“Our commitment to our patients is no longer limited to the clinical skills we demonstrate in the emergency department. Due to the changing dynamics of health care, our profession requires stellar leadership as well as political effectiveness.” – from ACEP’s webpage advertising Leadership and Advocacy Conference, 2011.
The 2011 ACEP Leadership and Advocacy Conference is now complete, and I’d like to update you on new developments. The focus of the conference was to provide the tools necessary to maximize our impact as emergency medicine leaders and as advocates. Through the four days of the conference, there were sessions geared to teach policy, the art of advocacy, and to update us all on the transforming health care scene. The goal — stellar leadership and political effectiveness.
A critical component of this conference is spending time, face-to-face with our own legislators: to educate, create relationships, seek support for legislative initiatives and to show appreciation for prior support. This year, ACEP chose two specific areas to advocate upon – medical liability reform and Medicare reforms.
Two bills are currently represented in the House — HR 5 and HR 157. HR 5, the HEALTH Act of 2011 (Help Efficient, Accessible, Low Cost, Timely Healthcare includes the following terms:
- Limiting non-economic damages
- Instituting a ‘fair share’ rule
- Limiting attorney contingency fees to make sure the patient receives the appropriate share of the compensation
- Allowing for the introduction of collateral source benefits at trial
- Providing a reasonable stature of limitations on claims
- Allowing for the periodic payment of future damage awards
The second bill, HR 157, the Health Care Safety Net Enhancement Act of 2011, provides that physicians who provide EMTALA-related services should be eligible for the liability protection that is available to federal employees under the Public Health Safety Act. Because the nature of emergency care involves serious injury and illness and providers have little or no relationship with the patient, the treating physicians have much higher liability exposure and subsequently higher insurance premiums. By providing this liability protection to physicians who provide federally-mandated EMTALA services, will ensure that emergency and on-call specialists remain available to treat patients in their own communities.
Regarding Medicare reforms, ACEP is backing a repeal of the SGR. This year and next, we are scheduled to have a nearly 30% cut in physician reimbursement rates under the current SGR. With the instability and unreliability of the Medicare reimbursement system due to the implausibility of the SGR, Medicare beneficiaries have had limited access to all aspects of care as outpatient physicians opt-out of Medicare. ACEP advocates the creation of a stable, reliable Medicare reimbursement system that affords seniors the opportunity to have consistent access to primary care.
Finally, ACEP supports the repeal of IPAB. IPAB, the Independent Payment Advisory Board (IPAB) is to be created under the ACA. IPAB is concerning to physicians. IPAB will be an independent agency without accountability to Congress, health care providers, or to the public. The implementation of the cost cutting measures generated by IPAB will be considered obligatory. With both the SGR and IPAB in play, physician reimbursement rates within the Medicare reimbursement systems are subject to two independent measures charged to cut costs primarily from physician reimbursement. There is great concern that this can cause a cataclysmic departure of physicians from the Medicare Program. Access to physician care would ultimately suffer.
The Maryland Delegation met with our Senators’ staffs collectively. We spent significant time with Priscilla Ross, Senator Cardin’s Senior Policy Aide. Priscilla won an award at this ACEP Conference for Excellence in Congressional Leadership. Her interest and dedication to health care was immediately evident. We also met with staff in Senator Mikulski’s office. While we were very well received in both offices, there was no palpable enthusiasm from any staff to support HR 5. At the root of that particular bill lies the conflict of the definition of state’s rights. HR 157 seemed to garner more traction — the argument to be under Federal liability protection is clear and, albeit expensive, nonpartisan. I am hoping that we will be able to continue momentum on this front. Regarding the SGR, there is clearly momentum to create a sustainable formula. The actual ‘fix’ is quite controversial. However, there is agreement that a final, permanent solution must be found.
Finally, in regard to the IPAB, most offices agreed that it is far from a perfect system and would happily repeal it if there were other cost cutting measures to replace it. We were invited, in earnest, to help problem solve and create solutions to the cost crisis.
There remains plenty of work for us to do on the National level. Clearly we must continue to foster the relationships we are developing with our legislators and continue to serve as a resource of education to them. And, the lessons learned on the national stage are very applicable to the local scene — we must continue to be deeply involved. We must be a part of the solution to our national healthcare crisis. It is only through continued advocacy and involvement that we can hope to reform healthcare to be sustainable for our patients, the Nation, and for ourselves — the providers.
Thanks and please stay tuned!