Joshua Lapps

Can quality measurement and comparisons serve as the backbone for a major shift in the Medicare payment system to reward value instead of volume? That is the question being explored over the next few years as the Physician Quality Reporting System (PQRS) and, by extension, the physician value-based payment modifier (VBPM) come fully into effect for all physicians.

There seems to be a consensus in the policy community that the fee-for-service model of payment is past its prime and needs to be replaced with a more dynamic and responsive payment system. Medicare hopes that PQRS and the VBPM will enable adjustments to physician payments to reward high-quality and low-cost care. Although these programs currently are add-ons to the fee-for-service system, they likely will serve as stepping stones to more radical departures from the existing payment system.

SHM advocates refinements to policies for PQRS and similar programs to make them more meaningful and productive for both hospitalists and the broader health-care system. Each year, SHM submits comments on the Physician Fee Schedule Rule, which creates and updates the regulatory framework for PQRS and the VBPM. SHM also provided feedback on Quality and Resource Use Reports (QRURs), the report cards for the modifier that were being tested over the past year.

From a practical standpoint, SHM engages with measure development and endorsement processes to ensure there are reportable quality measures in PQRS that fit hospitalist practice. In addition, SHM is helping to increase accessibility to PQRS reporting by offering members reduced fare access to registry reporting through the PQRI Wizard.

The comments range from the technical aspects of individual quality measures in PQRS to how hospitalists appear to be performing in these programs. SHM firmly believes that the unique positioning of hospitalists within the health-care system presents challenges for their identification and evaluation in Medicare programs. In some sense, hospitalists exist on the line between the inpatient and outpatient worlds, a location not adequately captured in pay-for-performance programs.

It’s imperative that pay-for-performance programs have reasonable and actionable outcomes for providers. If quality measures are not clinically meaningful and do not capture a plurality of the care provided by an individual hospitalist, it is difficult for the program to meet its stated aims. If payment is to be influenced by performance on quality measures, it follows that those measures should be relevant to the care provided.

There is a long way to go toward creating quality measurement and evaluation programs that are relevant and actionable for clinical quality improvement (QI). By becoming involved in SHM’s policy efforts, members are able to share their experiences and impressions of programs with SHM and lawmakers. This partnership helps create more responsive and intuitive programs, which in turn leads to greater participation and, hopefully, improved patient outcomes. As these programs continue to evolve and more health professionals are required to participate, SHM will be looking to its membership for their perspectives.

Join the grassroots network to stay involved and up to date by registering at www.hospitalmedicine.org/grassroots.

Joshua Lapps is SHM’s government relations specialist.

Can quality measurement and comparisons serve as the backbone for a major shift in the Medicare payment system to reward value instead of volume? That is the question being explored over the next few years as the Physician Quality Reporting System (PQRS) and, by extension, the physician value-based payment modifier (VBPM) come fully into effect for all physicians.

There seems to be a consensus in the policy community that the fee-for-service model of payment is past its prime and needs to be replaced with a more dynamic and responsive payment system. Medicare hopes that PQRS and the VBPM will enable adjustments to physician payments to reward high-quality and low-cost care. Although these programs currently are add-ons to the fee-for-service system, they likely will serve as stepping stones to more radical departures from the existing payment system.

SHM advocates refinements to policies for PQRS and similar programs to make them more meaningful and productive for both hospitalists and the broader health-care system. Each year, SHM submits comments on the Physician Fee Schedule Rule, which creates and updates the regulatory framework for PQRS and the VBPM. SHM also provided feedback on Quality and Resource Use Reports (QRURs), the report cards for the modifier that were being tested over the past year.

From a practical standpoint, SHM engages with measure development and endorsement processes to ensure there are reportable quality measures in PQRS that fit hospitalist practice. In addition, SHM is helping to increase accessibility to PQRS reporting by offering members reduced fare access to registry reporting through the PQRI Wizard.

The comments range from the technical aspects of individual quality measures in PQRS to how hospitalists appear to be performing in these programs. SHM firmly believes that the unique positioning of hospitalists within the health-care system presents challenges for their identification and evaluation in Medicare programs. In some sense, hospitalists exist on the line between the inpatient and outpatient worlds, a location not adequately captured in pay-for-performance programs.

It’s imperative that pay-for-performance programs have reasonable and actionable outcomes for providers. If quality measures are not clinically meaningful and do not capture a plurality of the care provided by an individual hospitalist, it is difficult for the program to meet its stated aims. If payment is to be influenced by performance on quality measures, it follows that those measures should be relevant to the care provided.

There is a long way to go toward creating quality measurement and evaluation programs that are relevant and actionable for clinical quality improvement (QI). By becoming involved in SHM’s policy efforts, members are able to share their experiences and impressions of programs with SHM and lawmakers. This partnership helps create more responsive and intuitive programs, which in turn leads to greater participation and, hopefully, improved patient outcomes. As these programs continue to evolve and more health professionals are required to participate, SHM will be looking to its membership for their perspectives.

Join the grassroots network to stay involved and up to date by registering at www.hospitalmedicine.org/grassroots.

Joshua Lapps is SHM’s government relations specialist.

Can quality measurement and comparisons serve as the backbone for a major shift in the Medicare payment system to reward value instead of volume? That is the question being explored over the next few years as the Physician Quality Reporting System (PQRS) and, by extension, the physician value-based payment modifier (VBPM) come fully into effect for all physicians.

There seems to be a consensus in the policy community that the fee-for-service model of payment is past its prime and needs to be replaced with a more dynamic and responsive payment system. Medicare hopes that PQRS and the VBPM will enable adjustments to physician payments to reward high-quality and low-cost care. Although these programs currently are add-ons to the fee-for-service system, they likely will serve as stepping stones to more radical departures from the existing payment system.

SHM advocates refinements to policies for PQRS and similar programs to make them more meaningful and productive for both hospitalists and the broader health-care system. Each year, SHM submits comments on the Physician Fee Schedule Rule, which creates and updates the regulatory framework for PQRS and the VBPM. SHM also provided feedback on Quality and Resource Use Reports (QRURs), the report cards for the modifier that were being tested over the past year.

From a practical standpoint, SHM engages with measure development and endorsement processes to ensure there are reportable quality measures in PQRS that fit hospitalist practice. In addition, SHM is helping to increase accessibility to PQRS reporting by offering members reduced fare access to registry reporting through the PQRI Wizard.

The comments range from the technical aspects of individual quality measures in PQRS to how hospitalists appear to be performing in these programs. SHM firmly believes that the unique positioning of hospitalists within the health-care system presents challenges for their identification and evaluation in Medicare programs. In some sense, hospitalists exist on the line between the inpatient and outpatient worlds, a location not adequately captured in pay-for-performance programs.

It’s imperative that pay-for-performance programs have reasonable and actionable outcomes for providers. If quality measures are not clinically meaningful and do not capture a plurality of the care provided by an individual hospitalist, it is difficult for the program to meet its stated aims. If payment is to be influenced by performance on quality measures, it follows that those measures should be relevant to the care provided.

There is a long way to go toward creating quality measurement and evaluation programs that are relevant and actionable for clinical quality improvement (QI). By becoming involved in SHM’s policy efforts, members are able to share their experiences and impressions of programs with SHM and lawmakers. This partnership helps create more responsive and intuitive programs, which in turn leads to greater participation and, hopefully, improved patient outcomes. As these programs continue to evolve and more health professionals are required to participate, SHM will be looking to its membership for their perspectives.

