Public Policy

The Nursing Home Get Out of Jail Card (“We Don’t Want Our Patient Back”). It’s Now Adios.

The Centers for Medicare & Medicaid Services (CMS) has not updated its rules ("conditions for participation") for nursing homes in twenty-five years. Late last year they finally did. Many of the changes will have an impact on the daily lives of NH residents but are far removed from hospital medicine.  Think a resident's ability to pick their own roommate and have all hours visitors.  However, there are a few changes that intersect with HM, and a notable one will affect how you respond to a frequently encountered roadblock long-term care facilities sometimes throw our way. First, though, some of the changes CMS finalized.  With SHM members now moving into the post-acute and LTC realm, several have real relevance (I only cite a sliver of them): (more…)

A Renewed Call to Overhaul Hospital Observation Care

by Ann Sheehy, MD, MS, FHM
By Ann M. Sheehy, MD, MS, FHM In response to concerns about Medicare beneficiary out-of-pocket financial risk, Congress unanimously passed the NOTICE Act, which President Obama signed into law August 5, 2015. This law states that all Medicare beneficiaries hospitalized for 24 hours or more as outpatients under observation must to be notified in writing that they are outpatients “…not later than 36 hours after the time such individual begins receiving such services…”, as well as the associated “…implications for cost-sharing…”. Last month, the Centers for Medicare & Medicaid Services (CMS) released the final Medicare Outpatient Observation Notice (MOON) that hospitals will start delivering to patients no later than March 8, 2017 to comply with the law. Patients or their representative must sign the form to acknowledge receipt. There is no doubt transparency is important, and patients should be informed when hospitalized as outpatients instead of as inpatients. But the…
Ann Sheehy, MD, MS, FHM, is a physician and associate professor at the University of Wisconsin (UW) School of Medicine and Public Health. She received her MD and MS in Clinical Research from Mayo Medical School and Mayo Graduate School, respectively, in Rochester, Minnesota. She completed her residency in internal medicine at Johns Hopkins Hospital in Baltimore, Maryland in 2005. The same year, Dr. Sheehy joined the Division of Hospital Medicine as a Clinical Assistant Professor of Medicine at the University of Wisconsin School of Medicine and Public Health. In 2011, she became a Clinical Associate Professor of Medicine. Dr. Sheehy held the position of Interim Director, prior to being appointed Division of Hospital Medicine Director in 2012. Dr. Sheehy has a background in academic medicine, with emphasis on diabetes screening practices and care of inpatients with hyperglycemia, as well as health care disparities and the effect of health care policy on patient care in the hospital. Dr. Sheehy is a member of the Society of Hospital Medicine Public Policy committee, and serves as Vice President of the University of Wisconsin Hospital and Clinics (UWHC) Medical Board and is chair of the Credentials Committee. Dr. Sheehy is a two-time recipient of the Evans-Glassroth Department of Medicine Inpatient Teacher of the Year Award and has also been awarded the University of Wisconsin Internal Medicine Residency Professionalism Award. Dr. Sheehy is an active SHM member in the Public Policy Committee and has found herself on Capitol Hill multiple times, testifying before Congressional committees focused on the U.S. healthcare system, on behalf of hospitalists and SHM.

Male Versus Female Hospitalists

If you have paid attention to the news, you picked up the study out in JAMA concerning how male versus female physicians deliver inpatient care.  Not just any inpatient docs, though, but hospitalists. The investigators were meticulous in their analysis of over a million Medicare beneficiaries and looked at readmit and mortality rates.  They examined various diagnoses and adjusted for the usual doctor and hospital characteristics. Across the board, males took a drubbing and the NNT for both outcomes of interest hovered around 200 (0.5% absolute difference). Ashish Jha, one of the investigators and a leader in the study of hospital quality and safety (who really needs to speak at an SHM annual, incidentally) goes into more depth over at his blog: (more…)

ER Docs And Out Of Network Billing. Are We In The Same Boat?

This recent article in the NYT and the NEJM study precipitating it widened the (malevolent) coverage of the fees paid by patients and insurance companies to out of network physicians.  If you are not familiar with the issue, doctors working in hospitals--who may not participate in the plans the hospitals accept--separately bill the insurance companies for higher than average charges.  Since there is no upfront negotiated discount, typically found when docs belong to a plan, the insurance company may or may not pay the asking fee.  If they do not, the often sky-high balance becomes the patient's responsibility.  From the patient's point of view, the process makes no sense; if a hospital participates in their plan, so should the docs. Not so.  Hospitals do their thing.  Professional do theirs. The problem of balance billing and out of network providers does not reside in one or two states, and the practice touches…

The Medicaid Overhaul And How Hospitals And Its Providers Could Be Hardest Hit

Given the signs Paul Ryan, Speaker of the House, has flashed during his tenure, expect phase one of the health care financing overhaul to be heavily focused on Medicaid. The incoming administration aligns with this change (#6), as does the president-elect's choice of Tom Price for HHS Secretary.    This turn will have an impact on hospitals and something you should pay attention to.  You will see lots of press over the coming months, and you will hear the term Medicaid block grants.  You should have an opinion, especially if you work in a rural, safety net, urban, or academic medical center.  I would imagine that holds true for many of you. (more…)