March 18, 2026
Statement for the Record submitted by the Society of Hospital Medicine on the House Energy and Commerce Subcommittee on Health hearing titled Lowering Health Care Costs for All Americans: An Examination of the U.S. Provider Landscape.
Dear Chairman Griffith, Ranking Member DeGette, and Members of the Subcommittee ,
On behalf of the Society of Hospital Medicine (SHM) and the 50,000 hospitalists practicing across the United States, SHM submits this statement for the record. We thank the Subcommittee on Health for the opportunity to submit a statement for the record on one of the most pressing challenges facing American patients and families: the affordability of hospital-based healthcare.
Hospitalists are physicians who specialize in the care of hospitalized patients and who occupy a unique and strategically important position in American healthcare. They are present at the intersection of clinical quality and cost for care in the hospital. Every admission they manage, every discharge they coordinate, and every care transition they navigate has direct implications for what patients pay, what insurers reimburse, and what the Medicare and Medicaid programs spend. This statement will address three broad themes: (1) the current crisis of hospital affordability, (2) how hospitalists contribute to cost reduction and quality improvement, and (3) a legislative and policy agenda to further those contributions.
Hospital care remains the single largest category of healthcare expenditure in the United States, accounting for approximately 31 cents of every dollar spent on healthcare — roughly $1.6 trillion annually, according to the most recent data from the Centers for Medicare and Medicaid Services (CMS).[1] For many patients, this translates to a tangible and often devastating financial burden. Studies consistently show that medical debt is the leading cause of personal bankruptcy in the United States, and hospital bills are a contributor to that debt.
Unlike ambulatory or elective hospital care, much hospital care is rarely discretionary. Patients arrive in crisis, and they are physically, emotionally, and often financially unprepared. The power imbalance between a hospitalized patient and the healthcare system is profound. Patients cannot comparison-shop for inpatient services during a medical emergency. They cannot easily evaluate the cost implications of a recommendation to extend a stay, order additional testing, or pursue a certain treatment pathway. This vulnerability demands that the healthcare providers and systems responsible for their care take affordability seriously as an ethical obligation, not merely a regulatory requirement.
The Hospitalist Contribution to Affordability
Hospital medicine is the fastest-growing physician specialty in the United States, and we estimate their number to be well over 50,000. Hospitalists provide comprehensive inpatient care: admitting, managing, and discharging patients; coordinating with specialists; communicating with patients and families; and bridging care transitions to post-acute and outpatient settings. Historically, primary care physicians divided their time between the office and hospital to manage their patients who were hospitalized. Today, hospitalists are continuously physically present in the hospital and solely focused on inpatient care. This specialization enables faster response times, better care coordination, and more consistent quality.
Hospital medicine has been valued for more than two decades for its contributions to quality, efficiency, and ultimately, cost savings. Patient care managed by hospitalists is associated with:
- Shorter length of stay (LOS), typically one-half to one full day shorter per admission compared to non-hospitalist care[2],[3]
- Lower total cost per hospitalization, with savings ranging from several hundred to several thousand dollars per case, depending on complexity and setting[4],[5]
- Reduced rates of 30-day readmission when robust discharge planning protocols are employed
- Higher rates of compliance with evidence-based care protocols, which reduces unnecessary testing and treatment variation
Length of stay is a powerful lever for reducing inpatient costs. Each additional hospital day for a patient can cost between $2,000 and $3,000 on average, and costs are passed on directly or indirectly to payers, employers, and patients. By facilitating appropriate, timely, and well-organized discharges, hospitalists generate substantial savings that flow through the entire system.
A core function of hospital medicine is care coordination, the often-invisible work of ensuring that the right providers, the right information, and the right resources are in place at the right time. Poor coordination in the hospital is extraordinarily expensive. When a specialist consultation is delayed, the patient waits and the bill grows. When a patient is discharged without clear medication reconciliation and a follow-up plan, they frequently return to the hospital, triggering a new admission and increased costs.
Hospitalists serve as the integrative hub of inpatient care. We communicate with specialists in the hospital, primary care providers, home health agencies, skilled nursing facilities, and insurance case managers. We facilitate transitions of care that, when done well, dramatically reduce the downstream utilization that drives up total episode costs. Under bundled payment models and accountable care organization (ACO) structures, this coordination work is increasingly recognized and rewarded. Under traditional fee-for-service, it remains systematically undervalued and uncompensated.
Another important yet underappreciated contribution of hospitalists to affordability is the elimination of low-value care, including tests, treatments, and interventions that generate cost without commensurate clinical benefit. SHM, in partnership with hospitalist experts, has historically supported hospitalists in these efforts through an educational series known as ‘Things We Do For No Reason’, which highlights diagnostic tests, therapies, or other clinical practices that are commonly performed even though they are of low value to inpatients. Overuse of diagnostic imaging, reflexive laboratory ordering, and routine consultations for conditions that do not require specialist input are among the most prevalent and costly forms of waste in inpatient medicine. Hospitalists systematically apply evidence-based criteria to testing and treatment decisions and when they have the institutional support and culture to do so, the savings are measurable and meaningful. However, these efforts go uncompensated and often unrecognized.