Join the grassroots network to stay involved and up to date by registering at www.hospitalmedicine.org/grassroots.

Joshua Lapps is SHM’s government relations specialist.

Medicare requires beneficiaries to have at least three consecutive days as a hospital inpatient to qualify for Medicare-covered skilled nursing facility (SNF) care. As the use and duration of observation status continues to rise throughout the nation, patients have been getting caught more frequently within a policy trap: Even though they are physically within the hospital and generally receive care that is indistinguishable from the care received by other inpatients, Medicare is not covering their subsequent SNF stays.

Why? Observation status is considered “outpatient” by both the hospital and Medicare and, therefore, is not counted toward Medicare’s three-day rule.

This leaves seniors on the hook for their skilled nursing care costs, which often exceed their ability to pay. Further, this shortsighted policy might actually result in a net greater cost to Medicare and the health-care system. Faced with mounting costs, many seniors truncate or opt out of SNF care altogether, leaving them vulnerable to added health issues (e.g. dehydration, falls). With new conditions that were not present at the time of the original hospital stay, many of these seniors are at risk to return to the hospital and become another readmission statistic.

As key players in hospitals and, increasingly, in skilled nursing facilities, hospitalists are caught squarely in the middle of this policy. Transitions of care both in and out of these institutions should be guided by sound medical decision-making, not whether Medicare will cover the costs incurred. Although the three-day rule—and, indeed, observation status itself—was originally cast as a cost-containment policy, such policies should incorporate broader care process and delivery reforms that do not add burden to patients when they are at their most vulnerable.

SHM affirms that it is sensible for Medicare to provide coverage for skilled nursing care if a clinician recommends it as part of a treatment plan. Coverage determination should not be beholden to a patient status subject to other systemic pressures, but should reflect the best interest of the patient and the care ordered by providers.

The Improving Access to Medicare Coverage Act, sponsored by Rep. Joe Courtney (D-Conn.), Rep. Tom Latham (R-Iowa), and Sen. Sherrod Brown (D-Ohio), would clarify the law to indicate that Medicare beneficiaries in observation status are deemed inpatients in the hospital for the purposes of the three-day requirement for SNF coverage. This simple adjustment would ensure that patients are able to access the skilled nursing care they need and that providers do not have to worry about this systemic barrier to patient care.

SHM is actively supporting this legislation. A letter of support was sent to Courtney and Brown earlier this year, and membership was mobilized to take action through our Legislative Action Center (www.hospitalmedicine.org/advocacy). Hospitalists also plan to voice their support for the legislation during Hospitalists on the Hill, to be held this month in conjunction with HM13.

As one of only a few specialty medical societies that are active on this issue, SHM stands out as a leader on health-care-system reforms that improve access to care for patients and reduce administrative barriers to medically appropriate care.

Joshua Lapps is SHM’s government relations specialist.

Medicare requires beneficiaries to have at least three consecutive days as a hospital inpatient to qualify for Medicare-covered skilled nursing facility (SNF) care. As the use and duration of observation status continues to rise throughout the nation, patients have been getting caught more frequently within a policy trap: Even though they are physically within the hospital and generally receive care that is indistinguishable from the care received by other inpatients, Medicare is not covering their subsequent SNF stays.

Why? Observation status is considered “outpatient” by both the hospital and Medicare and, therefore, is not counted toward Medicare’s three-day rule.

This leaves seniors on the hook for their skilled nursing care costs, which often exceed their ability to pay. Further, this shortsighted policy might actually result in a net greater cost to Medicare and the health-care system. Faced with mounting costs, many seniors truncate or opt out of SNF care altogether, leaving them vulnerable to added health issues (e.g. dehydration, falls). With new conditions that were not present at the time of the original hospital stay, many of these seniors are at risk to return to the hospital and become another readmission statistic.

As key players in hospitals and, increasingly, in skilled nursing facilities, hospitalists are caught squarely in the middle of this policy. Transitions of care both in and out of these institutions should be guided by sound medical decision-making, not whether Medicare will cover the costs incurred. Although the three-day rule—and, indeed, observation status itself—was originally cast as a cost-containment policy, such policies should incorporate broader care process and delivery reforms that do not add burden to patients when they are at their most vulnerable.

SHM affirms that it is sensible for Medicare to provide coverage for skilled nursing care if a clinician recommends it as part of a treatment plan. Coverage determination should not be beholden to a patient status subject to other systemic pressures, but should reflect the best interest of the patient and the care ordered by providers.

The Improving Access to Medicare Coverage Act, sponsored by Rep. Joe Courtney (D-Conn.), Rep. Tom Latham (R-Iowa), and Sen. Sherrod Brown (D-Ohio), would clarify the law to indicate that Medicare beneficiaries in observation status are deemed inpatients in the hospital for the purposes of the three-day requirement for SNF coverage. This simple adjustment would ensure that patients are able to access the skilled nursing care they need and that providers do not have to worry about this systemic barrier to patient care.

SHM is actively supporting this legislation. A letter of support was sent to Courtney and Brown earlier this year, and membership was mobilized to take action through our Legislative Action Center (www.hospitalmedicine.org/advocacy). Hospitalists also plan to voice their support for the legislation during Hospitalists on the Hill, to be held this month in conjunction with HM13.

As one of only a few specialty medical societies that are active on this issue, SHM stands out as a leader on health-care-system reforms that improve access to care for patients and reduce administrative barriers to medically appropriate care.

Joshua Lapps is SHM’s government relations specialist.

Medicare requires beneficiaries to have at least three consecutive days as a hospital inpatient to qualify for Medicare-covered skilled nursing facility (SNF) care. As the use and duration of observation status continues to rise throughout the nation, patients have been getting caught more frequently within a policy trap: Even though they are physically within the hospital and generally receive care that is indistinguishable from the care received by other inpatients, Medicare is not covering their subsequent SNF stays.

Why? Observation status is considered “outpatient” by both the hospital and Medicare and, therefore, is not counted toward Medicare’s three-day rule.

This leaves seniors on the hook for their skilled nursing care costs, which often exceed their ability to pay. Further, this shortsighted policy might actually result in a net greater cost to Medicare and the health-care system. Faced with mounting costs, many seniors truncate or opt out of SNF care altogether, leaving them vulnerable to added health issues (e.g. dehydration, falls). With new conditions that were not present at the time of the original hospital stay, many of these seniors are at risk to return to the hospital and become another readmission statistic.

As key players in hospitals and, increasingly, in skilled nursing facilities, hospitalists are caught squarely in the middle of this policy. Transitions of care both in and out of these institutions should be guided by sound medical decision-making, not whether Medicare will cover the costs incurred. Although the three-day rule—and, indeed, observation status itself—was originally cast as a cost-containment policy, such policies should incorporate broader care process and delivery reforms that do not add burden to patients when they are at their most vulnerable.

SHM affirms that it is sensible for Medicare to provide coverage for skilled nursing care if a clinician recommends it as part of a treatment plan. Coverage determination should not be beholden to a patient status subject to other systemic pressures, but should reflect the best interest of the patient and the care ordered by providers.

