By Michael J. Gerardi, MD, FAAP, FACEP
First of all, I’d like to thank ACEP members for allowing me to serve as your President since October. It has been a joy to do my part in advancing the specialty and continuing our efforts to improve your lives and the care of our patients. Each quarter, we’re going to offer a report about what we’ve been working on lately and some of the events that shaped emergency medicine. As you will read below, we have done a lot already in 2015, but a lot of important work is still to come over the next few months, particularly with legislation that directly impacts us and with our Clinical Emergency Data Registry. I look forward to visiting with many of you in Washington, D.C. in May.
SGR Repeal, EMTALA Legislation Top Advocacy List in Early 2015
Two major pieces of legislation kicked off the first quarter of 2015, beginning with the EMTALA Services Medical Liability Reform Bill in early February and continuing with an attempt to repeal the Sustainable Growth Rate in late March.
On Feb. 10, ACEP leaders joined Representative Charlie Dent (R-PA) at a news conference in Washington, D.C., to announce the introduction of the Health Care Safety Net Enhancement Act of 2015 — to improve emergency care for patients. H.R. 836 will encourage physicians and on-call specialists to continue their lifesaving work and ensure emergency medical care will be available for your constituents when and where it is needed. Specifically, the legislation addresses the growing crisis in access to emergency care by providing emergency and on-call physicians who provide EMTALA-related services with temporary protections under the Federal Tort Claims Act.
The Bill was referred to the House Energy and Commerce Committee. As of today, it has 32 co-sponsors, but we can use your help growing that number. Please click here to learn more, and please contact your Member of Congress and ask for support.
On March 26, the House approved a bill that proposed significant changes to the Medicare system’s reimbursement model. It signals what could repeal the Sustainable Growth Rate Formula. The New York Times called it the “most significant bipartisan policy legislation to pass through that chamber since the Republicans regained a majority in 2011.” If successfully passed, the bill would put an end to the recurring threat of payment cuts to physicians. The measure would also increase premiums for some higher income Medicare beneficiaries and extend the Children’s Health Insurance Program for two years.
Unfortunately, the Senate failed to consider the legislation on March 27 before adjourning for two weeks. Senate Democrats wanted a chance to consider several amendments to the House-approved bill, but Majority Leader Mitch McConnell (R-KY) did not agree to that request, instead stating he would work with Minority Leader Harry Reid (D-NV) during the recess to settle on a pathway forward as soon as the Senate returns on April 13, 2015. The Centers for Medicare & Medicaid Services has indicated that it will hold claims through April 14 to give Congress time to act.
We are disappointed the Senate failed to act before leaving town. We remain optimistic that, after fighting this battle for more than 12 years, we will finally rid ourselves of the flawed SGR permanently. We are calling for the Senate to act expeditiously as soon as they return and seize this opportunity to enact real, meaningful change in the Medicare program. Visit the ACEP Grassroots Advocacy Center to send a message to your Senators today.
Supreme Court Rules on Medicaid Rate Challenges
On March 31, 2015 the Supreme Court of the United States issued a ruling on the case of Armstrong vs. Exceptional Child Center. At issue was whether medical providers could sue over low Medicaid rates as a way to enforce federal payment requirements to assure that payments are consistent with efficiency, economy and quality of care sufficient enough to enlist providers so as to maintain adequate provider networks.
The opposing view was that such a ruling would result in endless litigation for higher pay and that Congress had not authorized such suits. The court was divided 5 to 4, ruling that providers do not have a federal cause of action to challenge low Medicaid rates. Instead providers with complaints must appeal to the federal government for enforcement.
ACEP has successfully used legal action in various states such as Louisiana, New York and Washington when the Medicaid plan offered unreasonably low payment, limited the number of ED visits for Medicaid patients, or restricted the approved diagnosis list so as to be unreasonable. Going forward, we will have to look to Congress or HHS regulatory staff to enforce Medicaid provisions, making strong relationships with your elected leaders important.
The ACEP Reimbursement Committee is considering whether a “white paper” should be developed to guide ACEP members and stakeholders regarding whether the Armstrong case could be distinguishable for emergency medicine. The issue is whether the “prudent layperson” provisions of the Balanced Budget Act of 1997 that apply to Medicaid HMOs and the ACA provisions barring prior authorization provide legal rights and/or remedies to emergency medicine that are unique and different from the legal basis presented by the plaintiffs in the Armstrong case.
