Our monthly Leadership Report is the best way to stay apprised of how ACEP leaders are working on your behalf to advance emergency medicine. We know the challenges our members face, and we are continually taking steps to protect your interests and make it easier for you to provide the highest quality care for your patients. Keep reading for the latest updates from the national office.
LAC Attendees Advocate for Mental Health Care Access, Surprise Billing Framework
More than 550 emergency physicians from 47 states conducted 350 meetings with federal legislators and staff on Capitol Hill on Tuesday, May 7 during the ACEP 2019 Leadership and Advocacy Conference in Washington, DC. Attendees had the opportunity to educate and present solutions directly to legislators and their staff on hot-button issues like surprise billing and psychiatric patient boarding in the ED.
ACEP to Host Event with Key Health IT Stakeholders
ACEP is hosting the HIT Summit July 8 to bring the industry together to build a collaborative 10-year vision for emergency care through digital transformation. Stakeholders from diverse groups have been invited to participate, including physicians, hospitals, societies, research, academia, IT vendors, EHR vendors, government, quality, standards, consultants and payors. This collaborative vision aims to address some of the biggest issues facing technology in health care, including interoperability and data liquidity, HER usability and workflow, big data and what it means in emergency medicine. Look for a recap of the event in an upcoming edition of ACEP Now.
Opposing Medical Merit Badges
As part of the Coalition Opposed to Medical Merit Badges, ACEP continues to work at a state level on reducing/eliminating the need to take merit badge courses.
Grant to Fund Accreditation of 20 VA Facilities as Geriatric EDs
With a grant from the John A. Hartford Foundation and West Health, ACEP is offering to accredit 20 VA facilities as geriatric EDs at no cost. ACEP’s Geriatric ED Accreditation Program was developed by leaders in EM to ensure our older patients receive well-coordinated, quality care at the appropriate level at every ED encounter.
Addressing Protected Faculty Time with the ACGME
As one of its sponsoring bodies, ACEP leaders attended the ACGME Review Committee Meeting. The meeting featured considerable discussion about the proposed removal of protected time for faculty to teach, which continues to be a major issue for faculty at EM residency programs.
ACEP Meets with OSHA to Expand Protections from ED Violence
This week, ACEP held a meeting with the Occupational Safety and Health Administration (OSHA) in order to discuss strengthening protections for healthcare workers, especially those in the ED, from workplace violence. Currently, no such federal regulation exists, but OSHA has begun to explore its development. ACEP has long advocated for such protections; most recently, ACEP drew attention to the issue by releasing results of a survey it held that reported nearly half of emergency physicians polled had been physically assaulted, with more than 60 percent occurring in the past year. ACEP worked with Congressional offices to refine H.R. 1309, The Workplace Violence Prevention for Health Care and Social Service Workers Act, and last recently sent a letter of support asking Congress to consider how EDs in particular are staffed to ensure the important provisions of this legislation are implemented appropriately. Read more.
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Board of Directors Considers Influenza, Firearm Safety Research, Protected Time and More During April Meeting
ACEP’s Board of Directors convened April 10-11 and discussed several issues related to clinical topics and practice trends. Among their decisions, they voted in favor of:
Surveying the Council for a representative viewpoint on firearm-associated research, safety and policy
A policy statement about Salary and Benefits Considerations for EMS Professionals, which will provide justification for fair compensation regarding the dangers and risk as well as the out-of-hospital environment in which EMS providers operate.
A policy statement about Violence Prevention & Intervention in EMS System, which will provide the needed guidance regarding implementing steps to attain and maintain an EMS culture of patient and personnel safety
Hosting ACEP24 in Las Vegas
Creating a national Wellness award to celebrate institutions or organizations that demonstrate best practices when it comes to physician wellness, with the inaugural award presented during ACEP20
Partnering with the Center for Improvement in Healthcare Quality to develop an accreditation process for freestanding emergency centers
Approving an Influenza ED Best Practices information paper
Submitting a white paper to Annalsabout the potential impact of the Accreditation Council for Graduate Medical Education’s proposed policy that would restrict protected time for core faculty
Candidates Announced for Board, Council
The following candidates are running for ACEP leadership positions in 2019. Elections will take place during ACEP Scientific Assembly in Denver. More information on the candidates will be forthcoming.