The Improving Access to Medicare Coverage Act, sponsored by Rep. Joe Courtney (D-Conn.), Rep. Tom Latham (R-Iowa), and Sen. Sherrod Brown (D-Ohio), would clarify the law to indicate that Medicare beneficiaries in observation status are deemed inpatients in the hospital for the purposes of the three-day requirement for SNF coverage. This simple adjustment would ensure that patients are able to access the skilled nursing care they need and that providers do not have to worry about this systemic barrier to patient care.

SHM is actively supporting this legislation. A letter of support was sent to Courtney and Brown earlier this year, and membership was mobilized to take action through our Legislative Action Center (www.hospitalmedicine.org/advocacy). Hospitalists also plan to voice their support for the legislation during Hospitalists on the Hill, to be held this month in conjunction with HM13.

As one of only a few specialty medical societies that are active on this issue, SHM stands out as a leader on health-care-system reforms that improve access to care for patients and reduce administrative barriers to medically appropriate care.

Joshua Lapps is SHM’s government relations specialist.

Hospitalists on the Hill

WHEN: May 16, 2013

WHERE: Washington, D.C.

HOW: Register today at www.hospitalmedicine2013.org/onthehill Space is limited.

The American Taxpayer Relief Act, which was signed into law Jan. 3 to stave off the fiscal cliff, contained a little-mentioned provision that reauthorized $10 million in Medicare funding for the National Quality Forum (NQF). Hospitalists, taking on the role of policy advocates, helped secure this reauthorization and score a victory for national quality-improvement (QI) efforts.

The NQF is a nonprofit organization established to create consensus around national priorities and measures for performing reporting and improvement in healthcare. It receives funding through a variety of sources ranging from public funds, private organizations and membership dues. Since 2009, it has received $10 million annually from a U.S. Department of Health and Human Services contract. That contract, a significant portion of NQF funding, was set to end in 2012.

The Stand for Quality coalition, composed of healthcare organizations supportive of the NQF, helps ensure that Congress sustains funding and support of performance measurement reporting and QI. SHM historically has been a strong proponent of the NQF, pitching in at the start of Stand for Quality four years ago this month. As it became clear that the federal contract for the NQF was not likely to be renewed by Congress for the 2013 calendar year, the member organizations of Stand for Quality were asked to step up to the plate in any way they could.

Jumping at the opportunity to assist, SHM linked hospitalists to their members of Congress in support of the NQF. Through members of SHM's Public Policy and Performance Measurement and Reporting committees, SHM connected with congressional offices and urged them to join a sign-on letter from the office of U.S. Sen. Mark Begich (D-Alaska) office in support of continued NQF funding. Letters between members of Congress are a way that legislators internally lobby on behalf of a particular issue. Hearing from their constituents can help persuade a legislator to act.

Sharing professional expertise also can inform a legislator's decisions. SHM members have a wealth of specialized knowledge and experiences that greatly benefit health policy discussions. In December 2012, SHM was asked to join NQF staffers and several other organizations on Capitol Hill for visits with select members of Congress, including several physician-legislators. These meetings were designed to raise the profile of the important work NQF is doing for QI and to make sure that NQF funding was not forgotten in any debt deal.

Mangla Gulati, MD, FACP, FHM, a hospitalist and SHM member, participated in these visits on behalf of hospital medicine and provided much-needed physician input on the importance of NQF's work.

The benefits of in-person visits are mutual: Members of Congress learn more about the real-life effects of a particular policy and, according to Dr. Gulati, "the visits to the Hill were a very valuable experience and shed a whole new light on the challenges we face in medicine."

Taken together, these advocacy tactics—coalition-building, contacting congressional offices, and in-person visits in Washington—were crucial to securing NQF's funding reauthorization and are critical tools for the advocacy work at SHM. The most concrete and impactful advocacy includes positioning hospitalists on the front line and sharing their perspectives and experiences with policymakers and their staffs.

We hope you'll heed this call and join SHM in Washington, D.C., May 16 for Hospitalists on the Hill, part of SHM's annual meeting. For more information and to register, go to www.hospitalmedicine2013.org/onthehill.

Joshua Lapps is SHM's government relations specialist.

Hospitalists on the Hill

WHEN: May 16, 2013

WHERE: Washington, D.C.

HOW: Register today at www.hospitalmedicine2013.org/onthehill Space is limited.

The American Taxpayer Relief Act, which was signed into law Jan. 3 to stave off the fiscal cliff, contained a little-mentioned provision that reauthorized $10 million in Medicare funding for the National Quality Forum (NQF). Hospitalists, taking on the role of policy advocates, helped secure this reauthorization and score a victory for national quality-improvement (QI) efforts.

The NQF is a nonprofit organization established to create consensus around national priorities and measures for performing reporting and improvement in healthcare. It receives funding through a variety of sources ranging from public funds, private organizations and membership dues. Since 2009, it has received $10 million annually from a U.S. Department of Health and Human Services contract. That contract, a significant portion of NQF funding, was set to end in 2012.

The Stand for Quality coalition, composed of healthcare organizations supportive of the NQF, helps ensure that Congress sustains funding and support of performance measurement reporting and QI. SHM historically has been a strong proponent of the NQF, pitching in at the start of Stand for Quality four years ago this month. As it became clear that the federal contract for the NQF was not likely to be renewed by Congress for the 2013 calendar year, the member organizations of Stand for Quality were asked to step up to the plate in any way they could.

Jumping at the opportunity to assist, SHM linked hospitalists to their members of Congress in support of the NQF. Through members of SHM's Public Policy and Performance Measurement and Reporting committees, SHM connected with congressional offices and urged them to join a sign-on letter from the office of U.S. Sen. Mark Begich (D-Alaska) office in support of continued NQF funding. Letters between members of Congress are a way that legislators internally lobby on behalf of a particular issue. Hearing from their constituents can help persuade a legislator to act.

Sharing professional expertise also can inform a legislator's decisions. SHM members have a wealth of specialized knowledge and experiences that greatly benefit health policy discussions. In December 2012, SHM was asked to join NQF staffers and several other organizations on Capitol Hill for visits with select members of Congress, including several physician-legislators. These meetings were designed to raise the profile of the important work NQF is doing for QI and to make sure that NQF funding was not forgotten in any debt deal.

Mangla Gulati, MD, FACP, FHM, a hospitalist and SHM member, participated in these visits on behalf of hospital medicine and provided much-needed physician input on the importance of NQF's work.

The benefits of in-person visits are mutual: Members of Congress learn more about the real-life effects of a particular policy and, according to Dr. Gulati, "the visits to the Hill were a very valuable experience and shed a whole new light on the challenges we face in medicine."

Taken together, these advocacy tactics—coalition-building, contacting congressional offices, and in-person visits in Washington—were crucial to securing NQF's funding reauthorization and are critical tools for the advocacy work at SHM. The most concrete and impactful advocacy includes positioning hospitalists on the front line and sharing their perspectives and experiences with policymakers and their staffs.

We hope you'll heed this call and join SHM in Washington, D.C., May 16 for Hospitalists on the Hill, part of SHM's annual meeting. For more information and to register, go to www.hospitalmedicine2013.org/onthehill.

Joshua Lapps is SHM's government relations specialist.

