ACEP Leadership Report

Week of April 16, 2018

  • Want a rapid rundown of what’s happening on Capitol Hill? Don’t miss this Capital Minute, where ACEP reports on testifying before congress on opioids, new MEDPAC recommendations on freestanding EDs, ACA exchange information, comments from ACEP on the government proposed conscience rule, and the very latest on #LAC18. Click here to watch now.
  • ACEP has launched the Geriatric Emergency Department Accreditation Program (GEDA). GEDA recognizes that one-size ED care does not fit all patients. Older people in the ED have presentations, needs, dispositions, and outcomes that are specific to their age range. A geriatric ED may be either a separate space designated for older adults, or more likely, the integration of best practices for older adults. Learn more about the program at https://www.acep.org/GEDAHome/.
  • After careful consideration of several very qualified and talented candidates, ACEP has chosen Gerald Beltran, DO, FACEP to be the ACEP representative to the National Disaster Life Support Foundation Board of Directors. The foundation is not-for-profit, and dedicated to the establishment and propagation of standardized, all-hazards, multi-disciplinary, and competency-based training programs for first responders in mass casualty situations.
  • ACEP recently led the development and drafting of two emergency medicine-focused bills that were introduced in Congress last month, aimed at addressing the growing opioid epidemic. ACEP Board member Mark Rosenberg, MD, FACEP was invited by the House Energy & Commerce Health Subcommittee to testify on these two bills—his testimony before the Committee can be watched here.
  • In late March, ACEP was invited by the Congressional House Ways & Means Health Subcommittee to participate in a roundtable on reducing administrative burdens for physicians in the Medicare program. ACEP Board member Jon Mark Hirshon, MD, FACEP participated and shared with the Subcommittee a number of regulatory burdens facing emergency physicians, and ACEP’s recommended solutions.
  • ACEP continues its advocacy work, both with regulators and in the media, to oppose Anthem’s dangerous policy to retroactively deny coverage of emergency department visits by its policyholders that it deems as “non-emergent”. ACEP’s public relations work on the issue led to this NBC Nightly News piece on Anthem’s actions.
  • ACEP submitted a response to the Department of Health and Human Services’ proposed rule around enforcing so-called “conscience protections ”for providers, which as written would allow health care providers to deny treating a patient if they had any religious or moral objections, and to do so without ensuring any continuity of care or referral to another provider. ACEP strongly voiced its objected to the proposed rule in the response, noting that both by law and by oath, emergency physicians care for all patients seeking emergency medical treatment, and that denial of emergency care or delay in providing emergency services on the basis of race, religion, sexual orientation, gender identity, ethnic background, social status, type of illness, or ability to pay, is unethical. In late January when the proposed rule was first announced by HHS, ACEP and EMRA responded with a joint media statement.

