Members of SHM met with legislators and staff to discuss important issues affecting hospitalists and their patients during SHM’s annual Hill Day in September
On September 26, 2024, SHM’s Public Policy Committee (PPC) and SHM Chapter members visited Washington, D.C. for SHM’s annual Hill Day. Participants educated legislators and their staff about hospital medicine and advocated for some of the issues important to hospitalists and their patients.
Rick Hilger, MD, SFHM, SHM, PPC chair, and the system utilization and care management medical director at HealthPartners in Minneapolis, said. “It’s imperative that SHM maintains a presence on the Hill to keep front and center issues most important to patients and the hospitals that care for them. Even politicians and their healthcare aides who are most knowledgeable about the healthcare system benefit from the first-hand experience that hospitalists bring to discussions.”
Hospitalist advocates voiced their support for issues like increasing access to skilled nursing facilities (SNFs), streamlining prior authorization requirements under Medicare Advantage, and improving protections from workplace violence within the hospital.
“Being part of the PPC is very meaningful; our colleagues are inspiring!” said Claudia Geyer, MD, SFHM, past system chief of hospital medicine, hospital medicine fellowship senior advisor, and post-acute care and hospital medicine physician at Central Maine Healthcare in Lewiston, Maine. “I again learned a great deal and was glad to have a rural, community hospital-based viewpoint to share as we all recognized the value of diverse input.”
Dr. Geyer says it’s important to attend Hill Day because interacting with lawmakers on “inpatient issues creates the opportunity to share our patients’ stories and particularly discuss how our system impacts patients and requires improvements to safely and fairly serve their healthcare needs.” And, she said, “Connecting with other hospitalists from across the nation is an invaluable means of gaining insight and learning from a variety of perspectives and experiences.”
Access to SNF
SHM supports the Improving Access to Medicare Coverage Act (H.R. 5138/S. 4137). This legislation will help ensure patients get necessary medical care in the appropriate setting. It will empower clinicians and patients to focus on the clinical needs of patients rather than adhering to outdated observation policies. Specifically, this legislation will count all days spent under observation toward Medicare’s three-day inpatient stay requirement, allowing patients to qualify for SNF coverage.
Why this bill matters: To qualify for Medicare SNF coverage, a patient must be admitted to the hospital as an inpatient for three consecutive midnights, and time spent under observation doesn’t count toward this requirement. When SNF coverage is denied, patients often have to decide between foregoing clinically necessary care or incurring significant out-of-pocket costs.
Observation care is classified as an outpatient service even though the care is often indistinguishable from inpatient care, and it’s billed under Medicare Part B, meaning out-of-pocket costs can be higher, and more variable, than similar care provided to patients admitted as inpatients. Beneficiaries in the most disadvantaged communities are more likely to have an observation stay, have a repeated observation stay within 30 days, and experience long-term re-observation.1
Waivers of the three-day inpatient stay requirement during the COVID-19 Public Health Emergency did not increase SNF use, demonstrating the current three-day stay requirement is an unnecessary impediment to SNF coverage.2
SHM members’ advocacy efforts have made a difference on this front as Representative Jamie Raskin (D-MD-8) cosponsored the Improving Access to Medicare Coverage Act (H.R. 5138) the day after the SHM delegation met with him.
Prior authorization reform
SHM also supports the Improving Seniors’ Timely Access to Care Act (S. 4532/H.R. 8702). This legislation will help reduce prior authorization delays under Medicare Advantage (MA) by streamlining the prior authorization process and encouraging plans to align their prior authorization decisions with evidence-based guidelines.
Specifically, this legislation would establish an electronic prior authorization process; require the U.S. Department of Health & Human Services to establish a process for “real-time decisions” for items and services routinely approved; and improve transparency by requiring MA plans to report the extent of their use of prior authorization and the rate of approvals or denials to the Centers for Medicare and Medicaid Services (CMS).
Why this bill matters: Prior authorization processes under MA plans contribute to significant care delays and denials of clinically appropriate care. These processes create an appreciable administrative burden and redirect valuable time and resources away from direct patient care. While hospitalists want to spend their time caring for patients, prior authorization submissions and appeals are administrative tasks with no clinical benefit.
Hospitalists see real-life consequences of current prior authorization delays including longer than medically necessary hospital stays, which increases cost and the risk for hospital-acquired infections and conditions; delayed discharges, which contribute to existing inpatient bed shortages; delayed or denied rehabilitation services, medications, and necessary care, which can negatively affect patient outcomes; increased out-of-pocket costs for patients; and opaque and ill-defined prior authorization rules that frustrate patients and hospitalists.
The clinical needs of patients should be the top priority. Patients deserve physician-recommended care when and where they need it, without untimely delays.
Protecting healthcare workers from workplace violence
SHM supports the Safety from Violence for Healthcare Employees Act (H.R. 2584/S. 2768) to address the growing problem of violence against healthcare workers.