Hospitalists on the Hill

WHEN: May 16, 2013

WHERE: Washington, D.C.

HOW: Register today at www.hospitalmedicine2013.org/onthehill Space is limited.

The American Taxpayer Relief Act, which was signed into law Jan. 3 to stave off the fiscal cliff, contained a little-mentioned provision that reauthorized $10 million in Medicare funding for the National Quality Forum (NQF). Hospitalists, taking on the role of policy advocates, helped secure this reauthorization and score a victory for national quality-improvement (QI) efforts.

The NQF is a nonprofit organization established to create consensus around national priorities and measures for performing reporting and improvement in healthcare. It receives funding through a variety of sources ranging from public funds, private organizations and membership dues. Since 2009, it has received $10 million annually from a U.S. Department of Health and Human Services contract. That contract, a significant portion of NQF funding, was set to end in 2012.

The Stand for Quality coalition, composed of healthcare organizations supportive of the NQF, helps ensure that Congress sustains funding and support of performance measurement reporting and QI. SHM historically has been a strong proponent of the NQF, pitching in at the start of Stand for Quality four years ago this month. As it became clear that the federal contract for the NQF was not likely to be renewed by Congress for the 2013 calendar year, the member organizations of Stand for Quality were asked to step up to the plate in any way they could.

Jumping at the opportunity to assist, SHM linked hospitalists to their members of Congress in support of the NQF. Through members of SHM's Public Policy and Performance Measurement and Reporting committees, SHM connected with congressional offices and urged them to join a sign-on letter from the office of U.S. Sen. Mark Begich (D-Alaska) office in support of continued NQF funding. Letters between members of Congress are a way that legislators internally lobby on behalf of a particular issue. Hearing from their constituents can help persuade a legislator to act.

Sharing professional expertise also can inform a legislator's decisions. SHM members have a wealth of specialized knowledge and experiences that greatly benefit health policy discussions. In December 2012, SHM was asked to join NQF staffers and several other organizations on Capitol Hill for visits with select members of Congress, including several physician-legislators. These meetings were designed to raise the profile of the important work NQF is doing for QI and to make sure that NQF funding was not forgotten in any debt deal.

Mangla Gulati, MD, FACP, FHM, a hospitalist and SHM member, participated in these visits on behalf of hospital medicine and provided much-needed physician input on the importance of NQF's work.

The benefits of in-person visits are mutual: Members of Congress learn more about the real-life effects of a particular policy and, according to Dr. Gulati, "the visits to the Hill were a very valuable experience and shed a whole new light on the challenges we face in medicine."

Taken together, these advocacy tactics—coalition-building, contacting congressional offices, and in-person visits in Washington—were crucial to securing NQF's funding reauthorization and are critical tools for the advocacy work at SHM. The most concrete and impactful advocacy includes positioning hospitalists on the front line and sharing their perspectives and experiences with policymakers and their staffs.

We hope you'll heed this call and join SHM in Washington, D.C., May 16 for Hospitalists on the Hill, part of SHM's annual meeting. For more information and to register, go to www.hospitalmedicine2013.org/onthehill.

Joshua Lapps is SHM's government relations specialist.

Patient-level and institution-level advocacy often come naturally to physicians and health professionals. This level of involvement is integral to providing the best care for patients. Interestingly, a 2006 JAMA study showed that physicians overwhelmingly rated political involvement and collective advocacy as important to their work as healthcare professionals, at 91.6% and 97.0%, respectively. In practice, however, only about a quarter of respondents in the study participated in either type of activity in the past three years.¹

Part of SHM’s advocacy goal is to help hospitalists bridge the divide between their attitudes about political advocacy and their behavior.

Any number of barriers might exist for hospitalists to take action and participate in political action and health policy. Anecdotally, these range from a lack of comfort around the issues to lack of time to the opacity of the process to the unclear impact of individual efforts.

As a medical society, SHM serves a pivotal role in representing the views and perspectives of hospitalists in the health policy arena. Still, these efforts could be greatly intensified with more robust involvement from members. One tactic used by the society is advocacy action alerts that encourage members to engage directly with their elected representatives on policy issues of interest to hospitalists.

For example, a recent alert illustrated the potentially devastating impact of the impending budget sequester. As a budget-deficit and spending reduction mechanism, the budget sequester is poised to institute across-the-board cuts to defense and nondefense spending. For its part, the U.S. Department of Health and Human Services will see an approximate 8.2% cut in its budget, removing critical money from health programs and research funding. These are programs and research efforts in which hospitalists participate.

The action alert culminates with a customizable message that can be easily sent to members of Congress. Quick and easy, the action alert allows SHM members to participate in advocacy efforts with very little time investment. By sending messages to Congress, SHM members are able to share their expertise and perspectives on health policy, as both health professionals and constituents.

The impact of a single message to Congress, of course, is not always clear or easily definable. Advocacy, unfortunately, does not often show immediate results and requires a nuanced, multifaceted, long-term strategy. However, input directly from constituents is consistently rated among the most influential tactics for influencing Congress, and that includes emails, phone calls and in-person visits.²

SHM will continue to ask members to join in its advocacy efforts and, at the next annual meeting, invites all members to partake in in-person visits with their members of Congress during Hospitalists on the Hill. Medicine is as much about the systems as it is the one-on-one interactions; politics is no different. By communicating and meeting with lawmakers one on one, SHM members will continue to have a meaningful impact on the policies that frame the healthcare system. Join us as we continue to grow these efforts.

For more information about Hospitalists on the Hill, visit www.hospitalmedicine2013.org/advocacy.

Joshua Lapps is SHM’s government relations specialist.

References

1. Gruen RL, Campbell EG, Blumenthal D. Public roles of US physicians: community participation, political involvement, and collective advocacy. JAMA. 2006;296(20):2467-2475.
2. The Partnership for A More Perfect Union at the Congressional Management Foundation. Communicating with Congress: Perceptions of Citizen Advocacy on Capitol Hill. Congressional Management Foundation website. Available at: http://www.congressfoundation.org/projects/communicating-with-congress/perceptions-of-citizen-advocacy-on-capitol-hill. Accessed Nov. 1, 2012.

Patient-level and institution-level advocacy often come naturally to physicians and health professionals. This level of involvement is integral to providing the best care for patients. Interestingly, a 2006 JAMA study showed that physicians overwhelmingly rated political involvement and collective advocacy as important to their work as healthcare professionals, at 91.6% and 97.0%, respectively. In practice, however, only about a quarter of respondents in the study participated in either type of activity in the past three years.¹

Part of SHM’s advocacy goal is to help hospitalists bridge the divide between their attitudes about political advocacy and their behavior.

Any number of barriers might exist for hospitalists to take action and participate in political action and health policy. Anecdotally, these range from a lack of comfort around the issues to lack of time to the opacity of the process to the unclear impact of individual efforts.

As a medical society, SHM serves a pivotal role in representing the views and perspectives of hospitalists in the health policy arena. Still, these efforts could be greatly intensified with more robust involvement from members. One tactic used by the society is advocacy action alerts that encourage members to engage directly with their elected representatives on policy issues of interest to hospitalists.