Week of March 19, 2018

  • Need to catch up fast on ACEP advocacy and leadership activities? Check out this week’s Capital Minute, where we report on new ACEP-supported legislation about opioids that is now before Congress, new CDC data regarding opioid overdoses and emergency patients, more congressional pressure being applied to Anthem insurance, ACEP Board of Directors member Dr. Jon Mark Hirshon talking to lawmakers on Capitol Hill about administrative burdens, and the announcement of LAC speakers. Click here to watch now.
  • ACEP Board of Directors member Mark S. Rosenberg, DO, MBA, FACEP has been appointed to the Department of Health and Human Services (HHS) Pain Management Best Practices Inter-Agency Task Force (PTMF). The PTMF was created to determine whether there are gaps or inconsistencies in pain management best practices among federal agencies, and propose recommendations on addressing gaps or inconsistencies. Click here to learn more about the PTMF.
  • ACEP and CMS Center for Clinical Standards and Quality (CCSQ) met on March 1 to discuss Quality Measures policy, process, and the future vision for CMS’ approach to Meaningful Measures. The meeting was very productive and provided insight to the ACEP team in preparation for developing the next generation of quality measures, validating existing measures, and their applicability to ACEP’s Quality Clinical Data Registry, known as Clinical Emergency Data Registry (CEDR).
  • Laura Wooster, ACEP’s Associate Executive Director of Public Affairs, represented ACEP in a day-long meeting in DC held by HHS’ Assistant Secretary for Preparedness and Response, Dr. Robert Kadlec, to gain stakeholder input on how to implement his vision for a national medical disaster system. Dr. Kadlec will be sharing more on this vision when he joins ACEP's Public Policy Town Hall during the Leadership and Advocacy Conference on May 21.
  • ACEP Board member Jon Mark Hirshon MD, PhD, MPH, FACEP participated in a roundtable held by the House Ways & Means Health Subcommittee on its “Red Tape Initiative” to reduce provider administrative burdens. Dr. Hirshon talked about administrative burdens in the Medicare program that impact emergency physicians, and provided recommendations for addressing them.
  • Last month, ACEP joined with the American Hospital Association and the American College of Radiology in a joint letter to Anthem Chief Clinical Officer Craig Sammit, MD, to state concerns with the insurer’s policy to retroactively deny coverage for emergency visits it deems as non-emergent. ACEP also has worked closely on the Anthem issue with Senators Ben Cardin of Maryland and Claire McCaskill of Missouri, who last week wrote a joint letter to U.S. Secretary of Health and Human Services Alex Azar and Department of Labor Secretary Alexander Acosta stating concerns on the Anthem policy and seeking information on whether it violates federal regulation.
  • Last week, two emergency medicine opioid bills that ACEP was heavily involved in developing were introduced in Congress. The “Alternatives to Opioids (ALTO) in the Emergency Department Act” would provide $30 million (over three years) to establish a demonstration program to test nationally the ALTO protocol developed at St. Joseph’s Regional Medical Center by ACEP Board member Dr. Mark Rosenberg—the program uses alternative pain management protocols to limit the use of opioids in the emergency department.  Additionally, the “Preventing Overdoses While in Emergency Rooms (POWER) Act” would provide $50 million (over five years) in grants to establish policies and procedures for administering Medication-Assisted Treatment (MAT) in the emergency department to opioid overdose patients with subsequent referral to community providers.
  • ACEP President Paul Kivela, MD, MBA, FACEP was formally invited by the National Academy of Sciences (NAS) onto a panel to discuss "Leading Changes at the Ground Level" (of clinical medicine/healthcare administration), at the workshop titled Engaging the Private Sector Health Care System in Building Capacity to Respond to Threats to the Public’s Health and National Security. Dr. Kivela worked with ACEP's EMS and Disaster Sections of Membership for his discussions.

Week of February 8, 2018

Members of ACEP and ACEP staff met with the VA to discuss care of geriatric patients in VA emergency departments. Among the issues discussed were ways to identify veterans who present to our EDs and connecting them with VA outpatient resources – especially those with mental health issues. Also discussed was the potential participation of VA hospitals in the ACEP Geriatric ED Accreditation program.

Senior ACEP staff and representatives of other medical specialties met with the Patient Centered Outcome Research Institute (PCORI) on January 26th to discuss ways of disseminating the research findings they funded. A few studies were highlighted, including one by ACEP member Erik Hess, MD of the University of Alabama Birmingham on chest pain risk stratification and shared decision making. 

ACEP Board of Directors Member Aisha Liferidge, MD FACEP along with senior ACEP staff attended a 2-day conference with the National Institute of Drug Abuse on January 26th and 27th to discuss potential treatment of patients with opioid addiction. ACEP member Gail D’Onofrio, MD FACEP led the meeting. Dr. D’Onofrio is the Chair of Emergency Medicine at Yale and is a well-respected researcher in substance abuse disorders. 

On January 24th, ACEP’s President Dr. Paul Kivela and members of ACEP’s senior staff, Loren Rives, Laura Wooster, and Sandy Schneider, met with CMS to discuss mental health and sedation. CMS was very supportive of emergency physicians’ ability to screen all patients with emergency conditions, including those with mental health issues. They continue to agree that emergency physicians are ‘uniquely qualified’ to perform sedation. More clarification to come.

