A Pivotal Year for Policy

The Hospitalist. 2009 April;2009(04):

April 21, 2009|The Hospitalist

Change is in the air. With a new ad-ministration promising to be a change agent, an overhauled Congress, and a seemingly unanimous national interest in tackling healthcare reform, what changes can hospital medicine expect in 2009?

“I think there’s certainly the political will and interest now,” says Eric Siegal, MD, chair of SHM’s Public Policy Committee. “We haven’t had enough political will to ‘go big’ until recently. Now that we have it, the trillion-dollar question is where the money will come from.”

With that in mind, let’s explore three of the hottest healthcare issues:

Comprehensive Healthcare Reform

Providing healthcare coverage to all or most Americans was a centerpiece of President Obama’s campaign and a significant part of a proposal published by Senate Finance Committee Chairman Max Baucus (D-Mont.). Any actual reform will come through legislation, which will have to spell out who is covered and how, and where the money will come from. Any legislation will have to pass both the House and the Senate before Obama can sign it into law.

“The Democrats have certainly said [healthcare reform] is going to happen. Obama has talked about it … but how bipartisan will the effort be?” Dr. Siegal says. “This is too big and important for unilateral action; any durable healthcare reform must have bipartisan support. I do think that everyone can agree that the healthcare system is going to bankrupt itself if we don’t make changes.”

Dr. Siegal is skeptical that a major reform bill of any stripe will be passed anytime soon. “Given the depth of the recession and the projected cost of the stimulus package, my guess is that we will not see significant healthcare reform legislation passed in 2009,” he predicts. “However, I think that 2009 is still going to be an important year in that Congress will lay much of the foundation for new legislation. My guess is that 2010 is the year to look for major healthcare reform. And we want to make sure that the reform that happens is in the best interests of healthcare and of hospitalists.”

Less encompassing aspects of healthcare reform, the “easy stuff,” should have enough votes to pass in 2009, Dr. Siegal says. A good example is the State Children’s Health Insurance Program (SCHIP), which was passed the first week of February and increases the number of children eligible for free medical coverage from 7 million to 11 million. “SCHIP was as close to a slam dunk as possible.”

Major overhauls to the system, such as the healthcare exchange outlined in Sen. Baucus’ proposal or a major reworking of Medicare, may come about further down the road. “Those are going to take a lot of time, energy, and money,” Dr. Siegal says, “and I think that Congress has bigger fish to fry right now.”

Policy Points

HHS Targets Hospital-Acquired Infections

The U.S. Department of Health and Human Services (HHS) has released a new infection-control action plan that includes targeted goals for specific hospital-acquired infections (HAIs) within five years. The plan outlines how HHS will use measurement systems and data collected through its various agencies to track and reduce six HAIs: central-line-associated bloodstream; Clostridium difficile; catheter-associated urinary tract; methicillin-resistant Staphylococcus aureus (MRSA); surgical site; and ventilator-associated pneumonia. For more information on the plan, visit www.hhs.gov/ophs/initiatives/hai/infection.html.

Bundled Payment Demonstration

In January, CMS announced the five hospitals chosen to participate in its Acute Care Episode (ACE) demonstration. The new hospital-based trial will test the use of bundled payments for both hospital and physician services for a specific set of inpatient episodes of care. The dual goal is to use bundled payment to more closely align the incentives for hospitals and physicians—a concept seemingly tailor-made for hospitalists. The goal is to see if this model will lead to better quality and efficiency in the care delivered.

The demonstration sites are Baptist Health System in San Antonio; Oklahoma Heart Hospital in Oklahoma City; Exempla Saint Joseph Hospital in Denver; Hillcrest Medical Center in Tulsa, Okla.; and Lovelace Health System in Albuquerque, N.M.

For more information on the ACE demonstration, visit www.cms.hhs. gov/DemoProjects EvalRpts/MD/ itemdetail.asp?filterType=none &filterBy DID=99&sortByDID= 3&sort Order=descending&itemID=CMS1204388&intNumPerPage=10.