For example, a recent alert illustrated the potentially devastating impact of the impending budget sequester. As a budget-deficit and spending reduction mechanism, the budget sequester is poised to institute across-the-board cuts to defense and nondefense spending. For its part, the U.S. Department of Health and Human Services will see an approximate 8.2% cut in its budget, removing critical money from health programs and research funding. These are programs and research efforts in which hospitalists participate.

The action alert culminates with a customizable message that can be easily sent to members of Congress. Quick and easy, the action alert allows SHM members to participate in advocacy efforts with very little time investment. By sending messages to Congress, SHM members are able to share their expertise and perspectives on health policy, as both health professionals and constituents.

The impact of a single message to Congress, of course, is not always clear or easily definable. Advocacy, unfortunately, does not often show immediate results and requires a nuanced, multifaceted, long-term strategy. However, input directly from constituents is consistently rated among the most influential tactics for influencing Congress, and that includes emails, phone calls and in-person visits.²

SHM will continue to ask members to join in its advocacy efforts and, at the next annual meeting, invites all members to partake in in-person visits with their members of Congress during Hospitalists on the Hill. Medicine is as much about the systems as it is the one-on-one interactions; politics is no different. By communicating and meeting with lawmakers one on one, SHM members will continue to have a meaningful impact on the policies that frame the healthcare system. Join us as we continue to grow these efforts.

For more information about Hospitalists on the Hill, visit www.hospitalmedicine2013.org/advocacy.

Joshua Lapps is SHM’s government relations specialist.

References

1. Gruen RL, Campbell EG, Blumenthal D. Public roles of US physicians: community participation, political involvement, and collective advocacy. JAMA. 2006;296(20):2467-2475.
2. The Partnership for A More Perfect Union at the Congressional Management Foundation. Communicating with Congress: Perceptions of Citizen Advocacy on Capitol Hill. Congressional Management Foundation website. Available at: http://www.congressfoundation.org/projects/communicating-with-congress/perceptions-of-citizen-advocacy-on-capitol-hill. Accessed Nov. 1, 2012.

Patient-level and institution-level advocacy often come naturally to physicians and health professionals. This level of involvement is integral to providing the best care for patients. Interestingly, a 2006 JAMA study showed that physicians overwhelmingly rated political involvement and collective advocacy as important to their work as healthcare professionals, at 91.6% and 97.0%, respectively. In practice, however, only about a quarter of respondents in the study participated in either type of activity in the past three years.¹

Part of SHM’s advocacy goal is to help hospitalists bridge the divide between their attitudes about political advocacy and their behavior.

Any number of barriers might exist for hospitalists to take action and participate in political action and health policy. Anecdotally, these range from a lack of comfort around the issues to lack of time to the opacity of the process to the unclear impact of individual efforts.

As a medical society, SHM serves a pivotal role in representing the views and perspectives of hospitalists in the health policy arena. Still, these efforts could be greatly intensified with more robust involvement from members. One tactic used by the society is advocacy action alerts that encourage members to engage directly with their elected representatives on policy issues of interest to hospitalists.

For example, a recent alert illustrated the potentially devastating impact of the impending budget sequester. As a budget-deficit and spending reduction mechanism, the budget sequester is poised to institute across-the-board cuts to defense and nondefense spending. For its part, the U.S. Department of Health and Human Services will see an approximate 8.2% cut in its budget, removing critical money from health programs and research funding. These are programs and research efforts in which hospitalists participate.

The action alert culminates with a customizable message that can be easily sent to members of Congress. Quick and easy, the action alert allows SHM members to participate in advocacy efforts with very little time investment. By sending messages to Congress, SHM members are able to share their expertise and perspectives on health policy, as both health professionals and constituents.

The impact of a single message to Congress, of course, is not always clear or easily definable. Advocacy, unfortunately, does not often show immediate results and requires a nuanced, multifaceted, long-term strategy. However, input directly from constituents is consistently rated among the most influential tactics for influencing Congress, and that includes emails, phone calls and in-person visits.²

SHM will continue to ask members to join in its advocacy efforts and, at the next annual meeting, invites all members to partake in in-person visits with their members of Congress during Hospitalists on the Hill. Medicine is as much about the systems as it is the one-on-one interactions; politics is no different. By communicating and meeting with lawmakers one on one, SHM members will continue to have a meaningful impact on the policies that frame the healthcare system. Join us as we continue to grow these efforts.

For more information about Hospitalists on the Hill, visit www.hospitalmedicine2013.org/advocacy.

Joshua Lapps is SHM’s government relations specialist.

References

1. Gruen RL, Campbell EG, Blumenthal D. Public roles of US physicians: community participation, political involvement, and collective advocacy. JAMA. 2006;296(20):2467-2475.
2. The Partnership for A More Perfect Union at the Congressional Management Foundation. Communicating with Congress: Perceptions of Citizen Advocacy on Capitol Hill. Congressional Management Foundation website. Available at: http://www.congressfoundation.org/projects/communicating-with-congress/perceptions-of-citizen-advocacy-on-capitol-hill. Accessed Nov. 1, 2012.

Every summer, a crop of fresh-faced residents greets the medical world. Freed from the travails of medical school, these new physicians embark on a journey of learning by doing, experiencing firsthand the successes and pitfalls of our medical system. Undoubtedly, the vast majority of residents enter the profession with a desire to do good, to heal.

What might not be of immediate concern to the newly minted, patient-focused doctor, however, is the need to heal the medical system.

For residents, policy might seem slightly tangential to the practice of medicine. Indeed, it is possible to practice medicine without becoming involved in policymaking; however, changes in policies and regulations affect the practice of medicine every day.

Whether at the organizational, local, or national level, policy is a vital consideration for practicing physicians. As a new resident, policy helps shape your day-to-day life, from how you interact with patients to the number of hours you are working.

In New York, for example, the 1989 Libby Zion law restricts the number of hours a resident may work to 80 hours per week, a limit formally endorsed in 2003 by the Accreditation Council for Graduate Medical Education (ACGME) for all accredited residency programs nationwide. These standards, which safeguard against the negative effects of sleep deprivation and chronic sleep loss, encourage better physical and mental care for residents and, ideally, promote better patient care. On the other hand, this rule changes the structure of residency programs and increases the number of patient handoffs to conform to hour restrictions. The challenge inherent in policy work is weighing competing interests and positions to find balance, or to justify imbalance.

When you sit down at a computer to input information about a patient, you will be using an electronic health record (EHR). This program is governed by regulations for health information technology (HIT). In fact, SHM commented on a recent proposed rule for the Stage 2 EHR Meaningful Use incentive program and whether hospitalists qualify for a hospital-based provider exemption from the program. By providing feedback to federal agencies, SHM actively influences the development of regulations, changing the impact of policies for hospitalists nationwide.

Your paycheck, too, is directly influenced by health policy, with much of the funds for residency programs coming from the federal Department of Health and Human Services and the rest coming from hospital sources. Recently, SHM supported U.S. Reps. Allyson Schwartz (D-Pa.) and Joe Heck (R-Nev.) in their introduction of H.R. 5707, the Medicare Physician Payment Innovation Act, which would repeal the sustainable growth rate (SGR) that threatens deep cuts to Medicare reimbursements originally intended to control spending. SHM actively advocates for rewarding high-value not simply high quantities of care, reflecting the orientation of hospitalists’ desire to improve the healthcare system.