American Hospital Association (AHA)
Publication Promotes Value of Emergency Care
In late March, the AHA issued a publication that highlighted emergency care’s value and role in the health care system. The report “explores the standby role and its critical importance to our nation’s health care system. It outlines the pressures hospitals face and frames critical economic and policy questions that must be addressed to ensure future hospital standby capacity can meet the growing health and public safety challenges.”
ACEP and the AHA worked together to issue a joint letter about the report, which was entitled “Always There, Ready to Care.” It was made available to all members. We encouraged ACEP members to share this report with key leaders and policy makers in your community and state and promote through social media. If you haven’t received a copy, click here.
ACEP Responds to Measles Crisis
On the heels of the Ebola crisis last fall, ACEP leaders and staff responded quickly to another epidemic when the United States experienced a record number of measles cases in early 2015.
This virus represents a challenge to Emergency Medicine because it is highly infectious and has been rarely seen in emergency departments in the recent past. ACEP developed a Fact Sheet about this disease for a review of its presentation, clinical course and implications for the ED. Emergency physicians and other health care professionals can visit acep.org/measles for more information and for new resources, which will be added as needed.
- Comment Period on tPA Clinical Policy Closed March 13: Early in 2015, ACEP opened a 60-day comment period on the draft clinical guideline: “Clinical Policy: Use of Intravenous tPA for the Management of Acute Ischemic Stroke in the Emergency Department.” The next step is for the Clinical Policy Committee to review comments and draft a revision as appropriate to submit for ACEP Board approval.
- Mental Health, Substance Abuse Patient Care Resources Added to ACEP’s Website: In early January, ACEP combined numerous mental health and substance abuse resources at www.acep.org, anchored by the Emergency Medicine Practice Committee’s information paper on “Care of the Psychiatric Patient in the ED: A Review of the Literature.” Included on this new resource page was also information about sobering centers, ACEP Policy Statements, Patient Resources and more. See these resources here.
- ACEP Releases New Publication, Cardiovascular Emergencies: More than 6 million people present to EDs each year with chest pain and forms of cardiac disease—arrhythmias, infections and cardiovascular complications from other conditions. ACEP’s newest publication, Cardiovascular Emergencies, provides information to help you deliver efficient and cutting-edge care to patients who present with acute cardiovascular conditions. Learn more.
- EMRA Launches Updated PressorDex App: Newly revised and updated for 2015, PressorDex is a comprehensive therapeutic guide to the myriad of pressors, vasoactive drugs, continuous infusions, and other medications needed to treat the critically ill patient. Written by emergency medicine physicians for emergency medicine physicians, this app gives you concise tools for choosing the right medication and dosing regimen every time, even during the busiest of shifts. Find it and other useful EMRA apps here.
- Qualified Clinical Data Registry Work Continues: ACEP announced last year that it would begin work on a Qualified Clinical Data Registry (QCDR). This is a very complex project, but it will position emergency medicine to develop quality measures that will resonate with members and, we believe, improve quality. We can develop measures that apply to patients beyond the Medicare population. As Executive Director Dean Wilkerson, JD, MBA, CAE, wrote in the December issue of ACEP Now, “If we have our own QCDR, we can control the playing field and develop measures we believe are appropriate without having to submit them to the National Quality Forum for other groups to approve. Rather than having measures imposed on us, we will drive the measures ourselves.” Quality measure reporting and quality improvements are of increasing importance for physician reimbursement. ACEP’s QCDR will allow our members to avoid cuts to their reimbursement and obtain incentive payments. The initial testing and QCDR approval phase began in February 2015 with the participation of five emergency departments. The pilot phase is expected to begin in May of 2015. Through the aggregation and organization of data on clinical effectiveness, patient safety, care coordination, patient experience, efficiency and system effectiveness, ACEP’s Clinical Emergency Data Registry will provide clinicians with a definitive resource for informing and advancing the highest quality of emergency care. ACEP expects final approval of its Quality Measures and our QCDR later this month. Learn more about CEDR.
- End of Life/Advance Care Planning: A task force led by Vidor Friedman, MD, FACEP, Mark Rosenberg, DO, MBA, FACEP, FACOEP-D, and Sandy Schneider, MD, FACEP, has been assembled to prepare a white paper within the next few months to make recommendations to the Board on our next steps to promote a national discussion on EOL/AC issues.
