Archive for category From the President
ACEP is pleased to provide our members with a recent publication from the American Hospital Association (AHA) “Always There, Ready to Care,” promoting the extraordinary value of emergency medicine. The AHA is promoting this report by sharing it with policymakers, media and the public.
This publication describes the invaluable role of emergency physicians who must be prepared to respond to a wide range of medical conditions and are now experiencing capacity constraints in the face of rising demands.
It also describes the challenges of psychiatric patients in emergency departments, the complex issues of rural America and the nation’s increasingly heavy reliance on 24-hour access to care. In addition, it demonstrates the crucial role of emergency medicine in responding to disasters, featuring last year’s Ebola emergency and the outstanding response of emergency physicians following the explosions during the Boston Marathon.
The report concludes with a description of the funding challenges to maintaining the emergency department’s 24/7 role in an environment of declining financial support, asking the following policy questions:
- How will financing mechanisms need to be designed in order to support the 24/7 role in the future?
- How can the standby role be financed in an increasingly competitive health care marketplace where payers want to pay the lowest price?
- What is the appropriate role of government in supporting hospital-based disaster preparedness and relief?
- Should all health care facilities be required to support the community’s standby capacity and care needs?
- What steps can be taken to promote greater access to and utilization of primary care among low-income vulnerable populations to improve their health status and reduce the need for ED care?
Please share this report with key leaders and policymakers in your community and state and promote through social media.
|Michael J. Gerardi, MD, FAAP, FACEP
AHA President and Chief Executive Officer
As emergency physicians, we are skilled in responding to disasters and treating every kind of medical condition as part of our daily routines. We also are critical to America health care response to infectious diseases. This is because patients often show up first in emergency departments, as we saw during the anthrax attacks after 9/11 and in Dallas, Texas, yesterday when the first case of Ebola was confirmed in the United States. Clearly this disease deserves our attention and emphasis from health care providers across the country.
Ebola is a serious communicable disease. Heightened vigilance for case presentations and strict adherence by health care personnel to CDC advice, public education and a pre-planned medical response is necessary. Hospital physicians and entire health care teams have planned for these types of medical threats. Like SARS, MERS, and Hantavirus, newly identified serious population health threats continue to occur.
Even if this Ebola case is isolated, it is incumbent upon emergency physicians and other health care providers to properly screen and manage potential Ebola presentations. The CDC, the Emergency Care Coordination Center and the Assistant Secretary for Preparedness and Response, have provided materials that are excellent resources for emergency physicians and other staff in the ED to have readily available for dissemination.
These resources are available on ACEP’s website at www.acep.org/ebola.
The CDC recommends two initial steps in screening for Ebola Virus Disease:
- The symptoms are likely to be fever, headache, joint and muscle aches, weakness, fatigue, diarrhea, vomiting, stomach pain and lack of appetite, and in some cases bleeding.
- Travel to West Africa or other countries where EVD transmission has been reported by the World Health Organization within 21 days of symptom onset.
If both of these criteria are met, the patient should be moved to a private room, and standard-contact and droplet isolation precautions followed during further assessment.
We see dozens of patients each week, and particularly at this time of year, many will have a common cold or influenza. All health care professionals in the emergency department should know the protocols and what to ask so we can do everything possible to ensure that this Ebola case in Dallas remains isolated.
By Alexander M. Rosenau, DO, CPE, FACEP
As we come upon the halfway point of my Presidency, I’d like to offer ACEP members an update and share news about exciting things we’re working on for the coming months. For me, the past six months have been intense, as I’ve connected with individual members, groups, organizations and legislators in concert with our strong Board of Directors, expert staff and amazing volunteer physician members. Dialogue, conflict management for a better result, as well as bringing together the right folks for both the challenges at hand and those just over the horizon are daily activities. I’ve cherished every minute. Emergency physicians enjoy a tremendous relationship with each other, and I know we’ve done some things in the past six months to make our bond even stronger – and to appreciate our past even more. In all things emergency medicine, my mantra is “them is us and us is them,” meaning that the common bond we share is much stronger than the forces tugging at us in disparate directions. When you read this update, please know that I will continue to work hard for you over the next six months, and I welcome any feedback. I hope to see you at our Leadership and Advocacy Conference next month and ACEP14 this fall, and please don’t forget to say, “Hey.”
