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Current Issues

SHM's Observation White Paper Calls for Elimination of Observation

SHM is calling for major reform to observation care policies to streamline care. Download the white paper to read perspectives from frontline hospitalists and recommendations from SHM that aim to streamline care, reduce administrative burden and protect patients from unpredictable, out-of-pocket costs.

Latest News

SHM Publishes Policy Statement Addressing the Opioid Epidemic

SHM urges Congress to take action to address the opioid crisis facing the United States. View the full statement

SHM Supports Fairness for High Skilled Immigrants Act

The Fairness for High Skilled Immigrants Act (H.R. 392/S.281) replaces the current per-country caps on immigration with a first-come first-served visa system. This legislation will ensure that highly-skilled medical professionals and their families will not be turned away from working in the United States based on per-country limitations. Read the letters to the U.S. House and Senate.

SHM Offers Support for Advance Care Plan Legislation.

SHM submitted letters of support to the House and Senate for the Medicare Choices Empowerment and Protection Act, which would create incentives for patients to create advance directives. Read letters to the U.S. House and Senate.


Observation Care

Policies for observation care and the inpatient admission decision put significant pressure on hospitalists and their patients. Hospitalists are the key players providing observation care in hospitals and see firsthand the challenges and frustrations the policies cause.

Learn more about SHM's efforts to improve observation policy.


The Medicare Access and CHIP Reauthorization Act (MACRA), passed in 2015, repealed the Medicare sustainable growth rate (SGR) formula and instituted significant reforms to the Medicare physician payment system. MACRA created the Medicare Quality Payment Program (QPP) with the goal of moving away from fee-for-service payments and into more value-based payments.  

The QPP has two pathways for physician payment:

  • The Merit Based Incentive Payment System (MIPS) combines PQRS, physician value-based payment and Meaningful Use into one streamlined system. Providers in this pathway will receive Medicare Part B payment adjustments based around performance in the MIPS.
  • Alternate payment models (APMs) exempt providers from the MIPS and give a 5% Medicare payments bonus. APMs move farther away from fee-for-service Medicare and include models accountable care organizations (ACOs) and patient-centered medical homes (PCMHs).

Visit SHM's MACRA resource page to learn more about the QPP and how to participate.

Other Topics

SHM works on an array of other policy issues that impact hospitalists and their patients.

Recent efforts include:

  • Encouraging Congress to support advance care planning by incentivizing patients to create advance directives. Read our letter to Congress.
  • Advocating to the Centers for Medicare and Medicaid Services (CMS) for changes to the evaluation and management (E/M) documentation requirements. Read our letter to CMS.
  • Submitting ideas for relief from administrative and regulatory burdens to the federal administration, including asking for changes to observation, relief from PQRS penalties and addressing issues with MACRA alternative payment models. Read our letters to the House Ways and Means Committee.

Policy Resources

SHM offers hospital medicine professionals a wide variety of resources to navigate the ever-changing policy landscape.

MACRA Resources

MIPS Guide for Hospitalists: Understanding the Merit-based Incentive Payment System, as part of the Quality Payment Program. What does it mean for you?Learn how to report measures and participate in the Merit-based Incentive Payment System (MIPS).

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MACRA and the Quality Payment Program | Frequently Asked Questions (FAQs): Learn about MACRA’s Quality Payment Program and its two pathways for physician payments.

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Observation Resources

Understanding Observation Care Video: With the passage of the NOTICE Act and the new MOON document for observation patients, SHM created a video resource to help with those tough conversations.

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NOTICE Act Resources

NOTICE Act FAQs: This FAQ document explains the requirements for notifying patients under observation.

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