Jon Mark Hirshon, MD, FACEP (MD)
Mark Rosenberg, DO, FACEP (NJ)
Gary Katz, MD, FACEP (OH) – unopposed
Kelly Gray-Eurom, MD, FACEP (FL)
Andrea Green, MD, FACEP (TX)
Howard Mell, MD, FACEP (IL)
Board of Directors (four open positions)
Michael Baker, MD, FACEP (MI)
Jeffrey Goodloe, MD, FACEP (OK)
Rachelle Greenman, MD, FACEP (NJ)
Gabor Kellen, MD, FACEP (AACEM)
Pamela Ross, MD, FACEP (VA)
Gillian Schmitz, MD, FACEP (incumbent – GS)
Ryan Stanton, MD, FACEP (KY)
Thomas Sugarman, MD, FACEP (CA)
EM Physician Named Chief Executive Officer of AOA
ACEP Board member Kevin Klauer, DO, EJD, FACEP, has been appointed chief executive officer of the American Osteopathic Association, the professional membership organization for more than 145,000 osteopathic physicians and medical students. As CEO, he will be responsible for strategy, operating results, organizational growth and advocacy.
“We are thrilled for Dr. Klauer to join the AOA as our next CEO,” said AOA President William S. Mayo, DO. “The DO profession is undergoing significant growth, with approximately one in four medical students attending a college of osteopathic medicine. This is a pivotal moment for the osteopathic profession and health care overall, and we are confident in Dr. Klauer’s experience to lead us through a dynamic and evolving landscape.”
Dr. Klauer, an ACEP member since 1992 and current Medical Editor-in-Chief of ACEP Now, will finish his current term on the ACEP Board of Directors in October 2019 and will help transition a new emergency physician into the role of ACEP Now Medical Editor-in-Chief.
ACEP Advocateas for Workplace Violence Protections for Health Care Workers
Violence in the ED is a serious and growing concern. ACEP’s 2018 survey reported that nearly half of EM physicians polled had been physically assaulted, with more than 60 percent occurring in the past year. ACEP recently worked with congressional offices to refine H.R. 1309: The Workplace Violence Prevention for Health Care and Social Service Workers Act, and sent a letter of support asking Congress to consider how EDs in particular are staffed to ensure the important provisions of this legislation are implemented appropriately. ACEP's letter requested additional clarity of the legislation's wording to ensure any new federal requirements do not create any unintentional burdens for entities that do not directly control the health care workplace. Read more at www.acep.org/EDsafety.
ACEP Submits Statement on Surprise Billing, Bundled Payments
On April 2, ACEP submitted a statement for the record to the House Committee on Education and Labor's Subcommittee on Health, Employment, Labor, and Pensions that urged legislators to take into account the unique nature of emergency medicine while examining the surprise billing issue. The letter explains how EMTALA has disincentivized health plans from entering into fair and reasonable contracts to provide services at appropriate in-network rates.
This letter also explains ACEP’s stance on recent proposals related to bundled payments being discussed as part of negotiations to develop federal balance billing legislation: “We also note our strong concerns with proposals that would either provide a single bundled payment from a hospital for emergency services or would set a benchmark payment at a certain level of Medicare rates. A bundled payment would not actually address the underlying cost issues, but instead merely shift the venue for negotiation under the assumption that hospitals would somehow be able to better negotiate with physicians than insurers.”
ACEP, NAEMT Partner to Celebrate EMS Week
The 45th National EMS Week is May 19-25, bringing together local communities and medical personnel to publicize safety and honor the dedication of EMTs. In 1974, President Gerald Ford authorized EMS Week to celebrate EMS practitioners and the important work they do in our nation's communities. Presented by ACEP and the National Association of EMTs (NAEMT), our EMS 2019 theme is “BEYOND the CALL.”
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ACEP Applauds House Passage of Bill on Universal Background Checks for Firearm Transfer or Sale
ACEP sent a letter of support for H.R. 8, the “Bipartisan Background Checks Act of 2019,” which, introduced by Reps. Mike Thompson (D-CA) and Peter King (R-NY), would extend the existing system of background checks for firearms transactions to all sales, with certain exceptions for law enforcement, gifts to family members, and transfers for hunting, target shooting, and self-defense purposes. ACEP’s own policy supports universal background checks for firearms, and ACEP has supported similar legislation in the past. The House voted on and passed H.R. 8, though it is unlikely to be taken up in the Senate. Read the press release at newsroom.acep.org.
Emergency Physician Named First Chief Medical Officer of the Office of National Drug Control Policy
The White House Office of National Drug Control Policy (ONDCP) announced that Roneet Lev, MD, FACEP, an emergency physician from San Diego, California and member of the American College of Emergency Physicians (ACEP), will serve as ONDCP’s first ever Chief Medical Officer.