Report Card Garners Major Media Attention
Although we don’t like the results we saw from the release of the 2014 State-by-State Report Card on Emergency Medicine, an overall grade of D-Plus nationwide could have a positive impact on health care moving forward. Our Report Card fostered many a conversation with state legislators. Media outlets have pointed out what we already knew – that several states don’t have the resources and policies in place to support high-quality emergency care. Stories about the Report Card appeared in major newspapers, including The Washington Post, The Chicago Tribune, The New York Daily News, Forbes, The Huffington Post, The Los Angeles Times, San Francisco Chronicle, The Philadelphia Inquirer, Houston Chronicle and The Seattle Times, to name a few. Along with print stories, nearly 800 broadcast stories aired on news organizations including ABC’s World News Tonight with Diane Sawyer, MSNBC, CNN, Fox News’ Your World with Neil Cavuto, Fox Business News, CNBC’s Kudlow and Kramer, WNBC New York, and Telemundo as well as dozens of local television stations across the country. The estimated audience reach was 72.2 million people. Our dedicated spokespersons will continue to make sure the results of this study resonate nationwide. Keep up with the progress at www.emreportcard.org.
ACEP Working on Several Federal Advocacy Efforts
One of the most critical federal advocacy projects we’re currently working on is the support of H.R. 36/S.961, the “Health Care Safety Net Enhancement Act of 2013,” introduced by my 911 key contact, Rep. Charlie Dent (R-PA) in the House and Sen. Roy Blunt (R-MO) in the Senate. The bill provides medical liability relief for physicians providing care under the EMTALA mandate. The House bill continues to gain support and reached nearly 70 co-sponsors last month. Our advocacy team is working diligently on SGR repeal in concert with a number of allies. Although the CBO rated an SGR fix the most affordable ever, Congress failed to settle the offset funding issue and we didn’t get the permanent fix. The previous work of our Washington office in collaboration with our specialty and AMA allies assured prevention of a seriously damaging 24 percent cut in Medicare reimbursements for one year; also extending dozens of other expiring health care-related provisions. ACEP will continue to work with the AMA and other medical specialty societies to encourage members of Congress to take action this year on the permanent repeal of the SGR. We’ve also been working very closely with the Emergency Medicine Action Fund (EMAF) to address regulatory reform under the Affordable Care Act, including areas related to quality measures reporting and reimbursement.
ACEP Now Launched
When the calendar flipped to 2014, ACEP turned its monthly publication up a notch. We wanted to blend the needs of our membership with an edgy editorial vision related more closely to the world we work in. Beginning with a round-table discussion cover story and a compelling piece on breaking down racial barriers in the ED, the new-look ACEP Now hit mailboxes in mid-January and began receiving rave reviews from ACEP members. I hope you like the direction of our new medical editor-in-chief Kevin Klauer, DO, EJD, FACEP, and our new publishing partner, Wiley Press. The new ACEP Now is not only bigger, it features more incisive opinions, “you are there” real articles regarding our decision making and advice from some of emergency medicine’s most renowned physicians. The news from ACEP and events related to the College will always be a part of the magazine, so none of that has changed. What has changed is the attention to detail and open dialogue when opinions differ on controversial issues. If you haven’t seen ACEP Now lately, grab a copy soon. Your feedback is welcome at www.acepnow.com .
Strategic Plan Taking Shape
In leading the annual Board retreat in December, top-level goals and objectives for the college from now until 2017 were debated, prioritized and built for impact. Goal 1: Care transitions and reform of the health care delivery system continue at full gallup. Goal 2 received particular attention with the formation of the Membership Engagement Task Force, the Membership Bylaws Task Force and the Residency Visit Task Force. Your fellow member leaders of these groups, their Board of Director Liaisons, and assigned top level staff are poised for success in member engagement and satisfaction. Here’s an overview of the Strategic Plan:
Goal 1 – Reform and Improve the Delivery System for Emergency Care
- Objective A – Identify, support, and promote delivery models that provide effective and efficient emergency medical and acute care in different environments.
