February 2022 Board Blog - Legislative Wins, Updates on Task Forces, and More

Pictured here - My first 2022 in-person Chapter visit at the Homestead with our VA Chapter.

Gillian Schmitz, MD, FACEP
ACEP President

We had a rough start to 2022. First, the world lost Betty White, then Bob Saget. We had a rise in Omicron cases compounded by nursing shortages. It felt like the we were kicking off “twenty-twenty too.” Even as I write this, I am training medical students at Uniformed Services University of the Health Sciences (USUHS). Our military is gearing up for an escalating conflict with a possible Russian invasion of Ukraine. I’m filled with heaviness but also gratitude for our men and women in the armed services - for their service and sacrifice in uncertain times.

But on a bright note (and there always is one), spring is just around the corner ... at least in Texas. Omicron cases are way down and the CDC recently issued new guidance about masks. And it feels as if life is finally starting to return to normal. We’ve had a number of legislative and regulatory wins at both a national and state level. Throughout February, we celebrated Women Physicians Day, Black History Month, and our EM residents who survived the in-service exam.

So, I want to take just a minute to share a few highlights over the past few weeks.

Legislative Wins

1. ACEP applauds the Texas court ruling that the No Surprises Act implementation fails to follow the letter of the law. The concerns validated by this ruling are some of those shared by ACEP, ASA and ACR in a separate lawsuit currently in a Chicago district court. ACEP/ACR/ASA filed a Motion for Summary Judgment on our lawsuit on February 9. The Government’s response is due March 9.
    
2. South Dakota scored an important scope of practice victory this week. A bill was defeated by a vote of 16 for and 19 against, despite a last-minute and second attempt by the sponsor to amend the bill. The amendment, adopted by the Senate, defined practice agreement, increased the number of practice hours from 1,040 to 6,240, and required a practice agreement with a physician – not physician assistant, as allowed in the original bill. Despite this amendment, the bill was still fortunately defeated. During her remarks, the bill sponsor mentioned the “emails and pushback” Senators received on this bill. Clearly the emails from so many physicians in South Dakota, including our own, made the difference.
    
3. ACEP Applauds Passage of Dr. Lorna Breen Health Care Provider Protection Act: On Feb. 17, 2022, the Senate passed the ACEP-supported "Dr. Lorna Breen Health Care Provider Protection Act" (H.R. 1667) by voice vote. It now heads to President Biden for his signature into law. Read the full press release and additional background about ACEP's efforts to develop and progress this bill through the legislative process.
    
4. Virginia ACEP has been fighting Medicaid downcoding in their state: CMS approved a Medicaid policy to downcode ED E/M services based on a list of 800 diagnosis codes. Essentially, if your final diagnosis was on that list, you would not get paid the expected amount. This is a huge potential problem as other private payors generally follow payment trends set by the government. If this happens in one state, it could happen anywhere. The prudent layperson standard provides protections that reimbursement should be based on the patient’s presenting symptoms and medical evaluation (not just the final diagnosis).
   
   ACEP has been working with the VA chapter to clarify this policy with CMS. Representatives from our DC office and Virginia Chapter leadership met with CMS twice over the past several weeks and had very productive meetings. CMS was not aware that this policy was being implemented by Medicaid managed care organizations in Virginia until we brought it to their attention. While we are not out of the woods yet, the supporting documentation provided by ACEP helped raise the issue to the level where it is now being further investigated. We are optimistic that CMS will take action to correct any policy at the state level that would violate the prudent layperson standard. ACEP’s relationship with CMS and credibility being the largest national EM organization is a significant member benefit of helping to address these state issues head on.

February Highlights

Black History Month: Don't miss a recent Frontline podcast episode featuring Dr. Ray Johnson and Dr. Sandra Coker discussing their experiences working in EM. Dr. Coker founded the Black Girl White Coat nonprofit, and Dr. Johnson's been a leader in EM for more than 30 years. Find more BHM22 resources related to this year's theme, Black Health & Wellness.

Women Physicians Day: ACEP put out a statement to recognize Women Physicians Day and celebrate a unique period in our history where the presidents of almost all of the national EM organizations are currently women. The Frontline podcast recorded an episode with Drs. Torree McGowan and Anne Zink to discuss women in leadership. ACEP is working to release a webinar on women in medicine, to appreciate our history and future, and recognize opportunities and challenges ahead for gender equity.

Task Force Updates

As part of our strategic plan to approach workforce issues, ACEP announced the New Practice Models Task Force, which will kick off March 2022. As we look to expand demand for our services outside the four walls of a hospital, this group will begin to explore practice models and opportunities to expand our skill set as we evolve as a specialty and look to the future.

The Ownership Task Force, created in 2019, set out to evaluate the impact of different ownership models, including private equity, on quality, cost, patient satisfaction and outcomes. ACEP contracted with Milliman to investigate what, if any, data exists within emergency medicine. Simultaneously, both the AMA and MedPac, the organization that advises Congress, were unable to find objective data that links outcomes with ownership models. Milliman had the same challenges as they attempted to collect data 2020-2021, what little data exists is in aggregate rather than by individual ownership type. Although some anecdotal information exists, it is very difficult to make any firm conclusions based on the lack of transparency and objective data. ACEP, AMA, and others have pushed for more transparency in order to better determine the impact of various ownership models on our practice. While the data we need does not yet exist for emergency medicine, there is some data on nursing homes and other medical practices. The task force will be drafting a white paper this summer to summarize the existing literature to provide members some information on what we do know, what we don’t know, and what we need from the government to enforce more transparency.

The ED Accreditation Task Force is looking into the feasibility of ACEP accrediting emergency departments (much like the ACS does for trauma centers). ACEP already accredits geriatric EDs and pain management programs in the ED. Accrediting all emergency department has its share of challenges: how do we decide what are appropriate standards to prioritize, do we require different standards for rural EDs, how do we incentivize hospitals to pay for accreditation and value the standards that we set? This task force will provide an update this summer on phase 1 and offer the Board some recommended standards, business plan, and feasibility.

Physician Wellness

I want to remind you all about the ACEP Wellness and Assistance Program, a free member benefit.

ACEP offers 3 free counseling sessions (or more informal coaching) to all ACEP members. This can include anything from stress, fitness and eating to financial counseling, marriage counseling, and more. Make sure you’re taking care of yourselves!

Don’t forget to sign up for #BikERdocs and join in on the EM Peloton community. You don’t need a bike or treadmill to join in many of the activities. Find a schedule of upcoming events and sign up at www.acep.org/peloton.