“It is an honor and privilege to serve the administration and the American people,” said Dr. Lev. “I will integrate my 25 years of clinical experience to work on the prevention, treatment, and enforcement aspects of drug addiction. ONDCP Director James Carroll make it very clear that the purpose of our every day job is to save lives – just like what emergency physicians do every shift.”
“We are thrilled that Dr. Lev not only proudly represents emergency physicians in this prestigious role, but also the millions of emergency patients who rely on us every day for essential care,” said Vidor Friedman, MD, FACEP, president of ACEP. “Once again, the importance of emergency medicine is being recognized at the highest levels of government.”
Read the press release.
Recent Advocacy Efforts Focus on Out of Network Billing Issues
ACEP President Vidor Friedman, MD, FACEP, has conducted many meetings on Capitol Hill as part of continued outreach to address out-of-network billing issues and other issues important to emergency medicine. During a busy two-day sprint, Dr. Friedman met with with Senators Lamar Alexander (R-TN), Marsha Blackburn (R-TN), Sen. Patty Murray (D-WA), ranking member of the HELP Committee, as well as HELP Committee Republican staff, staff for Senator Bill Cassidy (R-LA), staff for House Minority Leader Kevin McCarthy (R-CA), Rep. Darren Soto (D-FL), and Rep. Mike Burgess, MD (R-TX), ranking member of the House Committee on Energy and Commerce Health Subcommittee. The following day, Dr. Friedman met with Sen. Maggie Hassan (D-NH), a member of the Senate Bipartisan Price Transparency Workgroup and author of her own surprise billing legislation, and attended a fundraiser with Sen. Johnny Isakson (R-GA).
ACEP’s DC staff continues to supplement Dr. Friedman’s ongoing advocacy efforts with dozens of meetings with key legislators and other stakeholders. ACEP responded to a data request sent to a number of physician associations and groups, hospitals, and insurers by the Senate bipartisan transparency workgroup led by Senator Cassidy that is developing federal legislation to address so-called “surprise bills.”
Sepsis Discussions Continue
ACEP recently met with the Society for Critical Care Medicine to discuss the issues around the Sep-3 definition of sepsis and the difficulties some EM physicians are having with reimbursement and meeting quality measures. Many of the components of the Sep-3 definition require laboratory values or time (response to fluids). Studies have shown that the Sep-3 definition is not accurate in the ED, and CMS does not use Sep-3. ACEP has sent letters to the insurance companies that have used Sep-3 in denials. SCCM provided some language for that letter but declined to sign it with ACEP.
ACEP and SCCM also discussed the 1-hour bundle. ACEP is working on a new guideline for early emergency care for septic patients. ACEP and SCCM agreed to look at joint research projects that would concentrate on early care of sepsis.
EM Physician Advocates During Surprise Billing Panel
ACEP board member Tony Cirillo, MD, FACEP, gave compelling opening remarks about the role of EPs during a surprise billing panel hosted by the Brookings Institute. Watch his remarks, which begin at 2:31:18 in the video.
Emergency Physician Advocates for SUD Funding on Capitol Hill
Eric Ketcham, MD, FACEP, participated in a congressional briefing sponsored by the Coalition to Stop Opioid Overdose (CSOO) and the Mental Health Liaison Group (MHLG), to share his perspective as an emergency physician who treats individuals with substance use disorders (SUDs) and to encourage Congress to continue its important efforts to address the nation’s opioid epidemic.
Dr. Ketcham’s remarks focused on the unique role of emergency medicine and how emergency departments can better coordinate with resources in the community to ensure patients receive appropriate short- and long-term care. He also reinforced the need for Congress to appropriate necessary funding for the Alternatives to Opioids (ALTO) and Preventing Overdoses While in Emergency Rooms (POWER) Acts that were passed into law by Congress last year as part of H.R. 6, the SUPPORT Act. These two ACEP-developed bills were authorized by Congress last year and now require funding to ensure these critical resources can help expand the reach of emergency medicine to better serve patients with SUDs.
Scoot Safe! Public Health and Safety Campaign Launches
Scooter-related ED visits are on the rise, so ACEP launched a public health and safety campaign to urge millions of electronic scooter riders to scoot safely. The campaign features a public service announcement and downloadable poster that offers commonsense tips for scooter riders.