- Objective B – Promote quality and patient safety, including development and validation of quality measures.
- Objective C – Pursue strategies for ensuring fair payment and practice sustainability.
- Objective D – Pursue solutions for workforce issues that ensure access to high quality emergency care.
- Objective E – Advocate for meaningful liability reform at the state and federal levels.
- Objective F – Communicate the value of emergency medicine as an important component of the health care system.
Goal 2 – Enhance Membership Value and Member Engagement
- Objective A – Increase total membership and transitioning resident retention.
- Objective B – Provide robust educational offerings, including novel delivery methods.
- Objective C – Support member well-being.
- Objective D – Ensure adequate infrastructure to support growth.
Building Bridges and Strengthening Relationships
My other mantra is to connect ACEP with others who share our passion for quality health care. If we build bridges and enhance our synergy with other health care organizations, we benefit and so do our patients. We’re currently working to provide input to ABEM for recognition of Clinical Ultrasound for subspecialty certification. This will improve education, continue to allow Ultrasound use for patient care by all members meeting ACEP guidelines and validate point of care as a reimbursable item. This contributes to our value. Our relationship with CORD continues to grow, as does our joint work with CORD and SAEM in GME matters. EMRA has a new executive director and our relationship with EMRA could not be stronger. We’re proud to announce the recent ACEP/SEMPA Advanced Practice Provider Academy drew rave reviews and more than 300 physician assistant and nurse attendees. I participated as our two organizations penned a new five-year management service contract in New Orleans last month. I directed a new task force be formed to reach out to identify opportunities for collaboration with the Society of Hospitalist Medicine. When it comes to building bridges, there are many organizations whose activities, benchmarks and plans have relevance to us. That is just one reason our executive director, Dean Wilkerson, has been such an asset to our organization for the past decade. We meet by phone at least weekly, communicate via email most days. Your Board members are out and about on a national scale gathering information, forming relationships and honing the judgment that all of you expect your elected leaders to use. I personally appreciate their diplomacy and expert work.
Two Clinical Policies Reviewed
ACEP reviewed two Clinical Policies recently. In response to the Council- and ACEP Board–adopted Amended Resolution 32(13), the “Clinical Policy: Use of Intravenous tPA for the Management of Acute Ischemic Stroke in the Emergency Department” is being reviewed. The Clinical Policies Committee, as per council, accepted comments until March 24. Findings and any recommendations regarding the policy will be reported to the ACEP Board in June. Also, per the resolution, future clinical policies will include a 60-day comment period before finalization. A Clinical Policies Subcommittee of ACEP completed a draft clinical guideline in late March, “Clinical Policy: Critical Issues in the Evaluation and Management of Adult Patients with Suspected Acute Non-Traumatic Thoracic Aortic Dissection.” It’s open for comments until May 28, 2014. To view the draft policy and comment form, go to http://www.acep.org/content.aspx?ekfrm=96266. For questions, please contact Rhonda Whitson at firstname.lastname@example.org.
Quality Measures and Reimbursement
ACEP has accepted donated emergency medicine quality measures from other organizations, and we’re developing our own for member benefit (both for CMS incentive and avoidance of CMS penalty). These steps, in addition to our continuing education on reimbursement and coding, add value to your bottom line and salary. We’ve had several recent articles, webinars and a spring conference devoted to Reimbursement and Coding, helping you prepare for reimbursement issues, the eventuality of ICD-10 and PQRS benefits in concert with ABEM.
ACEP’s Official Mobile App Improved
The official ACEP mobile app, an essential resource for members and other emergency care providers, received an upgrade early in 2013 to make navigation easier and to improve the design. The next phase of upgrades is currently being implemented. This includes the addition of several links to education resources from ACEP’s bookstore, audio recordings from the monthly Education on Demand newsletter and a section where emergency medicine news published in ACEP Now can be found. You can also find a secure Member Directory, a personalized Member Guide that reflects your chapter and sections, an events calendar and ACEP’s clinical policies. If you don’t have ACEP’s app on your phone, download it today for iPhone or Android devices.