ACEP President Dr. Paul Kivela recently met with Sen. Bill Cassidy (R-LA) to discuss: 

  • S.1530 psychiatric boarding in the emergency department (Cassidy is lead Republican on the bill)
  • ACEP’s interest in the Senate’s reauthorization of the Pandemic and All Hazards Preparedness Act (PAHPA)
  • Out-of-Network billing for emergency services

During the meeting, Dr. Cassidy agreed to address ACEP members during #LAC18, to provide an update on the latest health care initiatives being considered by Congress. He will be speaking at 8:45 a.m. on Tuesday, May 22nd.

Week Of January 15, 2017

 

  • Laura Wooster, ACEP Associated Executive Director for Public Affairs takes you through the first of 2018 and the issues that are important to ACEP members and their patients. They include new developments with Anthem's controversial emergency care policy, legislative priorities and updates on veteran's health issues. Click here for the latest ACEP news in the ACEP Capital Minute.
  • ACEP President Paul Kivela, President-Elect John Rogers, and ACEP staff met with leaders of the American Society of Anesthesiologists to discuss their sedation polices and potential impact on emergency medicine practice. They also discussed collaboration and strategies to ensure reasonable out-of-network reimbursement.
  • In late December, ACEP President-Elect John Rogers and ACEP’s Associate Executive Director for Public Affairs, Laura Wooster, met with representatives of Anthem to discuss Anthem’s announced policy in several states to deny payment for patient visits to the ED that ACEP contends are in violation of federal and state law protecting patients according to the prudent layperson standard
  • In December, ACEP’s Board held its annual strategic planning meeting. Among many issues discussed that impact the specialty, the Board discussed ways to overcome challenges to fair reimbursement, how to enhance ACEP’s engagement with members in social media, quality measures and ACEP’s clinical data registry (CEDR), patients with mental health disorders, seeking improved relations with other emergency medicine organizations, and assessing the efficiency of ACEP’s Board.

 

Week Of December 11, 2017

  • Want a high-speed rundown of what’s going on in Washington, DC? Check out ACEP’s Capital Minute here.
  • ACEP’s Associate Executive Director for Public Affairs, Laura Wooster, worked with an Associated Press reporter to develop a story on Anthem’s damaging policy to retroactively deny coverage for emergency department care—the syndicated article was picked up by more than 200 outlets in November including The New York Times, Time Magazine, ABC News, and The Washington Post, bringing national attention to the insurer’s assault on the prudent layperson standard.
  • ACEP President Paul Kivela, Past President Becky Parker and other ACEP leadership recently met at our office with leaders of EDPMA, EMAF, and PFC (Physicians for Fair Coverage) to discuss coordinating strategy and resources around the out-of-network battles that will be occurring in various states over the next year.
  • ACEP was invited to a meeting of specialty societies, state medical associations, specialty boards and the American Board of Medical Specialties to discuss the need for changes in Maintenance of Certification. It is very clear that there is significant discontent with the current programs in all specialties, and ABMS acknowledges the need for significant change. The specialty societies and state medical associations expressed the need for transparency of finances and process, re-establishing trust among the groups, flexibility of testing, retaining self-regulation and alternatives to the high-stakes periodic examination. While some changes to periodic assessment are already underway within various individual Boards, the ABMS is starting a process to examine continual competency assurance. It is clear that Boards will be encouraged to develop innovative alternatives to the current process. At the ACEP Council meeting, emergency medicine's Board, ABEM, announced that they, too, would be looking at alternatives to the current Maintenance of Certification program.
  • ACEP has had discussions with Veterans Administration (VA) staff regarding a variety of programs and awareness efforts for the two organizations to work more closely together to help achieve our respective missions. Some of the projects under discussion include creating tools to identify VA patients when they present for emergency care, education on military/veteran health issues, participation in EMS Week 2018, and participation in the Geriatric ED Accreditation program.
  • ACEP is collaborating with the American College of Healthcare Executives (ACHE) for Patient Safety initiative, a national leader in patient safety. ACEP has added a Patient Safety Sub-committee under the umbrella of the Quality and Patient Safety Committee (QPSC). Through this collaboration, ACEP expects to establish a vision and culture for patient safety for emergency medicine and contribute to the national movement toward patient-centered safety. More details are available here.
  • ACEP is working closely with the American Hospital Association (AHA) on a number of initiatives: a half-day workshop on physician wellness and resiliency that we intend to offer before LAC; a hospital flow conference that ACEP would offer in conjunction with an AHA meeting next summer; and discussions with AHA around their support for ACEP and state hospital associations regarding attacks on the prudent layperson standard. Details on these to come later.
  • ACEP and the AHA have also partnered to lead opioid-related education, training, awareness, best-practice development, and research. Some of the potential topics for future collaboration are:
    1. Collaboration with the National Institutes of Drug Abuse (NIDA) on Opioid Initiatives, including co-branding of Emergency Quality Network (E-QUAL) Opioid project
    2. Joint clinical policies on opioid usage
    3. Awareness of opioid issues for providers
    4. Awareness of opioid issues for patients/community
    5. Participation in Behavioral Health Toolkit and Dashboard development and deployment
    6. Emergency Department Information Exchange (EDIE)
    7. Alternatives to Opioids (ALTO)
    8. Publish stories of success
    9. Explore joint research opportunities and funding
     

