMS programs and advocate for aligning programs, ensuring the usefulness of quality measurement, and reducing administrative barriers and burdens.

Ultimately, the repeal of the SGR will take much thought and legislative will to accomplish. With a broad framework in place, the process has at least begun. It remains to be seen whether Congress will act now on the SGR “sale” and help the health-care system transition into something more sustainable and stable.

Josh Boswell is SHM’s senior manager of government relations

For those who remain unaware, hospitalists who care for Medicaid patients will be getting a raise in 2013 and 2014. The reason is that the Affordable Care Act (ACA) requires Medicaid rates for specified primary-care services to be equal to those of Medicare rates during those two years, with the federal government paying the difference. Hospitalists generally meet the requirements and, therefore, will see this pay increase for their applicable Medicaid billing. For some context of the scope of this change, on average, Medicaid pays physicians at 66% of the national Medicare rates, although there is significant variation among the states.

To qualify, a physician must have a specialty designation of family medicine, internal medicine, or pediatrics, then further attest to board certification in one of those specialties or related subspecialties. Alternatively, the physician must have a 60% claims history for the specified evaluation and management (E&M) codes.

Multiple parties who have heard reports about state plans for Medicaid parity recently have contacted SHM; the plans, they report, intentionally would exclude hospitalists from the promised increase. There are variations on the explanation for the exclusion and where the idea is coming from, but the inquiries follow this general theme: “Since the definition of eligible physicians remains a grey area, states are developing alternative plans with a more narrow interpretation of the qualifying factors for the increase. These plans are only including physicians who practice in the community setting (i.e. not the hospital setting).”

This is demonstrably wrong. Even if states are having these discussions, such a plan is not going to come to fruition. The final rule for Medicaid parity, which essentially has the effect of law, is very clear: It does not allow for differing eligibility or alternate state plans.

The Centers for Medicare & Medicaid Services (CMS) specifically stated in the final rule that the increase is not limited to office-based primary-care services, but it will also include hospital observation and consultation for inpatient services provided by nonadmitting physicians, ED services, and critical-care services. In other words, a hospitalist who attests eligibility for their respective state Medicaid agency and bills 99231-3, 99221-3, 99238-9, etc., will receive the increased payment for these codes.

In response to an SHM inquiry for further clarification, CMS officials have stated, “The regulation requires that qualified physicians billing eligible codes receive higher payment. States do not have the latitude to exclude physicians simply because they practice in hospitals.”

It is possible that some confusion might be arising due to the recent controversies around the upcoming Medicaid expansion, which would extend Medicaid eligibility to individuals who earn up to 138% of the federal poverty line. Some states have chosen to opt out of this expansion and have publicly fought its implementation. The Medicaid parity provision is parallel to, but independent of, Medicaid expansion. Even if a state opts out of the expansion, the Medicaid payment increase for primary-care services should remain unaffected.

This isn’t to say that the Medicaid parity provision is a certainty. With the eyes of Congress turned toward budget cuts and austerity, the funds allocated for this temporary increase could easily be targeted. Regardless, any change in eligibility would require a rule change at the federal level, which is unlikely.

Many states have already devoted much time and effort on plans to implement the provision, and the plans were due to be submitted to CMS on March 31. It is pretty late in the game to consider changes. Barring an unlikely rule change or total elimination of funding, it is clear that hospitalists are eligible for the payment bump and should remain so.

Josh Boswell is SHM’s senior manager of government relations.

For those who remain unaware, hospitalists who care for Medicaid patients will be getting a raise in 2013 and 2014. The reason is that the Affordable Care Act (ACA) requires Medicaid rates for specified primary-care services to be equal to those of Medicare rates during those two years, with the federal government paying the difference. Hospitalists generally meet the requirements and, therefore, will see this pay increase for their applicable Medicaid billing. For some context of the scope of this change, on average, Medicaid pays physicians at 66% of the national Medicare rates, although there is significant variation among the states.

To qualify, a physician must have a specialty designation of family medicine, internal medicine, or pediatrics, then further attest to board certification in one of those specialties or related subspecialties. Alternatively, the physician must have a 60% claims history for the specified evaluation and management (E&M) codes.

Multiple parties who have heard reports about state plans for Medicaid parity recently have contacted SHM; the plans, they report, intentionally would exclude hospitalists from the promised increase. There are variations on the explanation for the exclusion and where the idea is coming from, but the inquiries follow this general theme: “Since the definition of eligible physicians remains a grey area, states are developing alternative plans with a more narrow interpretation of the qualifying factors for the increase. These plans are only including physicians who practice in the community setting (i.e. not the hospital setting).”

This is demonstrably wrong. Even if states are having these discussions, such a plan is not going to come to fruition. The final rule for Medicaid parity, which essentially has the effect of law, is very clear: It does not allow for differing eligibility or alternate state plans.

The Centers for Medicare & Medicaid Services (CMS) specifically stated in the final rule that the increase is not limited to office-based primary-care services, but it will also include hospital observation and consultation for inpatient services provided by nonadmitting physicians, ED services, and critical-care services. In other words, a hospitalist who attests eligibility for their respective state Medicaid agency and bills 99231-3, 99221-3, 99238-9, etc., will receive the increased payment for these codes.

In response to an SHM inquiry for further clarification, CMS officials have stated, “The regulation requires that qualified physicians billing eligible codes receive higher payment. States do not have the latitude to exclude physicians simply because they practice in hospitals.”

