Most people think legislators and they envision representatives bickering about deals never to be, in a big crusty room, with portraits of the founding fathers staring down from on high.
Kind of true, but our elected officials serve another role often overlooked. Each house of congress has a committee system, and these bodies serve a unique role distinct from lawmaking. Members choose groups they wish to sit on. More on that below.
Some committees carry greater sway than others do. Legislators use their power through their posts to these assemblages to accrue money and muscle. Politicians want to connect with vested actors as they enable donations and propel careers upward.
Less cynically, if politicians value public service, they also wish to engage on consequential matters and make a difference. For example, committees such as Finance, Justice, and Intelligence have high impact sheen. Conversely, a berth on Space, Horticulture, or Fisheries means you got the charge due to prior experience in those fields, or you really ticked someone off. The sardine association will not be ringing your office bell and doling out reams of cash for your PAC. Although you still may help sardines and we all can acknowledge your oceanic service—no small thing, little fish do not make the front page.
Since health care comprises such a large portion of our economy, its allied committees also have great attraction to pols. Understandably, many constituents within the health economy careen alongside. If congress wants to hear about Medicare, you can bet the AARP, AMA, AHA, AHIP, PhRMA will be in tow. The trade associations and professional societies want to whisper in your ear and be your intimate. Each organization, including SHM, has something to say. They desire a forum to air their concerns.
So what do committees do to garner attention and make such close friends? They hold hearings on subjects under their purview to gather information and repair glitches in laws or expose wrongdoing.
Recently, one of SHM’s own went to Capitol Hill at the request of the House Ways and Means Committee to give testimony on a matter both the committee and SHM hold in high stead. We all know observation status has garnered a great deal of attention lately. I do not need to go into detail, but many folks have sounded alarms over the flawed policy. The policy hurts beneficiaries and muddles inpatient care delivery.
For Ways and Means—a powerful committee involved with Medicare (the title “Ways and Means” belies anything related to health care, but that’s congress for you), legislators wanted to hear from parties with stakes in the process. Our expert, Ann Sheehy, MD, MS from University of Wisconsin represented physicians, and due to her research portfolio and adroit touch, Congress called—with some strong assists from the SHM advocacy team. Along with Ann, reps from CMS, the Office of Inspector General, RACs and patient advocacy groups also appeared (see a clip of her testimony at the bottom of the post). The Hospital Leader reached out to Ann to obtain her insights.
Q. Ann, thanks for chatting with THL. Did you feel honored to visit Capitol Hill and testify?
Sheehy: It was a great honor to represent SHM on the issue of observation status, and I was fortunate that SHM chose me to be their voice. I became interested in this topic several years ago because I couldn’t believe what was happening to patients who were hospitalized but not meeting inpatient criteria. It was also an honor to be able to be the voice for all of the observation patients I personally have had the privilege to take care of.
Q. How does one prepare to caucus with members of congress–especially given the limited time to speak formally [note: a less rigid, lengthier Q&A follows individual testimony]? How did you whittle down an hours’ worth of information into five minutes?
Sheehy: Before I wrote my testimony, I had the opportunity to talk to both majority and minority staff to understand what topics they felt would have the highest impact in the hearing. In addition, SHM (Laura Allendorf, Josh Boswell, and Josh Lapps in particular) provided a lot of help and feedback, including background information on many potential questions and issues I might be asked in the Q&A. I also work with an incredible multidisciplinary team here at the UW. As just one example, in the days leading up to the hearing, our observation/Recovery Audit Contractor (RAC) data analyst Becky Borchert worked into the evening several nights just to provide our most up-to-date auditing data. This was on top of the data our hospital medicine analyst, Andrew LaRocque, had already provided to support my testimony. So I had an enormous amount of help and in preparing my written statement, and then felt as prepared as I could for questions that might come up. It was, of course, challenging to say everything I wanted to say in 5 minutes, but hopefully we were able to get our key points across.
