Hospitalists Can Take Leading Role In Health Care Reform Efforts

NATIONAL HARBOR, MD. — Hospitalists should be feeling upbeat about the potential opportunities for their profession under the new health care reform law, several speakers said at the annual meeting of the Society of Hospital Medicine.

The law will give hospitalists a chance to show that they can provide cost-effective and efficient care, thus validating their specialty, speakers said at a plenary session that opened the meeting.

For instance, the law apparently will rely heavily on so-called “accountable care organizations” (ACOs), or groups of providers who pool their resources and efforts, and then receive a single payment for a patient's care. Although details are not yet available regarding the form that most ACOs will take, hospitalists “should be very excited” about this development, as they will have a leading role in helping such organizations to improve the quality and cost-effectiveness of care, said Dr. Ronald Greeno, cofounder and chief medical officer of Cogent Healthcare, a Brentwood, Tenn.–based hospital medicine management and consulting company.

Dr. Patrick Conway, a former pediatric hospitalist who is now chief medical officer at the Department of Health and Human Services, agreed that health care reform will give hospitalists a greater opportunity to make a difference because their experience in coordination of care will be even more crucial in the new landscape.

However, audience members expressed disappointment that malpractice liability reform was not addressed and that Congress did not replace Medicare's sustainable growth rate factor in either of the health reform bills passed—the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010.

In response to an attendee's question about personal accountability for health, Leslie Norwalk, former acting administrator of the Centers for Medicare and Medicaid Services under President George W. Bush, said that the law does place an important new emphasis on prevention and wellness, but that changing patients' health habits will be an uphill battle in a largely sedentary society.

Ms. Norwalk also predicted that comparative effectiveness research would rarely be used to guide care decisions, even if it yielded important findings.

In a plenary session that ended the meeting, Dr. Robert M. Wachter expressed a similar thought, saying that although the government has been—and will be—making a major investment in comparative effectiveness research, Medicare is forbidden from using the results to make coverage decisions. The United States is likely to become a major exporter of such research, joked Dr. Wachter, chief of the division of hospital medicine at the University of California, San Francisco.

He said that although the passage of health care reform was a remarkable political act, the legislation is designed to improve access to care and to reform the insurance market; many of the hard decisions about health care quality, cost, and safety are yet to be made.

Dr. Wachter said he is skeptical that ACOs could become widespread. A handful of ACOs, such as the Mayo Clinic and the Health System, are examples of how to integrate systems to provide high-value, high-quality, low-cost care, he said. But these systems are hard to emulate, Dr. Wachter said.

A small community hospital would be able to learn more about care integration from the way its own hospitalist group is working within its walls, he added. “In many ways [hospitalist groups] will turn out to be a model, a leading edge for doctor-hospital integration going forward,” he predicted.

NATIONAL HARBOR, MD. — Hospitalists should be feeling upbeat about the potential opportunities for their profession under the new health care reform law, several speakers said at the annual meeting of the Society of Hospital Medicine.

The law will give hospitalists a chance to show that they can provide cost-effective and efficient care, thus validating their specialty, speakers said at a plenary session that opened the meeting.

For instance, the law apparently will rely heavily on so-called “accountable care organizations” (ACOs), or groups of providers who pool their resources and efforts, and then receive a single payment for a patient's care. Although details are not yet available regarding the form that most ACOs will take, hospitalists “should be very excited” about this development, as they will have a leading role in helping such organizations to improve the quality and cost-effectiveness of care, said Dr. Ronald Greeno, cofounder and chief medical officer of Cogent Healthcare, a Brentwood, Tenn.–based hospital medicine management and consulting company.

Dr. Patrick Conway, a former pediatric hospitalist who is now chief medical officer at the Department of Health and Human Services, agreed that health care reform will give hospitalists a greater opportunity to make a difference because their experience in coordination of care will be even more crucial in the new landscape.

However, audience members expressed disappointment that malpractice liability reform was not addressed and that Congress did not replace Medicare's sustainable growth rate factor in either of the health reform bills passed—the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010.

