New Party in Power

The Hospitalist. 2007 February;2007(02):

February 1, 2007 | The Hospitalist

For a complete list of committee members, visit SHM’s new Legislative Action Center at https://capwiz.com/hospitalmedicine/home/. See “New Advocacy Tool Available,” for more information on the Legislative Action Center, above.)

Starting Over on Key Issues

Many of the bills introduced in 2006—particularly spending bills—were not voted on by the end of the lame duck session last fall. That means that these bills must be reintroduced in the new year. Bills that recommend funding changes are frozen, so agencies continue to receive 2006 funding until the new Congress votes to change their budget.

“All bills have to be reintroduced in the 110th,” stresses Allendorf. “It will take some time—how much depends on the issue. The Democrats may want to hold hearings on legislation, or they may simply dust off legislation that was introduced last year.”

The Democrats are expected to move on many of the issues that SHM has been lobbying for. “They’ve said that they want to reform the healthcare system,” says Allendorf. “Top issues include providing coverage to the uninsured, reforming Medicare Part D, and resolving the physician payment issue.”

OIG Approves Gainsharing for Cardiac Surgeons

Despite the federal government’s general squeamishness over the practice of gainsharing—hospitals sharing the monies realized through cost savings with those physicians responsible—the Office of the Inspector General (OIG) approved a new gainsharing arrangement in November 2006. The arrangement is between an unnamed acute care hospital and its cardiac surgeons. The OIG has authorized the hospital to pay the surgeon group a share of the first-year cost savings directly attributable to specific changes in the group’s operating room practices.

Whether this approval is evidence of continued interest in gainsharing on the part of the administration remains to be seen.

Source: https://oig.hhs.gov/fraud/docs/advisoryopinions/2006/AdvOpn06-22NewA.pdf

HHS Pushes Healthcare Transparency

The Department of Health & Human Services (HHS) is taking President Bush’s executive order on healthcare transparency to the private sector. The executive order requires key federal agencies—including HHS—to collect information about the quality and cost of the healthcare they provide and to share that data with beneficiaries. HHS is planning to distribute an “employer toolkit” to the nation’s large employers and purchasers, asking their CEOs to pledge written support of the executive order.

The AMA has concerns about the toolkit, specifically about quality measures that were developed without input from medical groups and policies that focus on cost rather than quality.

Source: November 21, 2006 Federation Memo from AMA

Allendorf believes that there will be a bipartisan effort to push through physician payment reform. “There are some 265 members of Congress who requested action on this issue this year [in 2006],” she points out. “There’s a genuine interest and desire to address physician payment reform and pay-for-performance as well. They may differ on how quickly they want to move on some of these.”

The news is not so good on the issue of gainsharing, where physicians are allowed to share the profits realized by a hospital’s cost reductions when linked to specific best practices. “Representative Nancy Johnson (R-Conn.) was a big proponent of this issue in the House, and she was not re-elected,” says Allendorf. “Stark is an opponent of gainsharing, so there may not be the same Congressional push behind it—at least in the House.”

However, the unexpected gainsharing demonstration projects approved in 2006 are underway, and Congress will hear reports on those in several years, once the projects have been analyzed.

Another issue that may not be addressed is liability. “Medical liability reform will be on the back burner,” warns Allendorf. “It’s generally not supported by the Democrats.”

In 2006, SHM supported increased funding for the Agency for Healthcare Research and Quality (AHRQ)—this was one of the major issues addressed by members during Legislative Advocacy Day during the Annual Meeting in Washington, D.C. Whether the next budget includes more money for the agency remains to be seen. “The Democrats support increased funding for NIH (National Institutes of Health), AHRQ, and other healthcare agencies,” says Allendorf. “There’s certainly political will, but where is the money going to come from?”