It is possible that some confusion might be arising due to the recent controversies around the upcoming Medicaid expansion, which would extend Medicaid eligibility to individuals who earn up to 138% of the federal poverty line. Some states have chosen to opt out of this expansion and have publicly fought its implementation. The Medicaid parity provision is parallel to, but independent of, Medicaid expansion. Even if a state opts out of the expansion, the Medicaid payment increase for primary-care services should remain unaffected.

This isn’t to say that the Medicaid parity provision is a certainty. With the eyes of Congress turned toward budget cuts and austerity, the funds allocated for this temporary increase could easily be targeted. Regardless, any change in eligibility would require a rule change at the federal level, which is unlikely.

Many states have already devoted much time and effort on plans to implement the provision, and the plans were due to be submitted to CMS on March 31. It is pretty late in the game to consider changes. Barring an unlikely rule change or total elimination of funding, it is clear that hospitalists are eligible for the payment bump and should remain so.

Josh Boswell is SHM’s senior manager of government relations.

For those who remain unaware, hospitalists who care for Medicaid patients will be getting a raise in 2013 and 2014. The reason is that the Affordable Care Act (ACA) requires Medicaid rates for specified primary-care services to be equal to those of Medicare rates during those two years, with the federal government paying the difference. Hospitalists generally meet the requirements and, therefore, will see this pay increase for their applicable Medicaid billing. For some context of the scope of this change, on average, Medicaid pays physicians at 66% of the national Medicare rates, although there is significant variation among the states.

To qualify, a physician must have a specialty designation of family medicine, internal medicine, or pediatrics, then further attest to board certification in one of those specialties or related subspecialties. Alternatively, the physician must have a 60% claims history for the specified evaluation and management (E&M) codes.

Multiple parties who have heard reports about state plans for Medicaid parity recently have contacted SHM; the plans, they report, intentionally would exclude hospitalists from the promised increase. There are variations on the explanation for the exclusion and where the idea is coming from, but the inquiries follow this general theme: “Since the definition of eligible physicians remains a grey area, states are developing alternative plans with a more narrow interpretation of the qualifying factors for the increase. These plans are only including physicians who practice in the community setting (i.e. not the hospital setting).”

This is demonstrably wrong. Even if states are having these discussions, such a plan is not going to come to fruition. The final rule for Medicaid parity, which essentially has the effect of law, is very clear: It does not allow for differing eligibility or alternate state plans.

The Centers for Medicare & Medicaid Services (CMS) specifically stated in the final rule that the increase is not limited to office-based primary-care services, but it will also include hospital observation and consultation for inpatient services provided by nonadmitting physicians, ED services, and critical-care services. In other words, a hospitalist who attests eligibility for their respective state Medicaid agency and bills 99231-3, 99221-3, 99238-9, etc., will receive the increased payment for these codes.

In response to an SHM inquiry for further clarification, CMS officials have stated, “The regulation requires that qualified physicians billing eligible codes receive higher payment. States do not have the latitude to exclude physicians simply because they practice in hospitals.”

It is possible that some confusion might be arising due to the recent controversies around the upcoming Medicaid expansion, which would extend Medicaid eligibility to individuals who earn up to 138% of the federal poverty line. Some states have chosen to opt out of this expansion and have publicly fought its implementation. The Medicaid parity provision is parallel to, but independent of, Medicaid expansion. Even if a state opts out of the expansion, the Medicaid payment increase for primary-care services should remain unaffected.

This isn’t to say that the Medicaid parity provision is a certainty. With the eyes of Congress turned toward budget cuts and austerity, the funds allocated for this temporary increase could easily be targeted. Regardless, any change in eligibility would require a rule change at the federal level, which is unlikely.

Many states have already devoted much time and effort on plans to implement the provision, and the plans were due to be submitted to CMS on March 31. It is pretty late in the game to consider changes. Barring an unlikely rule change or total elimination of funding, it is clear that hospitalists are eligible for the payment bump and should remain so.

Josh Boswell is SHM’s senior manager of government relations.

On Nov. 1, 2012, the Centers for Medicare & Medicaid Services (CMS) released the final regulation implementing increased Medicaid payments for specified primary-care services to 100% of Medicare levels in 2013 and 2014.

Covered Medicaid services include evaluation and management codes between 99201 and 99499 when used by physicians with a specialty designation of family medicine, general internal medicine, or pediatric medicine. CMS also finalized a policy to qualify services provided by subspecialists related to the designated primary-care specialists board-certified by the American Board of Medical Specialties, American Osteopathic Association, and the American Board of Physician Specialties. Advanced-practice clinicians also qualify for the increased payment when services are furnished under a physician’s personal supervision.

In commenting on the proposed rule, SHM stated that hospitalists should qualify for purposes of the increased payment because they are an important part of the “team” of clinicians required to treat many common conditions within the Medicaid population, and that hospitalists often provide the first contact and facilitate an entry point into the comprehensive care network.

CMS agreed.

The codes included in the pay increase will be limited to traditional primary care but also will include hospital observation and consultation for inpatient services provided by nonadmitting physicians, ED services, and critical-care services.

Hospitalists will qualify for the enhanced payment, but it remains somewhat unclear how individual states will handle the increase. State Medicaid agencies could pay physicians based on their self-attestation alone or in conjunction with any other provider enrollment requirements that currently exist in the state. Further, inclusion of a code does not require a state to pay for the service if it is not already covered under the state’s Medicaid program. All other state coverage and payment policy rules related to the services also remain in effect.

