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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.

Issue Updates


SHM Position on Buprenorphine Deregulation

Buprenorphine is currently a Schedule III controlled substance but has restrictions placed upon its use for this indication. We believe ... Read Full Statement

Summer 2019 - Legislative Updates

Latest updates on key legislation impacting hospital medicine right now. Read Latest Newsletter

Trustworthy Individual Performance Measures? Show Them To Me

Public and private payers incentivizing providers (P4P) to coax desired clinical behaviors have failed. Both CMS derived measures and ... Read Blog Post


SHM Joins Multi-Stakeholder Letter Supporting the Improving Seniors Timely Access to Care Act

SHM, along with other professional and medical societies, supports the Improving Timely Access to Care Act of 2019 (HR 3107). This bill will standardize prior authorization under Medicare Advantage Programs, improve ... Read Letter

SHM Responds to CMS' Request for Information on "Patients Over Paperwork" Initiative

Our comments address CMS' Request for Information (RFI) regarding their "Patients Over Paperwork" Initiative. In this letter, we examine excessive administrative burden related to observation care, the 96-hour rule, Medicare Advantage (MA) plans, among other issues ... Read Letter


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The Medicare Access and CHIP Reauthorization Act (MACRA), passed in 2015, repealed the Medicare sustainable growth rate (SGR) formula and instituted significant reforms to the Medicare physician payment system.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.

Watch Video

NOTICE Act Resources

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

Download Now