This is just a very quick off the cuff, personal assessment, from many miles away from Capitol Hill, of what ACEP can learn from the health reform process we have just gone through.
ACEP talked to our Congressmen and women and our President’s staff about how EMTALA was an unfunded mandate that left hospitals and ED physicians holding the bag for all the uninsured patients and illegal aliens seeking care in the ED. Section 1011 funding was not renewed in the bill. Universal coverage was not achieved, and guess who will be taking care of those patients who still won’t be covered.
ACEP talked about how coverage did not mean access to care, and that we were losing money every time we treated Medicaid patients in the ED, and that our on-call backup specialty panels were degrading because Medicaid reimbursement sucked. Medicaid reimbursement rates will not increase under the new health reform bill, there will not be any incentive for PCPs to pick up all these new Medicaid patients, and guess who will be taking care of these patients?
ACEP cited the need for a fix to the Medicare SGR. Nope, not in the bill.
ACEP requested an increase in Medicare rates for emergency care, to beef up our on-call backup panels and make up for the unfunded EMTALA burden we will still be charged with bearing. Didn’t happen.
ACEP pleaded for malpractice reform so we could provide cost-effective care in the ED without fear of the inevitable malpractice hammer. Don’t blink, you will miss it.
That’s not to say ACEP did not prevail in some of our advocacy efforts: prudent layperson – in there; emergency care as a basic benefit package – in there; research funding – some; and there is more, which I will be happy to let ACEP’s leadership tout and justifiably proclaim.
I don’t think the question is: were we heard? I suspect that ACEP was not just heard, we were appreciated, respected, given consideration, even supported. We just weren’t powerful enough to make as big a difference as we ought to have made, considering what ACEP physicians bring to the table: considering our knowledge of the system, our fingers in the dike, our white hats, our key roles in care management; our substantial national PAC, our excellent advocacy staff in DC, our leadership’s enormous contribution of time and commitment, and our public image.
Why, you might reasonably ask. What can we learn from the recent experience. Personally, I think what we should learn is that we haven’t dug deeply enough into our own pockets to evidence our commitment to advocacy. The trial lawyers do it, so do the chiropractors and the prison guards. Doctors generally don’t, and we don’t. In light of the recent decision by the Supreme Court to allow corporations like Anthem and HealthNet free reign to contribute their amassed wealth to wrangling the political process; what we have been willing to contribute to advocacy will have even less impact. Fortunately, the level of contributions to advocacy we have been making is relatively meager, so as a specialty we have lots of room to make a difference without having to sacrifice a pound of flesh to have an impact. Furthermore, with a little reformulation of our approach to advocacy funding similar to that which CAL/ACEP has done in California; ACEP could find ways to not only greatly expand our presence and impact in D.C., but do so without having any adverse impact on college services to our members. Perhaps, just the opposite.
Maybe, if we had a serious horse to ride in on, more folks on Capitol Hill would notice the white hat.