Timing of the pay increase also remains unclear. The statute requires that states make higher payments for services provided on or after Jan. 1, 2013, but for many physicians, the higher payment might be longer in coming despite being retroactive to the January deadline. States must submit a State Plan Amendment (SPA) to reflect the fee schedule rate increases by March 31, 2013, and CMS may then take up to 90 days to review and approve the SPA. Therefore, it could be six months or longer before eligible physicians and practitioners receive any of the payment increase.

States will receive an estimated $5.8 billion in 2013 and $6.1 billion in 2014 in federal funds to meet this two-year requirement, unless Congress acts to extend or fund the provision permanently. In response to an SHM suggestion on the potential to extend the increase, CMS will be collecting relevant data on the impact of the pay increase on Medicaid patients.

Even with the remaining uncertainty and timing issues, this is a change in payment policy that presents an important shift in the valuation of primary-care services, including some services provided by hospitalists. Medicaid services are notoriously undervalued, and this increase to providers will certainly have a positive impact on the accessibility of care for patients.

Josh Boswell is SHM’s interim senior manager of government relations.

On Nov. 1, 2012, the Centers for Medicare & Medicaid Services (CMS) released the final regulation implementing increased Medicaid payments for specified primary-care services to 100% of Medicare levels in 2013 and 2014.

Covered Medicaid services include evaluation and management codes between 99201 and 99499 when used by physicians with a specialty designation of family medicine, general internal medicine, or pediatric medicine. CMS also finalized a policy to qualify services provided by subspecialists related to the designated primary-care specialists board-certified by the American Board of Medical Specialties, American Osteopathic Association, and the American Board of Physician Specialties. Advanced-practice clinicians also qualify for the increased payment when services are furnished under a physician’s personal supervision.

In commenting on the proposed rule, SHM stated that hospitalists should qualify for purposes of the increased payment because they are an important part of the “team” of clinicians required to treat many common conditions within the Medicaid population, and that hospitalists often provide the first contact and facilitate an entry point into the comprehensive care network.

CMS agreed.

The codes included in the pay increase will be limited to traditional primary care but also will include hospital observation and consultation for inpatient services provided by nonadmitting physicians, ED services, and critical-care services.

Hospitalists will qualify for the enhanced payment, but it remains somewhat unclear how individual states will handle the increase. State Medicaid agencies could pay physicians based on their self-attestation alone or in conjunction with any other provider enrollment requirements that currently exist in the state. Further, inclusion of a code does not require a state to pay for the service if it is not already covered under the state’s Medicaid program. All other state coverage and payment policy rules related to the services also remain in effect.

Timing of the pay increase also remains unclear. The statute requires that states make higher payments for services provided on or after Jan. 1, 2013, but for many physicians, the higher payment might be longer in coming despite being retroactive to the January deadline. States must submit a State Plan Amendment (SPA) to reflect the fee schedule rate increases by March 31, 2013, and CMS may then take up to 90 days to review and approve the SPA. Therefore, it could be six months or longer before eligible physicians and practitioners receive any of the payment increase.

States will receive an estimated $5.8 billion in 2013 and $6.1 billion in 2014 in federal funds to meet this two-year requirement, unless Congress acts to extend or fund the provision permanently. In response to an SHM suggestion on the potential to extend the increase, CMS will be collecting relevant data on the impact of the pay increase on Medicaid patients.

Even with the remaining uncertainty and timing issues, this is a change in payment policy that presents an important shift in the valuation of primary-care services, including some services provided by hospitalists. Medicaid services are notoriously undervalued, and this increase to providers will certainly have a positive impact on the accessibility of care for patients.

Josh Boswell is SHM’s interim senior manager of government relations.

On Nov. 1, 2012, the Centers for Medicare & Medicaid Services (CMS) released the final regulation implementing increased Medicaid payments for specified primary-care services to 100% of Medicare levels in 2013 and 2014.

Covered Medicaid services include evaluation and management codes between 99201 and 99499 when used by physicians with a specialty designation of family medicine, general internal medicine, or pediatric medicine. CMS also finalized a policy to qualify services provided by subspecialists related to the designated primary-care specialists board-certified by the American Board of Medical Specialties, American Osteopathic Association, and the American Board of Physician Specialties. Advanced-practice clinicians also qualify for the increased payment when services are furnished under a physician’s personal supervision.

In commenting on the proposed rule, SHM stated that hospitalists should qualify for purposes of the increased payment because they are an important part of the “team” of clinicians required to treat many common conditions within the Medicaid population, and that hospitalists often provide the first contact and facilitate an entry point into the comprehensive care network.

CMS agreed.

The codes included in the pay increase will be limited to traditional primary care but also will include hospital observation and consultation for inpatient services provided by nonadmitting physicians, ED services, and critical-care services.

Hospitalists will qualify for the enhanced payment, but it remains somewhat unclear how individual states will handle the increase. State Medicaid agencies could pay physicians based on their self-attestation alone or in conjunction with any other provider enrollment requirements that currently exist in the state. Further, inclusion of a code does not require a state to pay for the service if it is not already covered under the state’s Medicaid program. All other state coverage and payment policy rules related to the services also remain in effect.

Timing of the pay increase also remains unclear. The statute requires that states make higher payments for services provided on or after Jan. 1, 2013, but for many physicians, the higher payment might be longer in coming despite being retroactive to the January deadline. States must submit a State Plan Amendment (SPA) to reflect the fee schedule rate increases by March 31, 2013, and CMS may then take up to 90 days to review and approve the SPA. Therefore, it could be six months or longer before eligible physicians and practitioners receive any of the payment increase.