EMF Continues Endowment Push
Since October, EMF has launched a new logo and continues the momentum of the ACEP $1 million match to bring the endowment to maturity with a corpus of $2.5 million. To help achieve this goal, for every dollar contributed to EMF before June 30, EMF will match it with a contribution of 50 cents toward the endowment. EMF has a new board and a new Strategic Plan. It’s Goals and Objectives are to:
- Goal 1 – Position EMF as the principal sponsor of scientifically rigorous research and education to to improve the care of the acutely ill and injured and policy research that aligns with emergency care priorities
- Goal 2: Increase EMF’s capacity to engage more people in emergency medicine research and award more grants
- Goal 3 – Position EMF as the premier 501(c)(3) emergency medicine foundation
- Goal 4 – Increase EMF revenue to fund more research grants and education projects
Please go to www.emfoundation.org, and make EMF your charity of choice.
Annals Added to eCME Options
In collaboration with ACEP’s online education program, articles from the Annals of Emergency Medicine are being offered as a CME component. As of April 2014, there were 13 Annals-based articles available to members. ACEP looks forward to seeing this educational offering become a robust element of ACEP’s overall online education program. Learn more at www.acep.org/ecme.
Concurrent with the inauguration of the eCME program, Annals announced that it would continue its relationship with long-time publisher, Elsevier. The five-year contract runs through December 2018, and provides a solid and stable financial basis for journal revenues. The contract provides a generous editorial office stipend along with a guaranteed minimum royalty, enabling Annals to contribute substantially toward the overall financial success of the College.
ACEP Continues to Add Value, Enhance Image
The continued strength of our specialty requires us to do some heavy lifting in areas such as keeping prudent layperson as a recognized part of the ACA, working toward an SGR fix and changing perception about the cost of emergency care. Working together, we will make progress. As a result, our place in the House of Medicine will be enhanced. And we’re building strong connections with others while providing service to our chapters as they protect the interests of our members. Chapter efforts in Washington state and most recently in Virginia underscore the need for our teamwork. We believe that Steve Stack will become the AMA’s first ever Emergency Physician President. We have a real chance for the AMA to continue its re-invigoration with a clear view of EM’s contribution to the house of medicine because of his upcoming service. If you have any membership dollars available in your professional budget, I hope you consider making this year one in which you might become an AMA member to bolster our ACEP delegation at the AMA. There are certain things that are more do-able when we have a strong delegation within the AMA, whether advancing our cause within the house of medicine or in our negotiations at the RUC.
Spring Conferences in Full Swing, LAC Coming Up
ACEP’s busy spring conference lineup began in February with the Reimbursement and Coding Conferences in New Orleans. With the upcoming changes in coding and the implementation of the Affordable Care Act, payment topics have become even more popular and necessary. More than 200 emergency physicians participated in the February 2014 conference. Your next chance to brush up on your knowledge in this area is March 2015 when the R/C Conferences move to Las Vegas.
The 2014 Advanced Pediatric Emergency Medicine Assembly was held in New York City in March and drew more than 550 four-day registrants. This is the highest number in four years.
ACEP’s newest offering, the Advanced Practice Provider (APP) Academy, recently wrapped up. More than 300 attendees received a crash course in emergency department essentials. Held in conjunction with SEMPA, this conference is vital for emergency department providers who might be new to the ED or need help in certain areas. The demand for this conference was high and feedback positive, so ACEP and SEMPA have decided to hold a second installment of Phase I in August. The conference has also been renamed Emergency Medicine Academy.