Q. What bills or fixes are in play here, and why do you think they wanted to hear from a hospitalist and expert in observation policy?
Sheehy: We anticipate that the House Ways and Means Health Subcommittee will use the findings from the hearing to draft a comprehensive bill that addresses observation policy and the RAC auditing program. I believe Congress wanted to hear from a hospitalist because they recognized that we are front line witnesses to what is going on in observation status on hospital wards.
Q. Did you find our legislators well informed and what did you make of the questions? In addition, how did you react to some of their soliloquies and political point scoring? Congress in action, huh?
Sheehy: I was impressed with how much the legislators knew about observation policy. It was clear that many Congressmen and Congresswomen had heard about the challenges with observation policy from their constituents. Several Congress members read letters from hospitals or constituents in their district. To me, this reinforced the importance of SHM’s advocacy work, including the grassroots network and Hill Day visits. I witnessed first hand that these contacts do make a difference in informing and influencing our policymakers.
Q. Did you find testifying amidst the diverse panelists a challenge and did you experience any pushback from your copresentors?
Sheehy: Representatives from the Centers for Medicare and Medicaid Services (CMS) and the Office of Inspector General (OIG) made up the first panel. I was on the second panel, which included a representative from Johns Hopkins Hospital, a RAC representative, and a lawyer from the Center for Medicare Advocacy. We knew going in that the RAC representative would likely have different views from the rest of us, and that turned out to be the case. For the remaining 3 of us, despite coming from different organizations and different parts of the country, I was struck by how similar our experiences were, and how unified our message was. I think this strengthened our message to Congress. Observation and the RAC auditing programs are major problems all over the country.
Q. What do you think the representatives learned and did you sense your contribution would make a difference?
Sheehy: I believe that the representatives heard that observation status is a major problem for Medicare beneficiaries, and the 2-midnight rule simply shifts the observation burden to a new population of patients. I also believe they heard from us that while observation policy needs reform, no reform will be successful without concomitant reform of the RAC auditing program that enforces observation policy. Everybody understands that Medicare fraud and abuse cannot be tolerated, but the RAC system has really tipped the balance from being helpful in that regard to creating its own set of problems and expense in the Medicare program. Hopefully, these points will be used as the backdrop for new legislation.
Q. I also noted you had a nice moment with a representative from Wisconsin. Do share.
Sheehy: It was great to meet Representative Kind from Wisconsin. My parents are both from his district, and in our brief conversation I learned that the farm that my dad grew up on is very near his family farm. It was a thrill for me to see Representative Kind listening and asking questions in an attempt to figure out how best to help the people of Wisconsin.
Thanks for spending time with us, Ann. Wishing you continued success and we at SHM thank you for your efforts.
**Also, be on the lookout for an upcoming SHM white paper on observation status. The effort incorporates the largest national survey of inpatient practitioners ever performed. Unique and one of a kind data!!
Bradley Flansbaum, DO, MPH, MHM works for Geisinger Health System in Danville, PA in both the divisions of hospital medicine and population health. He began working as a hospitalist in 1996, at the inception of the hospital medicine movement. He is a founding member of the Society of Hospital Medicine and served as a board member and officer. He speaks nationally in promoting hospital medicine and has presented at many statewide meetings and conferences. He is also actively involved in house staff education.
Currently, he serves on the SHM Public Policy Committee and has an interest in payment policy, healthcare market competition, health disparities, cost-effectiveness analysis, and pain and palliative care. He is SHM’s delegate for the AMA House of Delegates.
Dr. Flansbaum received his undergraduate degree from Union College in Schenectady, NY and attended medical school at the New York College of Osteopathic Medicine. He completed his residency and chief residency in Internal Medicine at Long Island Jewish Medical Center in New York. He received his M.P.H. in Health Policy and Management at Columbia University.
He is a political junky, and loves to cook, stay fit, read non-fiction, listen to many genres of music, and is a resident of Danville, PA.