States will receive an estimated $5.8 billion in 2013 and $6.1 billion in 2014 in federal funds to meet this two-year requirement, unless Congress acts to extend or fund the provision permanently. In response to an SHM suggestion on the potential to extend the increase, CMS will be collecting relevant data on the impact of the pay increase on Medicaid patients.

Even with the remaining uncertainty and timing issues, this is a change in payment policy that presents an important shift in the valuation of primary-care services, including some services provided by hospitalists. Medicaid services are notoriously undervalued, and this increase to providers will certainly have a positive impact on the accessibility of care for patients.

Josh Boswell is SHM’s interim senior manager of government relations.

Hospital-based eligible professionals do not qualify for the Medicare or Medicaid electronic health record (EHR) incentive program or the impending payment penalties for not being “meaningful users” of EHR technology.

A hospital-based “eligible professional” (EP) is defined by the Centers for Medicare & Medicaid Services (CMS) as an EP who furnishes 90% or more of their covered professional services in either the inpatient or emergency departments of a hospital. This exemption applies to most hospitalists and recognizes they have very little control over whether their respective institutions invest in this technology.

Although this 90% threshold should qualify most hospitalists for the exemption, it does not tell the entire story. A growing number of hospitalists are spending time rounding in skilled nursing or other post-acute facilities, and some are focusing the entirety of their practice in the post-acute setting. Under the current CMS definition, these hospitalists are not hospital-based and will, therefore, be subject to the upcoming penalties for not being meaningful users of EHR technology.

Contrary to the 90% threshold, the reality for post-acute hospitalists is that when it comes to EHRs, they are no different than their hospital-based colleagues. A hospitalist, irrespective of setting, has very little control over what kind of technology, if any, a facility invests in.

For hospitalists who are rounding or spending more of their practice time in post-acute facilities, this mechanical classification based on practice location alone is problematic. A physician-implemented EHR is not practical and does not make sense given the unique practice patterns of hospitalists. Although SHM remains strongly committed to the promise represented by health information technology (HIT), SHM consistently has noted to CMS that hospitalist practice does not always fit the confines of their rulemaking.

Hospitalists should not be penalized for failure to implement their own HIT, because they already use facility EHRs or lack control over the availability of EHR systems. It is for these reasons that SHM has been a strong advocate for an additional exemption that works for hospitalists—an exemption that recognizes lack of control of availability.

In August, CMS released the final rule for Stage 2 of Meaningful Use, and the voice of hospitalists was clearly heard. The rule includes an SHM advanced-hardship exemption acknowledging that EPs who practice in multiple locations, such as nursing homes, could face a significant hardship as they would have no way to control the use of Certified EHR Technology (CEHRT). In promulgating the exemption, CMS specifically states that a “physician merely sees patients at the center or home, and does not have any other interest in the facility; they would exert little to no influence over whether the nursing home, center, or other similar outpatient site adopts and implements CEHRT.” Hospitalists seeking this exemption would need to apply annually for up to five years.

This hardship exemption could apply to hospitalists who work in multiple facilities outside of hospitals, such as nursing homes. Although imperfect due to the time-limited nature, the exemption represents a victory in the effort to differentiate HM from traditional practice patterns. It is precisely this difference that makes HM uniquely positioned to lead changes in the healthcare system.

Josh Boswell is SHM’s interim senior manager of government relations.

Hospital-based eligible professionals do not qualify for the Medicare or Medicaid electronic health record (EHR) incentive program or the impending payment penalties for not being “meaningful users” of EHR technology.

A hospital-based “eligible professional” (EP) is defined by the Centers for Medicare & Medicaid Services (CMS) as an EP who furnishes 90% or more of their covered professional services in either the inpatient or emergency departments of a hospital. This exemption applies to most hospitalists and recognizes they have very little control over whether their respective institutions invest in this technology.

Although this 90% threshold should qualify most hospitalists for the exemption, it does not tell the entire story. A growing number of hospitalists are spending time rounding in skilled nursing or other post-acute facilities, and some are focusing the entirety of their practice in the post-acute setting. Under the current CMS definition, these hospitalists are not hospital-based and will, therefore, be subject to the upcoming penalties for not being meaningful users of EHR technology.

Contrary to the 90% threshold, the reality for post-acute hospitalists is that when it comes to EHRs, they are no different than their hospital-based colleagues. A hospitalist, irrespective of setting, has very little control over what kind of technology, if any, a facility invests in.

For hospitalists who are rounding or spending more of their practice time in post-acute facilities, this mechanical classification based on practice location alone is problematic. A physician-implemented EHR is not practical and does not make sense given the unique practice patterns of hospitalists. Although SHM remains strongly committed to the promise represented by health information technology (HIT), SHM consistently has noted to CMS that hospitalist practice does not always fit the confines of their rulemaking.

Hospitalists should not be penalized for failure to implement their own HIT, because they already use facility EHRs or lack control over the availability of EHR systems. It is for these reasons that SHM has been a strong advocate for an additional exemption that works for hospitalists—an exemption that recognizes lack of control of availability.

In August, CMS released the final rule for Stage 2 of Meaningful Use, and the voice of hospitalists was clearly heard. The rule includes an SHM advanced-hardship exemption acknowledging that EPs who practice in multiple locations, such as nursing homes, could face a significant hardship as they would have no way to control the use of Certified EHR Technology (CEHRT). In promulgating the exemption, CMS specifically states that a “physician merely sees patients at the center or home, and does not have any other interest in the facility; they would exert little to no influence over whether the nursing home, center, or other similar outpatient site adopts and implements CEHRT.” Hospitalists seeking this exemption would need to apply annually for up to five years.

