ACEP Joins Coalition to Oppose Medical Merit Badges

March 30, 2017

The American College of Emergency Physicians is pleased to announce a historic collaboration involving nearly every major emergency medicine organization: The Coalition to Oppose Medical Merit Badges. Coalition members include the following organizations:

  • American Academy of Emergency Medicine (AAEM)
  • American Academy of Emergency Medicine/Resident and Student Association (AAEM/RSA)
  • American Board of Emergency Medicine (ABEM)
  • American College of Emergency Physicians (ACEP)
  • Association of Academic Chairs of Emergency Medicine (AACEM)
  • Council of Emergency Medicine Residency Directors (CORD)
  • Emergency Medicine Residents’ Association (EMRA)
  • Society for Academic Emergency Medicine (SAEM)

Board-certified emergency physicians who actively maintain their board certification should not be required to complete short-course certification in advanced resuscitation, trauma care, stroke care, cardiovascular care, or pediatric care in order to obtain or maintain medical staff privileges to work in an emergency department. Similarly, mandatory targeted continuing medical education (CME) requirements do not offer any meaningful value for the public or for the emergency physician who has achieved and maintained board certification. Such requirements are often promulgated by others who incompletely understand the foundation of knowledge and skills acquired by successfully completing an Accreditation Council for Graduate Medical Education–accredited emergency medicine residency program. These “merit badges” add no additional value for board-certified emergency physicians. Instead, they devalue the board certification process, failing to recognize the rigor of the ABEM Maintenance of Certification (MOC) program. In essence, medical merit badges set a lower bar than a diplomate’s education, training, and ongoing learning, as measured by initial board certification and maintenance of certification.

The Coalition finds no rational justification to require medical merit badges for board-certified emergency physicians who maintain their board certification. Our committed professional organizations provide the best opportunities for continuous professional development, and medical merit badges dismiss the quality of those educational efforts.

Opposing the requirements for medical merit badges will be a long and challenging struggle. It will take time to help administrators and regulatory bodies to better understand the rigorous standards to which we adhere as board-certified emergency physicians. In the coming months, we will develop our long-term strategy to create success and a pathway to recognize clinical excellence.

We welcome your thoughts and suggestions as to how we can best succeed. In the near future, we will ask for strong support and a loud and unified voice.

We will persist and we are up to the challenge—we are board-certified emergency physicians. Opposing medical merit badges is the right thing to do for our specialty. We will forever demonstrate a lifelong commitment to caring for anyone who is ill or injured, at any time, for any reason.

Sincerely,
Kevin G. Rodgers, MD
President, AAEM

Mary Haas, MD
President, AAEM/RSA

Michael L. Carius, MD
President, ABEM

John J. Rogers, MD
Chair of the Board, ACEP

Richard Zane, MD
President, AACEM

Saadia Akhtar, MD
President, CORD

Alicia Kurtz, MD
President, EMRA

Andra L. Blomkalns, MD
President, SAEM

ACEP Signs CMSS Letter on International Collaboration in Medicine

This week, ACEP signed a letter from the Council of Medical Specialty Societies (CMSS) expressing “concern that the recent executive order suspending some foreign entry into the United States will have a negative impact on patient care, medical research, the education of health professionals, and international scientific collaboration.”

ACEP joins more than 30 other medical associations in signing the CMSS letter, which aligns with ACEP’s mission and values of access to care for all, diversity and inclusion, medical education support and research.

Read the entire statement and see the other medical specialties that join ACEP in expressing these views.

ACEP Board: Statement on Rapid Transitions of ED Contracts

The following statement was issued by the ACEP Board of Directors on January 27, 2017

The ACEP Board of Directors and its leadership have had multiple communications with the parties involved and others affected by the recent abrupt emergency department contract transition at a health system in Ohio. The ACEP Board met recently and discussed the matter extensively.

Rapid transition of emergency department contracts may lead to serious disruption. Assuring that any such process is as smooth as possible is critically important to our specialty, and to ACEP.

ACEP is committed to promoting the highest quality of emergency care. To effectively achieve our mission, we are committed to supporting and protecting the interests of our specialty, patients, all members, residents in training programs, and academic and research elements of emergency medicine.

ACEP will be developing a white paper regarding best practices for how contract transitions should occur. When completed, it will not only be disseminated to the emergency medicine community, but also to hospitals and their administrators. We will also be publicizing to our members the availability of existing resources regarding ED contract provisions, negotiations, and other related materials.

We welcome the input of our members and others as we develop supportive resources.

