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Current Issues

Issue Updates

News

Policy Update: Split (or shared) Billing

One-pager on recently finalized rules for split (or shared) billing of hospital visits between physicians and NPs/PAs. Updated November 18, 2022. Read Now

SHM Signs AMA Letter on Split (or shared) Billing

SHM joined the AMA and other medical specialty societies, urging CMS to rescind the new policy on split (or shared) billing. Read Now

Blunting Medicare Payment Cuts and Addressing Physician Wellness

Congress has passed, and President Biden has signed into law, legislation that will blunt the majority of the scheduled Medicare reimbursement cuts. Additionally, Congress has passed legislation focused on reducing and preventing physician suicide. Read Now

Letters

Signs Joins Multi-Stakeholder Letter on Medicare Reimbursement

SHM, alongside dozens of other medical and specialty societies, has signed a letter to Congressional leadership urging Congress to establish a permanent Medicare payment system. Read Letter

SHM Submits Comments on 2023 Physician Fee Schedule Proposed Rule

SHM has submitted comments on the 2023 PFS Proposed Rule. SHM commented on various proposals including, but not limited to, telehealth, split (or shared) billing, code valuations, and the Quality Payment Program. Read Letter

SHM Submits Request for Information Response on Prior Authorization

Prior authorization requirements under Medicare Advantage (MA) plans often result in unnecessary delays or denials in medically necessary care. SHM has submitted comments to CMS to encourage the agency to standardize and streamline the prior authorization process. Read Letter

 

View more letters.

Social

Observation Care

Observation is an outpatient designation originally intended to give providers time to decide whether a patient should be admitted to the hospital as an inpatient or discharged back to the community. 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

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.

Download white paper

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.
  • 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.

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).

Download Now

Policy Update on 2022 Medicare Split (or Shared) Billing Rule

Learn more about recently finalized rules for split (or shared) billing of hospital visits between physicians and NPs/PAs. Updated Nov 2022.

Download Now

New Buprenorphine Practice Guidelines: FAQs

Learn about updated prescribing guidelines for buprenorphine in this FAQ. Updated May 2021.

Download Now