This hardship exemption could apply to hospitalists who work in multiple facilities outside of hospitals, such as nursing homes. Although imperfect due to the time-limited nature, the exemption represents a victory in the effort to differentiate HM from traditional practice patterns. It is precisely this difference that makes HM uniquely positioned to lead changes in the healthcare system.

Josh Boswell is SHM’s interim senior manager of government relations.

Hospital-based eligible professionals do not qualify for the Medicare or Medicaid electronic health record (EHR) incentive program or the impending payment penalties for not being “meaningful users” of EHR technology.

A hospital-based “eligible professional” (EP) is defined by the Centers for Medicare & Medicaid Services (CMS) as an EP who furnishes 90% or more of their covered professional services in either the inpatient or emergency departments of a hospital. This exemption applies to most hospitalists and recognizes they have very little control over whether their respective institutions invest in this technology.

Although this 90% threshold should qualify most hospitalists for the exemption, it does not tell the entire story. A growing number of hospitalists are spending time rounding in skilled nursing or other post-acute facilities, and some are focusing the entirety of their practice in the post-acute setting. Under the current CMS definition, these hospitalists are not hospital-based and will, therefore, be subject to the upcoming penalties for not being meaningful users of EHR technology.

Contrary to the 90% threshold, the reality for post-acute hospitalists is that when it comes to EHRs, they are no different than their hospital-based colleagues. A hospitalist, irrespective of setting, has very little control over what kind of technology, if any, a facility invests in.

For hospitalists who are rounding or spending more of their practice time in post-acute facilities, this mechanical classification based on practice location alone is problematic. A physician-implemented EHR is not practical and does not make sense given the unique practice patterns of hospitalists. Although SHM remains strongly committed to the promise represented by health information technology (HIT), SHM consistently has noted to CMS that hospitalist practice does not always fit the confines of their rulemaking.

Hospitalists should not be penalized for failure to implement their own HIT, because they already use facility EHRs or lack control over the availability of EHR systems. It is for these reasons that SHM has been a strong advocate for an additional exemption that works for hospitalists—an exemption that recognizes lack of control of availability.

In August, CMS released the final rule for Stage 2 of Meaningful Use, and the voice of hospitalists was clearly heard. The rule includes an SHM advanced-hardship exemption acknowledging that EPs who practice in multiple locations, such as nursing homes, could face a significant hardship as they would have no way to control the use of Certified EHR Technology (CEHRT). In promulgating the exemption, CMS specifically states that a “physician merely sees patients at the center or home, and does not have any other interest in the facility; they would exert little to no influence over whether the nursing home, center, or other similar outpatient site adopts and implements CEHRT.” Hospitalists seeking this exemption would need to apply annually for up to five years.

This hardship exemption could apply to hospitalists who work in multiple facilities outside of hospitals, such as nursing homes. Although imperfect due to the time-limited nature, the exemption represents a victory in the effort to differentiate HM from traditional practice patterns. It is precisely this difference that makes HM uniquely positioned to lead changes in the healthcare system.

Josh Boswell is SHM’s interim senior manager of government relations.

Section 10332 of the Affordable Care Act (ACA) allows the Centers for Medicare & Medicaid Services (CMS) to provide Medicare claims data to “qualified” private organizations for the purpose of reporting provider performance information. On June 8, CMS issued a proposed rule that includes tight parameters on who qualifies to receive the data, beneficiary privacy protections, and the rights of providers to correct errors before reports are made public. CMS also included estimates of the fees to receive the claims data: $275,000.

The fees are not a price as much as an effort to recoup the expense associated with providing the data. CMS has interpreted expenses to include the cost of providing technical assistance, processing qualified entities’ applications, and monitoring of qualified entities to ensure appropriate use of the data and appropriate adherence to data privacy and security standards.

For hospitalists, the opportunity to access this data presents both positives and negatives. On the positive side, research and QI data sources will be greatly expanded. Currently, it is not unheard of to receive multiple, sometimes contradictory, reports from different sources because they are based on different data from piecemeal claims or measures. This initiative grants the ability to combine private sector data with the enormous amount of data at CMS, which should result in the more useful quality reports. This broad pool of data also will allow for a new level of accuracy when it comes to analyzing quality, efficiency, and resource use.

On the negative side, the expense of obtaining this data could be cost-prohibitive for smaller organizations, and access could end up being limited to those with deeper pockets. Additionally, it will be critical to identify errors and inaccuracies in reports. As a result, hospitalists could be forced to spend time and resources reviewing privately produced performance reports before they are made public.

There is potential in this initiative to change the quality measurement landscape. If done well, the opportunity to combine claims data from both Medicare and the private sector will produce a wealth of information related to how providers and suppliers are performing.

SHM will be voicing support for the concept because it serves to increase performance transparency, not just for hospitalists but for all stakeholders.

Ready to Lead Hospital Medicine?

Join an SHM Committee

Dr. Li

When Kim Dickinson, MD, joined SHM’s Administrators Committee, it expanded her network of HM professionals. It also gave her an opportunity to take some of the best practices in the specialty to others within her company.

For other hospitalists interested in flexing leadership muscles and growing their network of hospitalists, now is the time to apply for positions on more than 30 of SHM’s committees and task forces. Potential applicants are encouraged to apply before January 2012.

Committee information and applications are available at www.hospitalmedicine.org/committees.