ACEP’s Leadership and Advocacy Conference will be May 18-21 in Washington, D.C. If you’ve never been to this conference, you’re missing one of the best three days of education and networking available. Thought-provoking, inspiring and challenging sessions by nationally recognized speakers and key decision makers will provide you the inside information and skills you need to maximize your impact as an emergency medicine leader and advocate. Invited Speakers for the Conference include: U.S. Sen. Ron Wyden (D-OR); U.S. Rep. Andy Barr (R-KY); Amy Walter, Political Analyst for the Cook Political Report; Patrick Conway, MD, Deputy Administrator for Innovation & Quality & CMS Chief Medical Officer. Please plan to come to Washington, D.C., next month to network with ACEP leaders and advocate for your specialty.
Please remember the elevator speech when you run into your hospital leaders and legislators:
We are 4% of the physician workforce seeing 28% of all acute care visits. We are the doctors of first contact, unscheduled, federally mandated care regardless of financial status. We are over 32,000 ACEP members seeing 130 million patient visits, 24/7/365 for about 4% of the national healthcare dollar. Our customers include primary care docs who send their patients to us for complex medical diagnostic work-ups. We are the portal of entry for 75% of all hospital admissions. We are the hub of the enterprise, and are working toward being masters of transitions of care. We are not only expected to be the admittors, but also the admitting avoidance service through our work in care coordination. And we do this in a room, in a hallway, in ‘copters and ambulances during disasters large and small every shift of every single day.
Thanks for the Past Six Months
I started my EM practice in the 1980s, and there are many reasons I value membership and the friends I’ve made over the years. I can pick up a phone and dial a colleague anywhere for advice. Like all families and all democratic groups filled with the riches of a knowledge-based constituency, we will have disagreements and some conflict. It’s all for a better result and a strong organization, as long as we stick together. The knowledge I’ve gained in reimbursement and coding and practice management has paid me back every dollar I ever contributed to ACEP, EMF and NEMPAC. The education I’ve received at conferences has made my practice better and improved the care of my patients. I was proud to join ACEP then, and I’m proud to be its President today. ACEP is growing. ACEP is dynamic. ACEP gives you a good return on your dues investment dollars. Your partners, your colleagues are the members of the committees, task forces, sections, Board, Council, and technical expert panels that create our future. Let’s connect. See you at LAC and ACEP14.
Alexander M. Rosenau, DO, CPE, FACEP
President, American College of Emergency Physicians
After an extensive look at ways to provide cost effective care to emergency department patients, the American College of Emergency Physicians believes there is room to improve the use of specific tests or procedures in emergency medicine to participate in the national “Choosing Wisely” campaign.
“Choosing Wisely” is part of a multi-year effort of the American Board of Internal Medicine (ABIM) Foundation to help physicians be better stewards of finite health care resources. The campaign encourages medical specialty organizations to identify five tests or procedures commonly used in their field, the necessity of which should be questioned and discussed by patients and physicians.
ACEP had previously declined participation in the “Choosing Wisely” campaign because of the challenges of this approach with the unique nature of emergency medicine, liability concerns, and a potential harm to physician reimbursement.
The College meanwhile remained steadfast in its commitment to cost-effective care and a high-value health care system, and last year, Immediate Past President Dr. David Seaberg appointed a Cost Effective Care Task Force, chaired by Dr. David Ross. The Task Force was charged with considering tests, processes and procedures with little or no value to emergency care that might represent meaningful cost savings if eliminated.
In a report to the ACEP Board of Directors this month, Task Force member Dr. Jay Schuur said that their Delphi panel and ongoing member surveys have suggested that a number of tests will meet the criteria of the “Choosing Wisely” campaign. They also determined that these tests would not increase the physician’s liability, and would not negatively impact payments for emergency physicians.
After being reviewed by experts, emergency medicine leaders, and the ACEP Board, the report’s data indicates that it would be appropriate for emergency medicine to participate in the campaign. A letter of ACEP’s intention to participate was sent to the ABIM Foundation today.
The list of recommendations should be established by June. ACEP’s Task Force is finalizing the evidence base for these recommendations, in part though the Emergency Medicine Practice Research Network (EMPRN). Attaching estimates of potential real-dollar savings to the recommendations is also being completed. Members of the Task Force and the ACEP Board believe this responsible approach will validate the substance of our recommendations, and provide assurance that there will be a real savings to the health care system while not impacting patient care.