- Psychiatric Emergency Care Initiative: We have already had our first summit of stakeholder organizations and have created COPE – “Coalition on Psychiatric Emergencies.” ACEP is a leader on the Steering Committee, and subcommittees have been created to: address education of the public and caregivers, study the latest advances in diagnosis and treatment, develop a research agenda, and configure an advocacy approach for true parity of care for psychiatric emergencies. In addition, we are working on a public relations release in the next few weeks announcing our mission and the stakeholders. Sandy Schneider, MD, FACEP, along with Barbara Tomar and Cynthia Singh of our staff are leading this effort.
- Sepsis Task Force: We have a task force led by Board Member John Rogers, MD, FACEP, Task Force Chair Don Yearly, MD, and Sandy Schneider, MD, FACEP, to review all of the current literature and summarize it for our members to use. We will also have an educational campaign for our members and other organizations highlighting our role in diagnosing and initiating treatment of sepsis to a point that we, Emergency Medicine, will “own sepsis.” We want to simplify sepsis management and also develop quality measures to be used by EP’s.
Join us in Washington, D.C. this May
The Legislative Advocacy Conference and Leadership Summit is coming up May 3-6 in Washington, D.C., and has been revamped for 2015. Don’t worry. The same excellent education will be available, but the schedule has been changed slightly to emphasize the unique opportunities available at this event. Sunday’s Leadership Essentials, presented by EMRA and the Young Physicians Section, is particularly appealing to those just getting started in advocacy and developing leadership skills. Monday is packed with the latest information about policy, payment models, innovation and much more.
Tuesday is Capitol Hill Day, when more than 500 emergency physicians head to the House and Senate office buildings to advocate for pending legislation and the need for reforms to strengthen emergency medicine and improve access to better patient care. Wednesday is a full day of leadership training and includes valuable CME courses. Please don’t miss this conference. I love our annual meeting in the fall, but this conference offers a chance to spend some time with people in a much more intimate setting while doing some excellent and crucial work for our specialty.
I’ll see you in Washington. Click here for more information.
Dr. Steven Stack to Take Over as AMA President
By the time our next quarterly update comes around, Steven Stack, MD, FACEP, will be the AMA’s 170th President. Dr. Stack takes over in June at the AMA annual meeting. He is the first emergency physician to ever hold that position, and when he assumes office, he will be the youngest president in the past century.
Dr. Stack currently practices in Lexington and surrounding central Kentucky. He has served as medical director of multiple emergency departments, including St. Joseph East (Lexington), St. Joseph Mt. Sterling (rural eastern Kentucky) and Baptist Memorial Hospital (Memphis, Tenn.). Born and raised in Cleveland, Dr. Stack graduated magna cum laude from the College of the Holy Cross in Worcester, Mass., where he was a Henry Bean Scholar for classical studies. He then returned to Ohio, where he completed his medical school and emergency medicine residency training at the Ohio State University before moving to Memphis to begin his clinical practice.
An expert in health information technology, Dr. Stack speaks on behalf of ACEP and emergency medicine at numerous events and conferences throughout the year and delivered the Rorrie Lecture last year at our annual conference.
We appreciate his efforts and congratulate Dr. Stack for his important new position.
New Headquarters Groundbreaking Set for April 16
I’m excited to announce that we will break ground on a new headquarters on April 16 on a six-acre tract of land near the Dallas-Fort Worth International Airport.
The new building will be three stories with approximately 57,000 square feet. This building will have all the things we do not have in our current building, including many member amenities, work areas, top-notch A/V capabilities and video conferencing, a small media room for filming and interviews, history recognition throughout the building and celebration of our specialty.
We have outgrown our space and comparison studies of other professional societies underscored what we expected – our outstanding staff is working under less than desirable conditions, especially as we grow in membership and management responsibilities (SEMPA, EMRA, CORD, EMF). A new building is also symbolic or our coming of age as a recognized and MAJOR specialty. We need advances in our headquarters for our staff and volunteers to serve our members and our patients.
This new building’s location is also nestled between two major hotels, allowing us to offer better service to our chapters and groups that use the national office for meetings and training, such as the Emergency Medicine Basic Research Skills (EMBRS) courses and the Emergency Medicine Foundation grant projects. The Texas chapter also uses our building for meetings, and this will assist in their efforts. There are other educational meetings ACEP may hold in this new building.
We have been in our current building for more than 30 years, and it has served us well. Our specialty is much different now, and this new headquarters is necessary for future growth.
Thanks for allowing me to update you on recent projects and offer a little about what’s coming around the corner. If you need anything, please don’t hesitate to contact me.
Dr. Michael Gerardi