SHM’s Public Policy Committee (PPC) monitors federal legislation and regulations affecting hospital medicine and recommending appropriate action by SHM. SHM works independently and through coalitions with like-minded organizations in pursuit of its policy objectives. This month, I’ll update you on PPC’s major activities in the past six months.
Physician Payment Reform
Late last year, as Congress debated whether to address pending reductions in 2007 Medicare payments to physicians before adjourning, PPC spearheaded a number of activities to influence debate on the issue. These efforts included:
- Sending a letter from then-SHM President Mary Jo Gorman, MD, MBA, to members of the key health committees, urging lawmakers to take action to avert the scheduled 5% cut in Medicare physician fees and enact a positive payment update that accurately reflects increases in practice costs;
- Launching a new advocacy tool that allows SHM members to quickly e-mail their members of Congress in opposition to the pending fee cut. In less than two weeks, 130 members sent nearly 390 messages to the U.S. House of Representatives and the Senate; and
- Lobbying Congress to ensure that any pay-for-reporting program for physicians be voluntary and based on valid measures developed by the medical profession.
The legislation approved by Congress (H.R. 6111) averted the 5% cut, as advocated by SHM, freezing rates at 2006 levels. Continuation of the current payment rates, combined with increases in evaluation and management services proposed by CMS and supported by SHM as part of the five-year review, translated into an average gain per hospitalist of approximately 8.8% on their Medicare billings.
A scheduled 10% cut in 2008 Medicare payments to physicians will dominate this year’s legislative agenda. The PPC will continue to oppose cuts in the physician update and advocate for a more permanent solution to the annual payment reductions caused by the flawed sustainable growth rate.
Pay for Performance
Together with SHM’s Performance and Standards Task Force (PSTF), the PPC has spent countless hours working to position SHM to influence the debate over pay for performance on Capitol Hill and with CMS. This has involved Hill visits by PPC members and staff in addition to conference calls, meetings, and communications with CMS officials. Part of the committee’s role is also to educate SHM members on how their practices will be affected by legislative and regulatory action in this area.
Under the new Physician Quality Reporting Initiative (PQRI) mandated under H.R. 6111, SHM members and other eligible professionals who successfully report quality measures on claims for dates of service from July 1 to Dec. 31 may earn a bonus payment, subject to a cap, of 1.5% of total allowed charges for covered Medicare physician fee schedule services.
Because measures were not originally developed for hospital medicine, PPC, PSTF, and staff actively lobbied CMS and the AMA’s Physician Consortium for Performance Improvement (PCPI) for changes to the measures that would allow wider reporting by SHM members. Significantly, PCPI accepted SHM’s recommendations, paving the way for hospitalist participation in this voluntary program. Had SHM not been at the table, hospitalists would have had only a limited opportunity to qualify for a 1.5% increase in their Medicare payments through participation in the PQRI program. SHM will also take the lead in developing measures on care transitions through the PCPI for 2009, which will position hospital medicine as the premier advocate for this important issue.
Funding for AHRQ
One of SHM’s legislative priorities is to advocate for increased funding for the Agency for Healthcare Research and Quality (AHRQ), whose mission is to improve the quality, safety, efficiency, and effectiveness of healthcare for all Americans. As part of this effort, we participate in the Friends of AHRQ, a voluntary coalition of more than 130 organizations that supports the AHRQ by sending joint letters to key members of Congress, making joint visits to members of Congress and their staff, and holding briefings to demonstrate the importance of AHRQ research.