ACEP Statement on Summa Health System in Ohio

In response to a January 1 emergency department staffing contract change at Summa Health System in Akron, Ohio, the president of the American College of Emergency Physicians Becky Parker, MD, FACEP, released the following statement:

“We are deeply concerned about the continuity and stability of training for the emergency medicine residents working in the Summa Health System following the abrupt shift in contracted emergency physician services from Summa Emergency Associates to U.S. Acute Care Solutions. Hospitals and health systems change staffing contracts routinely, but what is not routine at Summa Health is the abruptness of the change. Typically, it takes 90 to 120 days for a transition to be completed, to allow for adjustments to personnel, schedules and infrastructure. We are concerned about what plans Summa Health has to ensure smooth transition for the residency program and the residents directly involved.

“One of Summa Health’s top priorities must be to preserve the integrity of the training and support of its emergency medicine residents. Residency is a critical part of any physician’s education, and a clear plan, executed quickly, by Summa Health, is crucial to its residents’ education, training and well-being. The three years of residency are intensely focused on putting into practice, under stable supervision, the skills that are essential to a lifelong career in emergency medicine. Disruptions to that training can have damaging reverberations.

“We look forward to hearing about a more detailed plan from Summa Health on a seamless transition while continuing to provide a first-rate education to their emergency medicine residents of today and for the years to come.”

MACRA Final Rule Highlights

Provided by Barbara K. Tomar, ACEP’s Federal Affairs Director

The Medicare Access and CHIP Reauthorization Act (MACRA) Final Regulation was released Oct. 14. This rule – now designated by CMS as the “Quality Payment Program”- describes requirements for physicians to participate in the Merit-based Incentive Payment System (MIPS) and/or the Advanced Alternative Payment Models (Advanced APMs). Both begin January 1, 2017.

Former ACEP President Dr. Mike Gerardi appointed an APM Task Force that is developing some models that we hope will be reviewed and approved by CMS over the next year. Work of the Task Force was overseen this past year by Immediate Past President Dr. Jay Kaplan and current ACEP President Dr. Becky Parker has pledged to continue to support Task Force efforts.

It’s important to note that since few emergency physician groups have ever participated in various CMS bundled payment models/ACOs, etc. in the past, we expect most of the members to participate in MIPS for the next year or so.

We were pleasantly surprised in our early review of the 2,200-page rule, that CMS responded to ACEP’s comments on the timing and scope of some of the new programs.

Merit-based Incentive Payment System (MIPS):

  • Reduces timeframe for reporting. Instead of reporting quality measures (much like PQRS) for a full calendar year starting in January, members can report for as little as 90 days of their choosing and avoid the 4% penalty in 2019. (Similar to PQRS, there will be a 2-year lag between data reporting imposition of bonus/penalty.)
  • Doctors can report MIPS as individuals or through their groups. However, physicians must elect one or the other for all MIPS categories.
  • Quality measures reporting reduced from 9 to 6. Either 6 measures or a specialty measure set can be selected, 1 of which must be an outcome measure; if no outcome measures are available, a high priority measure.
    • Reporting thresholds reduced from 90% of patients (or 80% for claims reporting) to 50% in 2017.
    • Encourages the use of QCDRs and electronic sources through preferential scoring.
    • Increases quality percent of composite performance score: 60 percent of the composite performance score will be based on the quality performance category in 2017, due to the (requested) reduction of the cost performance category weight to zero next year. CMS was going to weight ‘resource use’ at 10% – a nearly impossible measure for EM due to current cost attribution methodology.
    • CMS working on patient condition and patient relationship codes to improve future cost attribution. (ACEP’s recent comment letter to CMS noted that none of the patient relationship codes fit EM practice so we will continue to work with CMS to change this).
  • (Clinical) Improvement Activities reporting burden reduced. Highly-weighted activities (20 points) reduced from 3 to 2 and medium-weighted activities or some combination of both need to equal 40 points. (Use of QCDR is highly weighted).
    • Allows 90-day reporting, also.
  • Advancing Care Information (previously known as Meaningful Use) reporting reduced.
    • EM has been exempt from reporting on EHR measures and may continue to be in spite of the burden placed by the hospitals.
    • Also reduced to 90-day reporting for 2017-2018

Advanced Alternative Payment Models (APM):

  • Reduces amount of losses that APMs must bear. CMS used the term “more than nominal risk” in the draft and proposed that qualified APMs pay of to 4% of Medicare spending. The final rule is based on physician/APM revenue which would be at risk for 5% of revenue losses instead.
  • Expanded the definition to include practitioners other than physicians so that models can address quality and costs of non-physician services.

Physician-focused payment model Technical Advisory Committee (PTAC):

Note: This brief description of PTAC is included as background as no changes to its role were made in the final rule.

  • MACRA created the PTAC (of outside experts) to assist physician groups who are creating APMs, providing a first line review of proposals to determine whether such proposed models meet the criteria established by the Secretary of HHS for PFPMs and offering some technical assistance. Based on its findings, PTAC can make recommendations to CMS as to whether the model should be refined, further studied, tested or implemented, but CMS makes the final decision through its own application process.