This legislation, modeled after existing federal protections for airport and aircraft workers, would create legal penalties for individuals who intentionally assault or intimidate any hospital workers on site, regardless of how they are employed; and establish enhanced penalties for acts that involve weapons, result in serious bodily injury, or occur during a public health emergency, with exceptions for individuals who may be mentally incapacitated due to illness or substance use.
Why this bill matters: As front-line physicians in U.S. acute care hospitals, hospitalists face increasing levels of violence in the workplace. Unfortunately, the full scope of workplace violence is likely underestimated, as estimates suggest up to 88% of incidents go unreported.3
Healthcare workers are at disproportionate risk of violence, being five times more likely to experience workplace violence than employees in all other industries. They saw a 63% increase in injuries resulting from violent attacks between 2011-2018, according to the U.S. Bureau of Labor Statistics.4,5
Violence against healthcare workers has increased significantly since the COVID-19 pandemic. The number of injuries that require days away from work has nearly doubled, and approximately 43% of healthcare workers reported experiencing some form of violence during this time.6,7
Unsafe workplaces hurt physician retention efforts and compound national healthcare practitioner shortages. Individuals who experience violence feel less motivated, are more dissatisfied with their jobs, and consider quitting following an event.
The September Hill Day—during the pre-election time—was “very active and energized,” Dr. Geyer said, but “participants in our discussions were engaged, supportive, and appreciative of hearing about our patients’ experiences. One of the meetings was my third over five years with the same healthcare-focused staffer, and at this visit, the Senator had signed on to all three bills we were advocating for.”
Another attendee, Naveen Baskaran, MD, MSHI, CPHIMS, a hospitalist and assistant professor of medicine at the University of Florida in Gainesville, agrees and said, “Meeting with Representative John Rutherford and the staff of Representatives Kat Cammack and Senator Marco Rubio allowed us to highlight the importance of bills. These discussions were well-received, and seeing the interest and engagement from the policymakers and their teams was encouraging. Collaborating with Dr. Jennifer Cowart and other seasoned physicians on the advocacy committee further enriched the experience, emphasizing the collective commitment to advancing healthcare.”
Dr. Hilger said he thought the day went extremely well. “We emphasized the ongoing epidemic of violence against healthcare workers (which seemed to surprise many staff members). Many offices also were surprised to hear that, overall, the boarding crisis has not truly been resolved with the end of the pandemic. We also prioritized discussions around the challenges of rural hospitals, and the longstanding need to bring stability to Medicare physician reimbursement. Another topic included the ongoing high denial rates for medical necessity and SNF prior authorization from for-profit Medicare Advantage plans. Hospitalists live these issues each day, which allows them to not only provide facts, but meaningful stories that drive home how patients and families are impacted by them.”
“Besides sharing gratitude [for legislative support so far], we were able to get key insights into other healthcare priorities as well as the likelihood of success for seeing some of the efforts come to fruition,” Dr. Geyer said. “We were also fortunate to have dinner with a physician congressperson who openly shared ongoing challenges and gains in healthcare policy over the past decade and the need for persistent hard work to influence change for the better.”
References
- Sheehy AM, et al. Thirty-day re-observation, chronic re-observation, and neighborhood disadvantage. Mayo Clin Proc. 2020;95(12):2644-54. doi:10.1016/j.mayocp.2020.06.059.
- Song A, et al. SNF 3-day waiver use during the COVID-19 pandemic. Avalere website. https://avalere.com/insights/snf-3-day-waiver-use-during-the-covid-19-pandemic. Published September 8, 2023. Accessed December 11, 2024.
- Arnetz JE, et al. Underreporting of workplace violence: comparison of self-report and actual documentation of hospital incidents. Workplace Health Saf. 2015;63(5):200-10. doi:10.1177/2165079915574684.
- U.S. Bureau of Labor Statistics. Fact sheet – workplace violence in healthcare, 2018. U.S. Bureau of Labor Statistics website. https://www.bls.gov/iif/factsheets/workplace-violence-healthcare-2018.htm. Published April 2020. Accessed December 11, 2024.
- Boyle, P. Threats against health care workers are rising. Here’s how hospitals are protecting their staffs. Association of American Medical Colleges website. https://www.aamc.org/news/threats-against-health-care-workers-are-rising-heres-how-hospitals-are-protecting-their-staffs. Published August 18, 2022. Accessed December 11, 2024.
- U.S. Bureau of Labor Statistics Employer reported workplace injuries and illnesses (annual) news release. US BLS website. https://www.bls.gov/news.release/archives/osh_11032021.htm. Published November 3, 2021. Accessed December 11, 2024.
- Banga A, et al. ViSHWaS: Violence study of healthcare workers and systems-a global survey. BMJ Glob Health. 2023;8(9):e013101. doi:10.1136/bmjgh-2023-013101.