But joining this national campaign is not the only approach ACEP is using its in journey to identify cost savings measures without compromising patient care.
In order for there to be a serious reduction in unnecessary tests and costs of defensive medicine over time, meaningful liability reform and safe harbors are vital. ACEP is encouraging ABIM and its campaign partners to lend their voices to the need for medical liability reform. This remains a top priority in ACEP’s advocacy agenda.
Additionally, the College is working on other significant and impactful efforts, including proposing an elimination of the 3-day-stay rule and better management of transitions of care.
A variety of recommendations that strive to improve patient care and provide meaningful cost savings continue to be initiated, developed, and adopted by ACEP. We are dedicated to ensuring that our specialty can be leaders in health care system efficiency while maintaining a high quality of emergency care and patient safety.
ACEP Calls for Increased Investment in Mental Health Resources and a Ban on the Sale of Assault Weapons
The American College of Emergency Physicians (ACEP) today expressed deepest sympathy to all those affected by the senseless tragedy in Connecticut and called on government at every level to increase investments in mental health resources and to ban the sale of assault weapons and high-capacity magazines.
Emergency physicians see the tragic consequences of gun violence every day. Our hearts go out to the families of the victims and to everyone affected by this terrible event in Newtown. We deplore the improper use of firearms and support legislative action to decrease the threat to public safety resulting from the widespread availability of assault weapons. We also are urging policymakers to restore dedicated funding for firearms injury prevention research.
ACEP’s policy on firearm injury prevention endorses limiting the availability of firearms to those “whose ability to responsibly handle a weapon is assured.” It also calls for aggressive action to enforce current laws against illegal possession, purchase, sale or use of firearms.
The nation’s emergency physicians call for increased funding for the development, evaluation and implementation of evidence-based programs and policies to reduce firearm related injury and death. We will fully support legislation that supports the principles of ACEP’s policy on firearms injury prevention.
The lack of mental health resources in the United States has contributed to a significant increase in visits to the emergency department. Psychiatric emergencies grew by 131 percent between 2000 and 2007, according to a recent study in Annals of Emergency Medicine. This is symptomatic of the lack of resources for these patients.
As you may know, today the United States Supreme Court decided to uphold The Patient Protection and Affordable Care Act. (Read the 193-page decision here.)
This decision will impact emergency medicine because it is clear that the amount of visits to the nation’s emergency department will continue to increase even with the implementation of health care reform.
As I stated in a press release today, the nation’s emergency physicians fully support the emergency care provisions in the law, such as inclusion of emergency services as an essential part of any health benefits package and the prudent layperson standard, which guarantees that health plans base coverage on the patient’s symptoms, not the final diagnosis.
And regardless of the Supreme Court’s decision, it does not change the mission of emergency physicians — we pledge to be there for our patients.
However, while there are provisions in the law to benefit emergency patients, it is clear that emergency visits will increase, as we have already seen nationwide. There are physician shortages and there are also drug shortages and serious mismatches between patient needs and available resources.
The College will continue to urge lawmakers and regulatory agencies to ensure that the implementation of the health care reform law does not endanger patient care or threaten the practice of emergency medicine.
ACEP has worked with — and will continue to work with — members of Congress to find solutions to improve the safety and efficiency of emergency care for all Americans. Emergency departments are a critical, life-or-death part of our health care system and we need help now. This crisis in emergency care is everyone’s problem, because every person is only one step away from a medical emergency.
According to the most recent GAO report, emergency patients who need care in 1 to 14 minutes are being seen in more than twice that timeframe — 37 minutes.
Significant growth of Medicaid is intended as one of the means of expanding coverage. Increasing the number of patients on Medicaid without an equivalent increase in the number of physicians willing to take that insurance will surely increase the flood of patients into our nation’s emergency departments.
Coverage does not equal access and critical problems facing emergency patients are not going away.