“SHM’s committees and task forces are the engines that drive SHM toward a vision of transforming healthcare and revolutionizing patient care in the hospital,” says SHM president Joseph Li, MD, SFHM. “And the broad span of issues covered by our committees gives every aspiring hospitalist an opportunity to channel their energy into something meaningful.”

Dr. Dickinson sees committee participation as a way to learn and grow.

“I always tell people about being on committees,” she says. “It’s a good learning experience for people, and it exposes you to a wide variety of people and different perspectives. What applies to a four-member group is very different than what applies to 40-member group.

“A lot of learning that can come from that.”

SHM’s Atchley Leadership Fund Supports the Next Generation of Hospitalist Leaders

Dr. Atchley

Hospitalist Bill Atchley, MD, SFHM, was there at the beginning of SHM’s Leadership Academy. Now, he’s helping it to endure.

After participating in the first Leadership Academy, he was hooked on the concept and later became a course facilitator.

As much as Bill has been a fixture at Leadership Academy, so has his wife, Anne. There, she saw firsthand her husband’s passion not only for the specialty, but also his passion for helping groom the next generation of hospitalist leaders. The academies also were the place where many got to see Bill and Anne together after hours, a scene that reminds hospitalists that leadership is not a solitary journey, but one to embark on with both colleagues and those closest to us.

When Anne passed in December 2009, following a valiant fight against cancer, Bill worked with SHM to create the Atchley Leadership Fund. The fund honors Anne’s memory by providing partial scholarships for Leadership Academy participants.

Hospitalists can join Bill in paying tribute to Anne and paving the way for new hospitalist leaders in healthcare by making a tax-free donation to the Atchley Leadership Fund. For more information, visit www.hospitalmedicine.org/atchley.

Section 10332 of the Affordable Care Act (ACA) allows the Centers for Medicare & Medicaid Services (CMS) to provide Medicare claims data to “qualified” private organizations for the purpose of reporting provider performance information. On June 8, CMS issued a proposed rule that includes tight parameters on who qualifies to receive the data, beneficiary privacy protections, and the rights of providers to correct errors before reports are made public. CMS also included estimates of the fees to receive the claims data: $275,000.

The fees are not a price as much as an effort to recoup the expense associated with providing the data. CMS has interpreted expenses to include the cost of providing technical assistance, processing qualified entities’ applications, and monitoring of qualified entities to ensure appropriate use of the data and appropriate adherence to data privacy and security standards.

For hospitalists, the opportunity to access this data presents both positives and negatives. On the positive side, research and QI data sources will be greatly expanded. Currently, it is not unheard of to receive multiple, sometimes contradictory, reports from different sources because they are based on different data from piecemeal claims or measures. This initiative grants the ability to combine private sector data with the enormous amount of data at CMS, which should result in the more useful quality reports. This broad pool of data also will allow for a new level of accuracy when it comes to analyzing quality, efficiency, and resource use.

On the negative side, the expense of obtaining this data could be cost-prohibitive for smaller organizations, and access could end up being limited to those with deeper pockets. Additionally, it will be critical to identify errors and inaccuracies in reports. As a result, hospitalists could be forced to spend time and resources reviewing privately produced performance reports before they are made public.

There is potential in this initiative to change the quality measurement landscape. If done well, the opportunity to combine claims data from both Medicare and the private sector will produce a wealth of information related to how providers and suppliers are performing.

SHM will be voicing support for the concept because it serves to increase performance transparency, not just for hospitalists but for all stakeholders.

Ready to Lead Hospital Medicine?

Join an SHM Committee

Dr. Li

When Kim Dickinson, MD, joined SHM’s Administrators Committee, it expanded her network of HM professionals. It also gave her an opportunity to take some of the best practices in the specialty to others within her company.

For other hospitalists interested in flexing leadership muscles and growing their network of hospitalists, now is the time to apply for positions on more than 30 of SHM’s committees and task forces. Potential applicants are encouraged to apply before January 2012.

Committee information and applications are available at www.hospitalmedicine.org/committees.

“SHM’s committees and task forces are the engines that drive SHM toward a vision of transforming healthcare and revolutionizing patient care in the hospital,” says SHM president Joseph Li, MD, SFHM. “And the broad span of issues covered by our committees gives every aspiring hospitalist an opportunity to channel their energy into something meaningful.”

Dr. Dickinson sees committee participation as a way to learn and grow.

“I always tell people about being on committees,” she says. “It’s a good learning experience for people, and it exposes you to a wide variety of people and different perspectives. What applies to a four-member group is very different than what applies to 40-member group.

“A lot of learning that can come from that.”

SHM’s Atchley Leadership Fund Supports the Next Generation of Hospitalist Leaders

Dr. Atchley

Hospitalist Bill Atchley, MD, SFHM, was there at the beginning of SHM’s Leadership Academy. Now, he’s helping it to endure.

After participating in the first Leadership Academy, he was hooked on the concept and later became a course facilitator.

As much as Bill has been a fixture at Leadership Academy, so has his wife, Anne. There, she saw firsthand her husband’s passion not only for the specialty, but also his passion for helping groom the next generation of hospitalist leaders. The academies also were the place where many got to see Bill and Anne together after hours, a scene that reminds hospitalists that leadership is not a solitary journey, but one to embark on with both colleagues and those closest to us.

When Anne passed in December 2009, following a valiant fight against cancer, Bill worked with SHM to create the Atchley Leadership Fund. The fund honors Anne’s memory by providing partial scholarships for Leadership Academy participants.

Hospitalists can join Bill in paying tribute to Anne and paving the way for new hospitalist leaders in healthcare by making a tax-free donation to the Atchley Leadership Fund. For more information, visit www.hospitalmedicine.org/atchley.

