Current Issues

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.

MACRA

The Medicare Access and CHIP Reauthorization Act (MACRA), passed in 2015, repealed the Medicare sustainable growth rate (SGR) formula and instituted significant reforms to the Medicare physician payment system.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.
• Supporting repeal of the Independent Payment Advisory Board. Read our position statement.
• 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.