Try as you might to avoid it, policy is all around you.

Even if such macro-level policy issues as value-based purchasing, payment bundling, or quality reporting initiatives seem beyond your scope of influence, it is important to stay involved and informed. SHM provides a conduit for hospitalists to become involved on large-scale policy issues. Ultimately, the strength of our organizational policy positions and influence grows with increased physician engagement.

More robust participation and more voices represented at the discussion increase the likelihood that meaningful and productive changes will occur.

As the next generation of hospitalists, today’s residents will be agents of change in their hospitals, improving patient care and advancing quality initiatives. By sharing these experiences, hospitalists can expand the policy conversation to reflect their work on the front lines—and help shape the reality for residents to come.

Every summer, a crop of fresh-faced residents greets the medical world. Freed from the travails of medical school, these new physicians embark on a journey of learning by doing, experiencing firsthand the successes and pitfalls of our medical system. Undoubtedly, the vast majority of residents enter the profession with a desire to do good, to heal.

What might not be of immediate concern to the newly minted, patient-focused doctor, however, is the need to heal the medical system.

For residents, policy might seem slightly tangential to the practice of medicine. Indeed, it is possible to practice medicine without becoming involved in policymaking; however, changes in policies and regulations affect the practice of medicine every day.

Whether at the organizational, local, or national level, policy is a vital consideration for practicing physicians. As a new resident, policy helps shape your day-to-day life, from how you interact with patients to the number of hours you are working.

In New York, for example, the 1989 Libby Zion law restricts the number of hours a resident may work to 80 hours per week, a limit formally endorsed in 2003 by the Accreditation Council for Graduate Medical Education (ACGME) for all accredited residency programs nationwide. These standards, which safeguard against the negative effects of sleep deprivation and chronic sleep loss, encourage better physical and mental care for residents and, ideally, promote better patient care. On the other hand, this rule changes the structure of residency programs and increases the number of patient handoffs to conform to hour restrictions. The challenge inherent in policy work is weighing competing interests and positions to find balance, or to justify imbalance.

When you sit down at a computer to input information about a patient, you will be using an electronic health record (EHR). This program is governed by regulations for health information technology (HIT). In fact, SHM commented on a recent proposed rule for the Stage 2 EHR Meaningful Use incentive program and whether hospitalists qualify for a hospital-based provider exemption from the program. By providing feedback to federal agencies, SHM actively influences the development of regulations, changing the impact of policies for hospitalists nationwide.

Your paycheck, too, is directly influenced by health policy, with much of the funds for residency programs coming from the federal Department of Health and Human Services and the rest coming from hospital sources. Recently, SHM supported U.S. Reps. Allyson Schwartz (D-Pa.) and Joe Heck (R-Nev.) in their introduction of H.R. 5707, the Medicare Physician Payment Innovation Act, which would repeal the sustainable growth rate (SGR) that threatens deep cuts to Medicare reimbursements originally intended to control spending. SHM actively advocates for rewarding high-value not simply high quantities of care, reflecting the orientation of hospitalists’ desire to improve the healthcare system.

Try as you might to avoid it, policy is all around you.

Even if such macro-level policy issues as value-based purchasing, payment bundling, or quality reporting initiatives seem beyond your scope of influence, it is important to stay involved and informed. SHM provides a conduit for hospitalists to become involved on large-scale policy issues. Ultimately, the strength of our organizational policy positions and influence grows with increased physician engagement.

More robust participation and more voices represented at the discussion increase the likelihood that meaningful and productive changes will occur.

As the next generation of hospitalists, today’s residents will be agents of change in their hospitals, improving patient care and advancing quality initiatives. By sharing these experiences, hospitalists can expand the policy conversation to reflect their work on the front lines—and help shape the reality for residents to come.

Every summer, a crop of fresh-faced residents greets the medical world. Freed from the travails of medical school, these new physicians embark on a journey of learning by doing, experiencing firsthand the successes and pitfalls of our medical system. Undoubtedly, the vast majority of residents enter the profession with a desire to do good, to heal.

What might not be of immediate concern to the newly minted, patient-focused doctor, however, is the need to heal the medical system.

For residents, policy might seem slightly tangential to the practice of medicine. Indeed, it is possible to practice medicine without becoming involved in policymaking; however, changes in policies and regulations affect the practice of medicine every day.

Whether at the organizational, local, or national level, policy is a vital consideration for practicing physicians. As a new resident, policy helps shape your day-to-day life, from how you interact with patients to the number of hours you are working.

In New York, for example, the 1989 Libby Zion law restricts the number of hours a resident may work to 80 hours per week, a limit formally endorsed in 2003 by the Accreditation Council for Graduate Medical Education (ACGME) for all accredited residency programs nationwide. These standards, which safeguard against the negative effects of sleep deprivation and chronic sleep loss, encourage better physical and mental care for residents and, ideally, promote better patient care. On the other hand, this rule changes the structure of residency programs and increases the number of patient handoffs to conform to hour restrictions. The challenge inherent in policy work is weighing competing interests and positions to find balance, or to justify imbalance.

When you sit down at a computer to input information about a patient, you will be using an electronic health record (EHR). This program is governed by regulations for health information technology (HIT). In fact, SHM commented on a recent proposed rule for the Stage 2 EHR Meaningful Use incentive program and whether hospitalists qualify for a hospital-based provider exemption from the program. By providing feedback to federal agencies, SHM actively influences the development of regulations, changing the impact of policies for hospitalists nationwide.

Your paycheck, too, is directly influenced by health policy, with much of the funds for residency programs coming from the federal Department of Health and Human Services and the rest coming from hospital sources. Recently, SHM supported U.S. Reps. Allyson Schwartz (D-Pa.) and Joe Heck (R-Nev.) in their introduction of H.R. 5707, the Medicare Physician Payment Innovation Act, which would repeal the sustainable growth rate (SGR) that threatens deep cuts to Medicare reimbursements originally intended to control spending. SHM actively advocates for rewarding high-value not simply high quantities of care, reflecting the orientation of hospitalists’ desire to improve the healthcare system.

Try as you might to avoid it, policy is all around you.

Even if such macro-level policy issues as value-based purchasing, payment bundling, or quality reporting initiatives seem beyond your scope of influence, it is important to stay involved and informed. SHM provides a conduit for hospitalists to become involved on large-scale policy issues. Ultimately, the strength of our organizational policy positions and influence grows with increased physician engagement.

More robust participation and more voices represented at the discussion increase the likelihood that meaningful and productive changes will occur.

As the next generation of hospitalists, today’s residents will be agents of change in their hospitals, improving patient care and advancing quality initiatives. By sharing these experiences, hospitalists can expand the policy conversation to reflect their work on the front lines—and help shape the reality for residents to come.

As America weighs the value of healthcare and health reform, many moving parts of the Patient Protection and Affordable Care Act (ACA) will continue to reshape the healthcare system. And hospitalists continue to be part of the reshaping.

The full title of the bill should serve as a reminder to hospitalists of the dual purposes of the ACA: patient protection and cost control. The bulk of popular consciousness about the ACA focused around the favored positions (no pre-existing conditions and children remaining on parents’ plans until age 26) or around points of contention (the individual mandate and the Medicaid expansion).