Telehealth and Coverage Innovation
The scope of hospital medicine has expanded significantly to include tele-hospitalist programs, in which remote physicians provide after-hours coverage or augment care at critical access hospitals and rural facilities. These models have the potential to reduce costs by preventing unnecessary transfers to tertiary centers, expanding access to care in underserved communities, and improving night and weekend coverage without proportionally increasing staffing costs.
Congress and CMS should ensure that telehealth payment policies, including those established or extended through pandemic-era waivers, are continued and adequately supported beyond the current 2027 deadline. The evidence base for tele-hospital medicine is growing, and payment parity and regulatory predictability are essential for these programs to scale.
Workforce Sustainability
A discussion of affordability can’t ignore the workforce crisis currently confronting hospital medicine and medicine in general. Burnout rates are high. When experienced hospitalists leave clinical practice or leave hospital medicine altogether, institutions lose care coordination expertise and quality infrastructure that cannot be easily replaced. Indeed, research suggests that experience enhances the efficiencies achieved by hospitalists, as measured by length of stay.[6] The downstream costs of turnover, in recruitment, onboarding, temporary staffing, and quality disruption, are substantial and borne ultimately by the healthcare system overall.
Policies that reduce administrative burden, expand the pipeline of physicians choosing hospital medicine as a specialty, support team-based care models that appropriately incorporate advanced practice providers, and address the systemic factors contributing to burnout will indirectly but powerfully advance health care affordability.. A well-staffed, fully engaged hospitalist and hospital medicine workforce is itself a cost-containment asset.
Specific Policy Recommendations
On the basis of the foregoing, we urge the Subcommittee to consider the following actions:
- Reform inpatient transitional care payment: Develop a Medicare payment mechanism that rewards structured, documented, evidence-based discharge planning and care transition execution.
- Establish tele-hospitalist payment parity: Permanently codify payment parity for tele-hospitalist services provided to patients at rural or critical access hospitals and clarify regulatory requirements to support such models.
- Support hospitalist workforce development: Fund graduate medical education slots directed toward hospital medicine and general internal medicine, and support loan repayment programs for hospitalists practicing in rural or underserved settings.
- Incent the identification of and movement away from low-value care, by funding and advancing research into evidence-based care and quality improvement.
- Reduce administrative burden to streamline clinical workflows and maximize efficiency for hospitalized patients:
- Enact prior authorization reform applicable to inpatient services;
- Simplify and reduce redundant documentation requirements;
- Reform, simplify or eliminate burdensome reporting and measurement programs that do not improve cost or quality, including the Quality Payment Program (QPP); and
- Expand safe harbor protections for evidence-based care standardization initiatives.
The Subcommittee has asked the right question. Hospitalizations are a large driver of healthcare expenditures in the United States, and the affordability crisis it generates falls most heavily on the patients least able to absorb it, the elderly, the chronically ill, the uninsured, and the underinsured. Hospitalists are not a panacea, but we are a powerful and underutilized resource for achieving the health care affordability, quality, and efficiency goals that are of interest to this Subcommittee.
Hospitalists care for patients at their most vulnerable. They sit at the center of every hospitalization, every length-of-stay decision, every care coordination challenge, and every transition of care. When they are supported with appropriate incentives, infrastructure, and payment design, hospitalists generate measurable cost savings and increased clinical quality. When they are ignored in payment policy, buried in administrative burden, or burned out from unsustainable workloads, the savings potential will go unrealized.
SHM and hospitalists stand ready to be partners in this work. Thank you for the opportunity to provide this statement.
Sincerely,
Eric Howell, MD, MHM
Chief Executive Officer
Society of Hospital Medicine
[1] Centers for Medicare and Medicaid Services (CMS). National Health Expenditures 2024 Highlights. https://www.cms.gov/data-research/statistics-trends-and-reports/national-health-expenditure-data/historical.
[2] Rifkin WD, Holmboe E, Scherer H, Sierra H. Comparison of hospitalists and nonhospitalists in inpatient length of stay adjusting for patient and physician characteristics. J Gen Intern Med. 2004 Nov;19(11):1127-32. doi: 10.1111/j.1525-1497.2004.1930415.x. PMID: 15566442; PMCID: PMC1494784.
[3] Davis KM, Koch KE, Harvey JK, Wilson R, Englert J, Gerard PD. Effects of hospitalists on cost, outcomes, and patient satisfaction in a rural health system. Am J Med. 2000 Jun 1;108(8):621-6. doi: 10.1016/s0002-9343(00)00362-4. PMID: 10856409.
[4] Lindenauer PK, Rothberg MB, Pekow PS, et al. Outcomes of care by hospitalists, general internists, and family physicians. N Engl J Med. 2007;357(25):2589–2600.
[5] David Meltzer, Willard G. Manning, Jeanette Morrison, et al. Effects of Physician Experience on Costs and Outcomes on an Academic General Medicine Service: Results of a Trial of Hospitalists. Ann Intern Med.2002;137:866-874. [Epub 3 December 2002]. doi:10.7326/0003-4819-137-11-200212030-00007
[6] Kuo YF, Goodwin JS. Effect of hospitalists on length of stay in the medicare population: variation according to hospital and patient characteristics. J Am Geriatr Soc. 2010 Sep;58(9):1649-57. doi: 10.1111/j.1532-5415.2010.03007.x. PMID: 20863324; PMCID: PMC2946246.