Guilt By Association
SHM steps in when Massachusetts wrongly penalizes hospitalists
by Katie Stevenson
This past summer, several SHM members contacted us about a new health benefits program in Massachusetts called the Select and Save Plan.
The plan is part of the Massachusetts Group Insurance Commission’s (GIC) Clinical Performance Improvement (CPI) Initiative, which establishes differing copayments and benefits for state employees based on a statistical analysis of the physician’s practice patterns.
SHM learned hospitalists were unintentionally grouped with office-based primary care physicians (PCPs) and, therefore, unjustly penalized. The unfair analyses were lowering their ratings within the program and affecting benefits and copayments for their patients.
SHM Senior Vice President Joseph Miller contacted GIC staff to correct this. The GIC agreed to separate hospitalists from PCPs if the names of physicians practicing hospital medicine in Massachusetts could be acquired. Using hospital medicine group information from our membership database, SHM contacted hospital leaders asking them to supply the names of the hospitalists practicing within their facility, and spread the word about the CPI’s faulty analysis to encourage other leaders to submit their information.
As a result of this grass-roots campaign, more than 400 hospitalists and 30 hospitals were identified. The information was submitted to the GIC, and now hospitalists in Massachusetts are distinctly identified as separate from PCPs in their practice profiles.