Section 10332 of the Affordable Care Act (ACA) allows the Centers for Medicare & Medicaid Services (CMS) to provide Medicare claims data to “qualified” private organizations for the purpose of reporting provider performance information. On June 8, CMS issued a proposed rule that includes tight parameters on who qualifies to receive the data, beneficiary privacy protections, and the rights of providers to correct errors before reports are made public. CMS also included estimates of the fees to receive the claims data: $275,000.

The fees are not a price as much as an effort to recoup the expense associated with providing the data. CMS has interpreted expenses to include the cost of providing technical assistance, processing qualified entities’ applications, and monitoring of qualified entities to ensure appropriate use of the data and appropriate adherence to data privacy and security standards.

For hospitalists, the opportunity to access this data presents both positives and negatives. On the positive side, research and QI data sources will be greatly expanded. Currently, it is not unheard of to receive multiple, sometimes contradictory, reports from different sources because they are based on different data from piecemeal claims or measures. This initiative grants the ability to combine private sector data with the enormous amount of data at CMS, which should result in the more useful quality reports. This broad pool of data also will allow for a new level of accuracy when it comes to analyzing quality, efficiency, and resource use.

On the negative side, the expense of obtaining this data could be cost-prohibitive for smaller organizations, and access could end up being limited to those with deeper pockets. Additionally, it will be critical to identify errors and inaccuracies in reports. As a result, hospitalists could be forced to spend time and resources reviewing privately produced performance reports before they are made public.

There is potential in this initiative to change the quality measurement landscape. If done well, the opportunity to combine claims data from both Medicare and the private sector will produce a wealth of information related to how providers and suppliers are performing.

SHM will be voicing support for the concept because it serves to increase performance transparency, not just for hospitalists but for all stakeholders.

Ready to Lead Hospital Medicine?

Join an SHM Committee

Dr. Li

When Kim Dickinson, MD, joined SHM’s Administrators Committee, it expanded her network of HM professionals. It also gave her an opportunity to take some of the best practices in the specialty to others within her company.

For other hospitalists interested in flexing leadership muscles and growing their network of hospitalists, now is the time to apply for positions on more than 30 of SHM’s committees and task forces. Potential applicants are encouraged to apply before January 2012.

Committee information and applications are available at www.hospitalmedicine.org/committees.

“SHM’s committees and task forces are the engines that drive SHM toward a vision of transforming healthcare and revolutionizing patient care in the hospital,” says SHM president Joseph Li, MD, SFHM. “And the broad span of issues covered by our committees gives every aspiring hospitalist an opportunity to channel their energy into something meaningful.”

Dr. Dickinson sees committee participation as a way to learn and grow.

“I always tell people about being on committees,” she says. “It’s a good learning experience for people, and it exposes you to a wide variety of people and different perspectives. What applies to a four-member group is very different than what applies to 40-member group.

“A lot of learning that can come from that.”

SHM’s Atchley Leadership Fund Supports the Next Generation of Hospitalist Leaders

Dr. Atchley

Hospitalist Bill Atchley, MD, SFHM, was there at the beginning of SHM’s Leadership Academy. Now, he’s helping it to endure.

After participating in the first Leadership Academy, he was hooked on the concept and later became a course facilitator.

As much as Bill has been a fixture at Leadership Academy, so has his wife, Anne. There, she saw firsthand her husband’s passion not only for the specialty, but also his passion for helping groom the next generation of hospitalist leaders. The academies also were the place where many got to see Bill and Anne together after hours, a scene that reminds hospitalists that leadership is not a solitary journey, but one to embark on with both colleagues and those closest to us.

When Anne passed in December 2009, following a valiant fight against cancer, Bill worked with SHM to create the Atchley Leadership Fund. The fund honors Anne’s memory by providing partial scholarships for Leadership Academy participants.

Hospitalists can join Bill in paying tribute to Anne and paving the way for new hospitalist leaders in healthcare by making a tax-free donation to the Atchley Leadership Fund. For more information, visit www.hospitalmedicine.org/atchley.

The federal government is taking a hard look at many of its regulations, and hospitalists might have the chance to help identify those that no longer make sense.

On Jan. 18, President Obama issued Executive Order 13563, which calls, in part, for a comprehensive retrospective review of existing government regulations. The stated goal of this review is to improve or remove those rules that are out of date, unnecessary, excessively burdensome, or in conflict with other rules.

The Office of Information and Regulatory Affairs (OIRA), the executive-level department charged with overseeing the execution of this order, asked federal agencies to submit preliminary plans for how they will conduct their internal reviews. The agencies responded, and on May 26, the White House released 30 agency preliminary plans to the public, including those prepared by the Department of Commerce, the Department of Energy, and the Department of Health and Human Services (HHS).

When reviewing some of these publicly available preliminary plans, the easy answer for some observers is to say that most rules should be eliminated. Rules requiring the use of such technologies as film X-rays instead of digital images are obvious culprits in the out-of date category; rules defining milk as "oil" (subjecting it to the same costly environmental safeguards as real oil) are just as absurd. Both of these regulations are being lifted as a result of the review.

In contrast, many rules actually do protect public health and safety and will not be subject to review. For example, as a result of federal rulemaking, highway deaths are at the lowest level in 60 years and the risk of contracting salmonella from eggs is relatively low.