In response to an attendee's question about personal accountability for health, Leslie Norwalk, former acting administrator of the Centers for Medicare and Medicaid Services under President George W. Bush, said that the law does place an important new emphasis on prevention and wellness, but that changing patients' health habits will be an uphill battle in a largely sedentary society.

Ms. Norwalk also predicted that comparative effectiveness research would rarely be used to guide care decisions, even if it yielded important findings.

In a plenary session that ended the meeting, Dr. Robert M. Wachter expressed a similar thought, saying that although the government has been—and will be—making a major investment in comparative effectiveness research, Medicare is forbidden from using the results to make coverage decisions. The United States is likely to become a major exporter of such research, joked Dr. Wachter, chief of the division of hospital medicine at the University of California, San Francisco.

He said that although the passage of health care reform was a remarkable political act, the legislation is designed to improve access to care and to reform the insurance market; many of the hard decisions about health care quality, cost, and safety are yet to be made.

Dr. Wachter said he is skeptical that ACOs could become widespread. A handful of ACOs, such as the Mayo Clinic and the Health System, are examples of how to integrate systems to provide high-value, high-quality, low-cost care, he said. But these systems are hard to emulate, Dr. Wachter said.

A small community hospital would be able to learn more about care integration from the way its own hospitalist group is working within its walls, he added. “In many ways [hospitalist groups] will turn out to be a model, a leading edge for doctor-hospital integration going forward,” he predicted.

NATIONAL HARBOR, MD. — Hospitalists should be feeling upbeat about the potential opportunities for their profession under the new health care reform law, several speakers said at the annual meeting of the Society of Hospital Medicine.

The law will give hospitalists a chance to show that they can provide cost-effective and efficient care, thus validating their specialty, speakers said at a plenary session that opened the meeting.

For instance, the law apparently will rely heavily on so-called “accountable care organizations” (ACOs), or groups of providers who pool their resources and efforts, and then receive a single payment for a patient's care. Although details are not yet available regarding the form that most ACOs will take, hospitalists “should be very excited” about this development, as they will have a leading role in helping such organizations to improve the quality and cost-effectiveness of care, said Dr. Ronald Greeno, cofounder and chief medical officer of Cogent Healthcare, a Brentwood, Tenn.–based hospital medicine management and consulting company.

Dr. Patrick Conway, a former pediatric hospitalist who is now chief medical officer at the Department of Health and Human Services, agreed that health care reform will give hospitalists a greater opportunity to make a difference because their experience in coordination of care will be even more crucial in the new landscape.

However, audience members expressed disappointment that malpractice liability reform was not addressed and that Congress did not replace Medicare's sustainable growth rate factor in either of the health reform bills passed—the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010.

In response to an attendee's question about personal accountability for health, Leslie Norwalk, former acting administrator of the Centers for Medicare and Medicaid Services under President George W. Bush, said that the law does place an important new emphasis on prevention and wellness, but that changing patients' health habits will be an uphill battle in a largely sedentary society.

Ms. Norwalk also predicted that comparative effectiveness research would rarely be used to guide care decisions, even if it yielded important findings.

In a plenary session that ended the meeting, Dr. Robert M. Wachter expressed a similar thought, saying that although the government has been—and will be—making a major investment in comparative effectiveness research, Medicare is forbidden from using the results to make coverage decisions. The United States is likely to become a major exporter of such research, joked Dr. Wachter, chief of the division of hospital medicine at the University of California, San Francisco.

He said that although the passage of health care reform was a remarkable political act, the legislation is designed to improve access to care and to reform the insurance market; many of the hard decisions about health care quality, cost, and safety are yet to be made.

Dr. Wachter said he is skeptical that ACOs could become widespread. A handful of ACOs, such as the Mayo Clinic and the Health System, are examples of how to integrate systems to provide high-value, high-quality, low-cost care, he said. But these systems are hard to emulate, Dr. Wachter said.

A small community hospital would be able to learn more about care integration from the way its own hospitalist group is working within its walls, he added. “In many ways [hospitalist groups] will turn out to be a model, a leading edge for doctor-hospital integration going forward,” he predicted.