A recent study in Annals of Emergency Medicine shows that crowding in emergency departments is growing twice as fast as the rate of ED visits, principally because emergency patients are showing up sicker and with more complicated health problems.
As the nation moves forward with implementing the health care reform law, we urge the Senate to follow the lead of the House in repealing the Independent Payment Advisory Board (IPAB), which was included in the law. The IPAB panel does not have any accountability to Congress, health care providers or the public and will harm Medicare patients’ access to medical care.
This law also includes medical liability dispute resolution alternatives, but that the scope is extremely limited, which limits its potential effectiveness. America’s medical liability system is broken and without true medical liability reform, patients’ access to lifesaving care will continue to suffer.
ACEP will continue to fight for meaningful medical liability reform and other emergency medicine issues. You can aid in this battle. Contributions to NEMPAC will support candidates who can positively impact emergency physicians and your patient care. Consider donating at the Give-A-shift level for maximum leverage of your PAC contribution.
Participation in the Emergency Medicine Action Fund is now more important than ever. With the Supreme Court decision upholding the law, an avalanche of regulations are being written and emergency physicians desperately need the EM Action Fund to keep them out of the regulatory and legal crossfire between payers, patients, policymakers and hospitals.
The EM Action Fund has unified the house of emergency medicine and become a powerful and influential voice in federal regulatory and legal issues that matter to you and your colleagues. Join the EM Action Fund today.
Although ACEP has previously reviewed the Choosing Wisely Campaign and agreed not to participate, due to continued questions and comments from our members, I convened a workgroup to re-review the campaign and ACEP’s participation. The workgroup consisted of a wide and diverse representation of ACEP members and Committees.
The group was overwhelming in support of not joining the Choosing Wisely Campaign. Although the issue of cost control is crucial for emergency medicine’s future, the Choosing Wisely Campaign is not the vehicle for ACEP’s participation.
Several important points were made during the workgroup meeting:
- The College needs to be viewed by CMS, payers, and the public as proactively addressing cost containment and overuse.
- ACEP needs to be seen as proactively providing solutions rather than appearing to be against any cost cutting or savings suggestions.
- The College developing and communicating a plan with proactive proposals/solutions will mitigate some cost cutting measures from those that do not understand the unique position of emergency care. It was noted part of the success of the Washington State initiative was the ability to come to the table with a plan, rather than push back against the plan of action presented by the State.
- Whatever is developed should showcase the specialty in a favorable light and not contradict or conflict with current advocacy efforts.
- There was support for identifying over-use and developing a positive message on cost savings and efficiencies in the emergency department.
- To come to consensus on a certain number of tests or services that have limited use would require so many caveats that it would be almost impossible to develop lists as found in the Choosing Wisely Campaign.
- Ideally any recommendations should include some liability reform/recommendations in using guidelines that may suggest certain tests or procedures are not effective or necessary.
It was recommended that ACEP develop a task force from committees, sections, and members with expertise in these areas to develop a proactive campaign that recognizes the role the emergency department and emergency physicians can play in controlling costs while improving efficiencies and quality patient care.
The process has already begun with the task force being constituted with the goal of developing messages and strategies for cost control in the emergency department. The task force will make their recommendations at the October ACEP Board of Directors meeting.
We also will be educating our members about cost savings programs from other specialties, such as the Image Wisely and Image Gently programs from the American College of Radiology.
DAVID SEABERG, MD, FACEP
President, American College of Emergency Physicians
A campaign called Choosing Wisely has gotten some attention of late because of its stated goal of reducing health care costs by eliminating tests and procedures that are not “necessary.” Since Choosing Wisely launched, nine medical specialty organizations have offered up their top five items for the chopping block. These range from CT scans for fainting from the American College of Physicians to antibiotics for chronic sinusitis from the American Academy of Allergy, Asthma and Immunology.
ACEP was asked to join the campaign in 2011, and after extensive review and discussion at the Committee level, ACEP declined. There are several reasons for our initial response:
- Emergency physicians have no right of refusal with our patients and often pick up the slack for other members of our esteemed profession. A recent member poll showed that 97% of us report seeing patients on a daily basis who are sent to the emergency department by their primary care physician. Many of these patients have been sent in with expressed instructions from the family physician to have this or that test ordered either because their office practice is swamped, the office is closed, or they lack the facilities to perform these tests.