ACEP and ASA Discuss Procedural Sedation, Opioids, OON Billing
ACEP leadership met with the American Society of Anesthesiologists Feb. 28 to discuss ACEP’s recent guideline on procedural sedation, the opioid epidemic, and out-of-network billing. Our groups were mutually interested in the topic of physician wellness and agreed physicians should be able to get help for mental illness without jeopardizing their license or hospital privileges. Other issues discussed included firearm violence, drug shortages and independent practice by Pas and NPs.
Committee Selection Process Opens
ACEP President-Elect, William P. Jaquis, MD, FACEP, has opened the selection process for appointing members to serve on national ACEP committees during fiscal year 2019-20. Committee interest forms are due May 17. Find more information about committee roles and selection.
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May 2019 Highlights
Our clinical affairs team developed an abbreviated algorithmic pathway to assist in the administration of Buprenorphine in the ED. This point-of-care tool is now available online for all ACEP members. They also worked with Dr. Christopher Baugh to develop and build out the Atrial Fibrillation tool, online now.
Our quality department statistically analyzed variance in raw ED performance data collected across 25 measures in our registry, with the goal of highlighting performance gaps (e.g. head CT utilization for minor head injury) that support the necessity of a measure that helps emergency clinicians provide higher-quality patient care.
Our grant development team worked on the creation of value sets that will be used to create electronic measures for EMS on behalf of NEMSQA. Once these EMS-specific value sets and electronic measures are created, they will be the first electronically specified measures endorsed for primary use in the field of EMS.
Our clinical affairs team worked with members and Ed Products staff to develop free eCME for ACEP members for two clinical policies.
Our reimbursement team lobbied for EM-friendly CPT rulings on fracture care and behavioral health coding guidance and alerted 12 states about a potentially damaging reimbursement policy by a large insurer which allowed ACEP to begin a rapid response to our members and their groups in the affected states.
Our regulatory affairs team responded to a request for information (RFI) on how to enhance the ability of health care insurers to sell health insurance coverage across state lines. In the response, ACEP supported increasing access to affordable health insurance but explained concerns about the potential impact this could have on the coverage of emergency services and access to care for higher risk populations. Davis and the PR team also issued a press release in reponse to the final rule released by the Department of Health and Human Services (HHS) that enhances conscience protections for health care providers who refuse to provide care that violates their religious beliefs. The final rule is extremely concerning and violates our core beliefs and ethical and legal duty as emergency physicians.
April 2019 Highlights
Our clinical affairs team helped persuade United Healthcare to change a Managed Medicaid policy that denied or down-coded emergency claims based on final diagnosis in 23 states - a violation of the Prudent Layperson Standard ACEP fought hard to establish. By writing letters to UHC and helping ACEP members turn up the heat, the policy has been reversed in all but two states, potentially saving ACEP members millions in lost reimbursement.
Our reimbursement department assisted hundreds of members with coding and reimbursement information and published the 2019 edition of "What Every Graduating Resident Needs to Know About Reimbursement."
Our clinical affairs team is working with The Joint Commission to create a survey on onerous regulations.
Our educational products team worked with Amazon to make the second edition of the ECG book on Amazon’s print-on-demand in six new marketplaces: UK, France, Italy, Germany, Spain, and Japan. This improvement greatly reduces shipping fees for our international customers.
Our quality team provided CMS with MIPS program leadership concerns with the program that directly affect EM practitioners who participate in MIPS, along with ideas to improve the program for EM and other clinicians.
Our legislative team in ACEP's DC office drafted legislation to create a grant program that will facilitate moving psychiatric/mental health patients out of the ED and into more appropriate treatment settings. This language is currently being reviewed by House and Senate lawmakers for possible sponsorship.
Our member communications team compiled salary information from ACEP and external sources to make a one-stop-shop online resource for members trying to negotiative appropriate compensation.
Our legislation team met with the Occupational Safety and Health Administration to discuss workplace violence and continued working on responses to regulations on interoperability and data blocking that will have a big impact on EM physicians. They helped respond to EMTALA-related questions around the treatment of psychiatric patients and are drafting responses to frequently asked questions on surprise billing.
Our clinical affairs team is leading a work group of Facility Guideline Institute Revision Committee Members on the review of the Emergency Services section of the guidelines to propose revisions.
Our grants development team led a review of candidate quality measures for the National EMS Quality Alliance (NEMSQA) that allowed experts in the EMS field to provide their input in how to improve the measure set in an organized and methodical method.
Our Annals of Emergency Medicine team worked with the husband of an Annals author to surprise his wife by framing a copy of her article.
Our clinical affairs team is liaisoning with the groups working to revise clinical policies on opioids, blunt trauma, appendicitis and mild traumatic brain injury.