The lesser-mentioned provisions centering around cost, quality, and payment reform have the potential to substantively reframe the conversation, particularly from the provider perspective. Hospitalists have a unique expertise that positions them to be critical in shaping these programs and regulations.

Two initiatives aim at moving the traditional fee-for-service models of payment for health services toward pay-for-performance. Both the hospital value-based purchasing and physician value-based payment modifier use quality measures to link the performance of care with payments. Hospitals and associated groups are in the process of working with the Centers for Medicare & Medicaid Services (CMS) as the value-based purchasing program moves forward.

The physician value-based modifier will combine quality measures and reports, similar to the 2010 Quality and Resource Use Reports piloted this year in Nebraska, Iowa, Kansas, and Missouri, with a to-be-determined payment adjustment. These reports represent a major step toward Medicare providing large-scale feedback to providers on healthcare quality and costs. When the modifier is enforced, a percentage of payments will reflect quality scores, making the feedback from hospitalists important in creating meaningful and useful measures.

Concurrently, the ACA spurred the development of additional quality-improvement (QI) programs. Quality efforts ranging from reducing hospital-acquired infections, stemming preventable complications, meaningful use of electronic health records (EHRs), and reducing readmissions round out a complement of programs that strive to create safer, more cost-effective care for patients. For example, the Partnership for Patients is a collaborative program between providers, patient groups, and the government that catalyzes care improvement in hospitals. Hospitalists have been QI leaders at the front lines in their hospitals for years, affording an informed perspective on policy development.

The ACA is a constellation of programs and initiatives that seek to test new systems for care delivery and payment reform while providing access and quality protections for patients. Even without the ACA, reforms in quality and payment models are necessary and will occur.

Through SHM, hospitalists actively are sharing their experiences with policymakers in an effort to create responsive and reflective programs. It is precisely this expertise with hospitalized patients that affords hospitalists a ground- and systems-level perspective on healthcare. With so many reforms taking place, it is vital that hospitalists remain connected and informed about these issues and engage the opportunities for policy leadership and feedback.

To get involved with SHM’s advocacy efforts, visit www.hospitalmedicine.org/advocacy.

As America weighs the value of healthcare and health reform, many moving parts of the Patient Protection and Affordable Care Act (ACA) will continue to reshape the healthcare system. And hospitalists continue to be part of the reshaping.

The full title of the bill should serve as a reminder to hospitalists of the dual purposes of the ACA: patient protection and cost control. The bulk of popular consciousness about the ACA focused around the favored positions (no pre-existing conditions and children remaining on parents’ plans until age 26) or around points of contention (the individual mandate and the Medicaid expansion).

The lesser-mentioned provisions centering around cost, quality, and payment reform have the potential to substantively reframe the conversation, particularly from the provider perspective. Hospitalists have a unique expertise that positions them to be critical in shaping these programs and regulations.

Two initiatives aim at moving the traditional fee-for-service models of payment for health services toward pay-for-performance. Both the hospital value-based purchasing and physician value-based payment modifier use quality measures to link the performance of care with payments. Hospitals and associated groups are in the process of working with the Centers for Medicare & Medicaid Services (CMS) as the value-based purchasing program moves forward.

The physician value-based modifier will combine quality measures and reports, similar to the 2010 Quality and Resource Use Reports piloted this year in Nebraska, Iowa, Kansas, and Missouri, with a to-be-determined payment adjustment. These reports represent a major step toward Medicare providing large-scale feedback to providers on healthcare quality and costs. When the modifier is enforced, a percentage of payments will reflect quality scores, making the feedback from hospitalists important in creating meaningful and useful measures.

Concurrently, the ACA spurred the development of additional quality-improvement (QI) programs. Quality efforts ranging from reducing hospital-acquired infections, stemming preventable complications, meaningful use of electronic health records (EHRs), and reducing readmissions round out a complement of programs that strive to create safer, more cost-effective care for patients. For example, the Partnership for Patients is a collaborative program between providers, patient groups, and the government that catalyzes care improvement in hospitals. Hospitalists have been QI leaders at the front lines in their hospitals for years, affording an informed perspective on policy development.

The ACA is a constellation of programs and initiatives that seek to test new systems for care delivery and payment reform while providing access and quality protections for patients. Even without the ACA, reforms in quality and payment models are necessary and will occur.

Through SHM, hospitalists actively are sharing their experiences with policymakers in an effort to create responsive and reflective programs. It is precisely this expertise with hospitalized patients that affords hospitalists a ground- and systems-level perspective on healthcare. With so many reforms taking place, it is vital that hospitalists remain connected and informed about these issues and engage the opportunities for policy leadership and feedback.

To get involved with SHM’s advocacy efforts, visit www.hospitalmedicine.org/advocacy.

As America weighs the value of healthcare and health reform, many moving parts of the Patient Protection and Affordable Care Act (ACA) will continue to reshape the healthcare system. And hospitalists continue to be part of the reshaping.

The full title of the bill should serve as a reminder to hospitalists of the dual purposes of the ACA: patient protection and cost control. The bulk of popular consciousness about the ACA focused around the favored positions (no pre-existing conditions and children remaining on parents’ plans until age 26) or around points of contention (the individual mandate and the Medicaid expansion).

The lesser-mentioned provisions centering around cost, quality, and payment reform have the potential to substantively reframe the conversation, particularly from the provider perspective. Hospitalists have a unique expertise that positions them to be critical in shaping these programs and regulations.

Two initiatives aim at moving the traditional fee-for-service models of payment for health services toward pay-for-performance. Both the hospital value-based purchasing and physician value-based payment modifier use quality measures to link the performance of care with payments. Hospitals and associated groups are in the process of working with the Centers for Medicare & Medicaid Services (CMS) as the value-based purchasing program moves forward.

The physician value-based modifier will combine quality measures and reports, similar to the 2010 Quality and Resource Use Reports piloted this year in Nebraska, Iowa, Kansas, and Missouri, with a to-be-determined payment adjustment. These reports represent a major step toward Medicare providing large-scale feedback to providers on healthcare quality and costs. When the modifier is enforced, a percentage of payments will reflect quality scores, making the feedback from hospitalists important in creating meaningful and useful measures.

Concurrently, the ACA spurred the development of additional quality-improvement (QI) programs. Quality efforts ranging from reducing hospital-acquired infections, stemming preventable complications, meaningful use of electronic health records (EHRs), and reducing readmissions round out a complement of programs that strive to create safer, more cost-effective care for patients. For example, the Partnership for Patients is a collaborative program between providers, patient groups, and the government that catalyzes care improvement in hospitals. Hospitalists have been QI leaders at the front lines in their hospitals for years, affording an informed perspective on policy development.

The ACA is a constellation of programs and initiatives that seek to test new systems for care delivery and payment reform while providing access and quality protections for patients. Even without the ACA, reforms in quality and payment models are necessary and will occur.

Through SHM, hospitalists actively are sharing their experiences with policymakers in an effort to create responsive and reflective programs. It is precisely this expertise with hospitalized patients that affords hospitalists a ground- and systems-level perspective on healthcare. With so many reforms taking place, it is vital that hospitalists remain connected and informed about these issues and engage the opportunities for policy leadership and feedback.

To get involved with SHM’s advocacy efforts, visit www.hospitalmedicine.org/advocacy.