As part of HHS, the Center for Medicare & Medicaid Services (CMS) specifically stated that "the goal of the retrospective review will be to identify opportunities to improve patient care and outcomes and reduce system costs by removing obsolete or burdensome requirements." A major CMS concern will be to prevent the elimination or revision of a regulation only to find that the problem it sought to solve resurfaces, or that its removal or revision results in unanticipated and more serious outcomes.

This review could significantly impact HM in areas of quality measurement and reporting requirements:

• What quality measurements might not accomplish their intent?
• What measures might result in more harm than good?
• What reporting or process requirements could be changed to make for less duplication?
• If requirements cannot be eliminated, how can they be improved?

Due to hospitalist expertise in quality-improvement (QI) efforts and cost containment, these stated goals and the concerns that come with them are areas where hospitalists are likely to have some good answers. Hospitalists should not hesitate to provide their input to SHM Government Relations staff so that your ideas can be shared with CMS.

A complete list of agency proposals is available at www.whitehouse.gov/21stcentury gov/actions/21st-century-regulatory-system.

The federal government is taking a hard look at many of its regulations, and hospitalists might have the chance to help identify those that no longer make sense.

On Jan. 18, President Obama issued Executive Order 13563, which calls, in part, for a comprehensive retrospective review of existing government regulations. The stated goal of this review is to improve or remove those rules that are out of date, unnecessary, excessively burdensome, or in conflict with other rules.

The Office of Information and Regulatory Affairs (OIRA), the executive-level department charged with overseeing the execution of this order, asked federal agencies to submit preliminary plans for how they will conduct their internal reviews. The agencies responded, and on May 26, the White House released 30 agency preliminary plans to the public, including those prepared by the Department of Commerce, the Department of Energy, and the Department of Health and Human Services (HHS).

When reviewing some of these publicly available preliminary plans, the easy answer for some observers is to say that most rules should be eliminated. Rules requiring the use of such technologies as film X-rays instead of digital images are obvious culprits in the out-of date category; rules defining milk as "oil" (subjecting it to the same costly environmental safeguards as real oil) are just as absurd. Both of these regulations are being lifted as a result of the review.

In contrast, many rules actually do protect public health and safety and will not be subject to review. For example, as a result of federal rulemaking, highway deaths are at the lowest level in 60 years and the risk of contracting salmonella from eggs is relatively low.

As part of HHS, the Center for Medicare & Medicaid Services (CMS) specifically stated that "the goal of the retrospective review will be to identify opportunities to improve patient care and outcomes and reduce system costs by removing obsolete or burdensome requirements." A major CMS concern will be to prevent the elimination or revision of a regulation only to find that the problem it sought to solve resurfaces, or that its removal or revision results in unanticipated and more serious outcomes.

This review could significantly impact HM in areas of quality measurement and reporting requirements:

• What quality measurements might not accomplish their intent?
• What measures might result in more harm than good?
• What reporting or process requirements could be changed to make for less duplication?
• If requirements cannot be eliminated, how can they be improved?

Due to hospitalist expertise in quality-improvement (QI) efforts and cost containment, these stated goals and the concerns that come with them are areas where hospitalists are likely to have some good answers. Hospitalists should not hesitate to provide their input to SHM Government Relations staff so that your ideas can be shared with CMS.

A complete list of agency proposals is available at www.whitehouse.gov/21stcentury gov/actions/21st-century-regulatory-system.

The federal government is taking a hard look at many of its regulations, and hospitalists might have the chance to help identify those that no longer make sense.

On Jan. 18, President Obama issued Executive Order 13563, which calls, in part, for a comprehensive retrospective review of existing government regulations. The stated goal of this review is to improve or remove those rules that are out of date, unnecessary, excessively burdensome, or in conflict with other rules.

The Office of Information and Regulatory Affairs (OIRA), the executive-level department charged with overseeing the execution of this order, asked federal agencies to submit preliminary plans for how they will conduct their internal reviews. The agencies responded, and on May 26, the White House released 30 agency preliminary plans to the public, including those prepared by the Department of Commerce, the Department of Energy, and the Department of Health and Human Services (HHS).

When reviewing some of these publicly available preliminary plans, the easy answer for some observers is to say that most rules should be eliminated. Rules requiring the use of such technologies as film X-rays instead of digital images are obvious culprits in the out-of date category; rules defining milk as "oil" (subjecting it to the same costly environmental safeguards as real oil) are just as absurd. Both of these regulations are being lifted as a result of the review.

In contrast, many rules actually do protect public health and safety and will not be subject to review. For example, as a result of federal rulemaking, highway deaths are at the lowest level in 60 years and the risk of contracting salmonella from eggs is relatively low.

As part of HHS, the Center for Medicare & Medicaid Services (CMS) specifically stated that "the goal of the retrospective review will be to identify opportunities to improve patient care and outcomes and reduce system costs by removing obsolete or burdensome requirements." A major CMS concern will be to prevent the elimination or revision of a regulation only to find that the problem it sought to solve resurfaces, or that its removal or revision results in unanticipated and more serious outcomes.

This review could significantly impact HM in areas of quality measurement and reporting requirements:

• What quality measurements might not accomplish their intent?
• What measures might result in more harm than good?
• What reporting or process requirements could be changed to make for less duplication?
• If requirements cannot be eliminated, how can they be improved?

Due to hospitalist expertise in quality-improvement (QI) efforts and cost containment, these stated goals and the concerns that come with them are areas where hospitalists are likely to have some good answers. Hospitalists should not hesitate to provide their input to SHM Government Relations staff so that your ideas can be shared with CMS.

A complete list of agency proposals is available at www.whitehouse.gov/21stcentury gov/actions/21st-century-regulatory-system.