- ABIM, the organization sponsoring the campaign, refused to allow any discussion of liability reform as a component of the Choosing Wisely campaign. To quote from the letter ACEP Past President Dr. Sandy Schneider sent to Daniel Wolfson, ABIM’s Executive VP and COO: “This is a significant issue in emergency medicine and a critical factor as to why emergency physicians order the number of tests and procedures they do. Unlike primary care physicians, emergency physicians are not chosen by their patients, who have a greater tendency to sue for any perceived untoward event. In addition, we often lack prior care information. It is simply not possible for emergency physicians to talk about reducing ‘unnecessary’ testing without including messages about the need for medical liability reform.”
- Emergency physicians approach our patients with the goal of eliminating anything life threatening. We cannot afford to miss anything, even something that seems like a long-shot. The consequences may be life or death for our patients. A test that is unnecessary for 99 patients may save the life of patient number 100.
- Emergency medical care constitutes just 2 percent of all health care spending in the United States, no doubt in part because so much of the care we deliver is uncompensated. We are masters of efficiency and improvisation but there is only so far a dollar can be stretched. Emergency departments have been closing at an alarming rate across the country because so much care isn’t paid for. This is not the place to cut costs any further.
- Lastly, should ACEP participate in this campaign, it very well may assure that emergency physicians will not receive reimbursement for the five identified procedures or tests.
ACEP is dedicated to advancing emergency care and promoting evidence-based quality improvement measures for its patients. To that end, we are reevaluating our response to the Choosing Wisely campaign by developing a workgroup, comprised of members from the Reimbursement, Medical-Legal, EM Practice, Clinical Policies, Quality and Performance, and Public Relations Committees to examine the issue and prepare a proposal for ACEP Board consideration.
DAVID SEABERG, MD, FACEP
President, American College of Emergency Physicians
Today’s health care reform vote on Capitol Hill, while high drama, really only signals the beginning of the work that needs to be done by emergency physicians to improve access to emergency care for our patients and future patients. As I write this, I am watching the floor deliberations via the miracle of technology, and I know that the outcome will disappoint 48% of ACEP members, 48% of all physicians, and 48% of the American public, if polls are to be believed … and that will occur regardless of the outcome.
The greatness of our democracy lies in the ability of our people to freely elect their government representatives and to express themselves fully in the debate over crucial issues. Never in my lifetime has this been more apparent than during the health care reform debate. I believe that almost everyone has an opinion on health care, including many non-Americans, and almost everyone has expressed that opinion at some point.
The real challenge to our democracy, to our specialty, and to our organization is to move forward once today’s vote has been taken. We must have great care not to fall victim to Jefferson’s “tyranny of the minority.” We must move forward to create the greatest health care system in the world, befitting the greatest nation in the world, no matter the outcome of today’s vote.
There is no “win” today for emergency medicine. There is only new illumination on the path to achieving better emergency care. The real work comes as we identify areas that need our skills in innovation and problem-solving and get to work shoring up the nation’s emergency care system. My fervent wish is that emergency physicians will find a common bond in the needs of our patients, and put the rancor and division of the path to health care reform behind us in the interest of better emergency care for everyone.
Thank you for your leadership and partnership in this endeavor,
Angela F. Gardner, MD, FACEP
American College of Emergency Physicians
In a letter to the ACEP Council this week, ACEP President Dr. Angela Gardner outlined the current state of national health care reform and conveyed the essential components of reform outlined in ACEP policies. Her letter includes ACEP’s positions and a breakdown of the EM provisions in the pending bills.
“In recent years, there has been an increasing focus on the need for comprehensive reform of America’s health care system. With almost 50 million uninsured Americans and sharply rising costs in health care, the current system is unsustainable. There is, however, considerable disagreement and controversy over how to fix the severely challenged health care system.”