SHM recently joined more than 30 organizations in the Council of Medical Specialty Societies (CMSS) in signing a letter to the Centers for Medicare & Medicaid Services (CMS) to affirm the importance of—and to voice concerns about—some provisions in the proposed Sunshine Rule for doctor-industry relationships.

Specifically, the letter highlights some critical distinctions in compensation for teaching Continuing Medical Education (CME) courses.

The Sunshine Rule was proposed in response to the adoption of the Physician Payments Sunshine Act in Section 6002 of the Affordable Care Act of 2010. The act requires gifts or payments to physicians from pharmaceutical and medical device manufacturers worth more than $10 to be reported publicly by manufacturers. CMS created the proposed rule to frame which situations and exchanges of value fall within and outside the reporting requirements. As part of the rulemaking process, CMS welcomed comments to help refine and develop the final rule.

The proposed rule asserts that the category of “Direct Compensation for Serving as a Faculty or as a Speaker for a Medical Education Program” be broadly understood to encompass any situation in which a manufacturer compensates physicians for speaking engagements. This includes certain indirect payments through a third-party like a CME provider. So if you serve as a faculty member sharing your expertise through accredited or certified CME, your service could be reportable if the provider received industry funding. This could happen even if you have no specific knowledge of the industry funder.

The CMSS letter identifies a distinction between promotional education programs and accredited or certified CME programs, noting that only the former implies a relationship between a physician and manufacturer. Accredited and certified CME programs, on the other hand, already are governed by the Standards for Commercial Support: Standards to Ensure the Independence of CME Activities, which includes guidance to ensure the independence of CME activities from industry funders. Industry grants do not pay accredited or certified CME faculty directly, but rather go to CME providers who organize and develop the programs. This clarification expressly acknowledges the established self-regulation and ethical guidelines of the CME programs. Importantly, the letter does support disclosure of compensation from promotional education programs directly sponsored by industry.

By signing on to this letter, SHM has expressed its support for greater transparency in relationships between physicians and industries, while illuminating areas of concern in the rule.

The Sunshine Rule illustrates some of the richness and complexity of policy initiatives, and highlights potential topics to broaden our conversation and involvement. These types of issues generate robust discussions about ethics and professionalism within the medical establishment.

Hospitalists can, and should, engage these debates both within SHM and from their unique vantage point within the hospital.

As a membership organization, SHM details our efforts at transparency in our relationship with industry partners at www.hospitalmedicine.org/industry.

SHM recently joined more than 30 organizations in the Council of Medical Specialty Societies (CMSS) in signing a letter to the Centers for Medicare & Medicaid Services (CMS) to affirm the importance of—and to voice concerns about—some provisions in the proposed Sunshine Rule for doctor-industry relationships.

Specifically, the letter highlights some critical distinctions in compensation for teaching Continuing Medical Education (CME) courses.

The Sunshine Rule was proposed in response to the adoption of the Physician Payments Sunshine Act in Section 6002 of the Affordable Care Act of 2010. The act requires gifts or payments to physicians from pharmaceutical and medical device manufacturers worth more than $10 to be reported publicly by manufacturers. CMS created the proposed rule to frame which situations and exchanges of value fall within and outside the reporting requirements. As part of the rulemaking process, CMS welcomed comments to help refine and develop the final rule.

The proposed rule asserts that the category of “Direct Compensation for Serving as a Faculty or as a Speaker for a Medical Education Program” be broadly understood to encompass any situation in which a manufacturer compensates physicians for speaking engagements. This includes certain indirect payments through a third-party like a CME provider. So if you serve as a faculty member sharing your expertise through accredited or certified CME, your service could be reportable if the provider received industry funding. This could happen even if you have no specific knowledge of the industry funder.

The CMSS letter identifies a distinction between promotional education programs and accredited or certified CME programs, noting that only the former implies a relationship between a physician and manufacturer. Accredited and certified CME programs, on the other hand, already are governed by the Standards for Commercial Support: Standards to Ensure the Independence of CME Activities, which includes guidance to ensure the independence of CME activities from industry funders. Industry grants do not pay accredited or certified CME faculty directly, but rather go to CME providers who organize and develop the programs. This clarification expressly acknowledges the established self-regulation and ethical guidelines of the CME programs. Importantly, the letter does support disclosure of compensation from promotional education programs directly sponsored by industry.

By signing on to this letter, SHM has expressed its support for greater transparency in relationships between physicians and industries, while illuminating areas of concern in the rule.

The Sunshine Rule illustrates some of the richness and complexity of policy initiatives, and highlights potential topics to broaden our conversation and involvement. These types of issues generate robust discussions about ethics and professionalism within the medical establishment.

Hospitalists can, and should, engage these debates both within SHM and from their unique vantage point within the hospital.

As a membership organization, SHM details our efforts at transparency in our relationship with industry partners at www.hospitalmedicine.org/industry.

SHM recently joined more than 30 organizations in the Council of Medical Specialty Societies (CMSS) in signing a letter to the Centers for Medicare & Medicaid Services (CMS) to affirm the importance of—and to voice concerns about—some provisions in the proposed Sunshine Rule for doctor-industry relationships.

Specifically, the letter highlights some critical distinctions in compensation for teaching Continuing Medical Education (CME) courses.

The Sunshine Rule was proposed in response to the adoption of the Physician Payments Sunshine Act in Section 6002 of the Affordable Care Act of 2010. The act requires gifts or payments to physicians from pharmaceutical and medical device manufacturers worth more than $10 to be reported publicly by manufacturers. CMS created the proposed rule to frame which situations and exchanges of value fall within and outside the reporting requirements. As part of the rulemaking process, CMS welcomed comments to help refine and develop the final rule.

The proposed rule asserts that the category of “Direct Compensation for Serving as a Faculty or as a Speaker for a Medical Education Program” be broadly understood to encompass any situation in which a manufacturer compensates physicians for speaking engagements. This includes certain indirect payments through a third-party like a CME provider. So if you serve as a faculty member sharing your expertise through accredited or certified CME, your service could be reportable if the provider received industry funding. This could happen even if you have no specific knowledge of the industry funder.

The CMSS letter identifies a distinction between promotional education programs and accredited or certified CME programs, noting that only the former implies a relationship between a physician and manufacturer. Accredited and certified CME programs, on the other hand, already are governed by the Standards for Commercial Support: Standards to Ensure the Independence of CME Activities, which includes guidance to ensure the independence of CME activities from industry funders. Industry grants do not pay accredited or certified CME faculty directly, but rather go to CME providers who organize and develop the programs. This clarification expressly acknowledges the established self-regulation and ethical guidelines of the CME programs. Importantly, the letter does support disclosure of compensation from promotional education programs directly sponsored by industry.

By signing on to this letter, SHM has expressed its support for greater transparency in relationships between physicians and industries, while illuminating areas of concern in the rule.

The Sunshine Rule illustrates some of the richness and complexity of policy initiatives, and highlights potential topics to broaden our conversation and involvement. These types of issues generate robust discussions about ethics and professionalism within the medical establishment.

Hospitalists can, and should, engage these debates both within SHM and from their unique vantage point within the hospital.

As a membership organization, SHM details our efforts at transparency in our relationship with industry partners at www.hospitalmedicine.org/industry.