Week of Nov. 10, 2017 

Members of ACEP and ACEP staff met with the VA to discuss care of geriatric patients in VA emergency departments. Among the issues discussed were ways to identify veterans who present to our EDs and connecting them with VA outpatient resources – especially those with mental health issues. Also discussed was the potential participation of VA hospitals in the ACEP Geriatric ED Accreditation program.

 

 

Senior ACEP staff and representatives of other medical specialties met with the Patient Centered Outcome Research Institute (PCORI) on January 26th to discuss ways of disseminating the research findings they funded. A few studies were highlighted, including one by ACEP member Erik Hess, MD of the University of Alabama Birmingham on chest pain risk stratification and shared decision making.

 

 

ACEP Board of Directors Member Aisha Liferidge, MD FACEP along with senior ACEP staff attended a 2-day conference with the National Institute of Drug Abuse on January 26th and 27th to discuss potential treatment of patients with opioid addiction. ACEP member Gail D’Onofrio, MD FACEP led the meeting. Dr. D’Onofrio is the Chair of Emergency Medicine at Yale and is a well-respected researcher in substance abuse disorders.

 

 

On January 24th, ACEP’s President Dr. Paul Kivela and members of ACEP’s senior staff, Loren Rives, Laura Wooster, and Sandy Schneider, met with CMS to discuss mental health and sedation. CMS was very supportive of emergency physicians’ ability to screen all patients with emergency conditions, including those with mental health issues. They continue to agree that emergency physicians are ‘uniquely qualified’ to perform sedation. More clarification to come.

 

 

ACEP President Dr. Paul Kivela recently met with Sen. Bill Cassidy (R-LA) to discuss: 
 

  • S.1530 psychiatric boarding in the emergency department (Cassidy is lead Republican on the bill)
  • ACEP’s interest in the Senate’s reauthorization of the Pandemic and All Hazards Preparedness Act (PAHPA)
  • Out-of-Network billing for emergency services


During the meeting, Dr. Cassidy agreed to address ACEP members during #LAC18, to provide an update on the latest health care initiatives being considered by Congress. He will be speaking at 8:45 a.m. on Tuesday, May 22nd.

Week of Oct. 23, 2017

  • ACEP Board leaders Becky Parker, Paul Kivela and Bill Jaquis, along with ACEP senior staff and Dr. Alison Haddock, Chair of ACEP’s State Legislative committee, met with senior executives of Cigna insurance on October 12. This was a follow-up meeting to one held in July.

    ACEP and Cigna discussed the need to protect the prudent layperson standard as a matter of patient safety and patient access to care. Cigna sought ACEP’s guidance on ways to engage more ED groups to contract to be in their networks. Both organizations share a commitment to combatting the opioid crisis and discussed their efforts. Cigna is interested in working with ACEP to promote the use of interoperable emergency department information exchanges such as the EDIE/PreManage program of Collective Medical Technologies that is supported by ACEP. The groups agreed to follow up on things discussed and meet again. Cigna expressed a strong interest in having a collaborative relationship with ACEP.
  • Earlier this week, ACEP President Dr. Becky Parker sent a letter to Senator Alexander and Senator Murray regarding ACEP’s support of the bipartisan Alexander-Murray agreement. The agreement was released late Tuesday evening to provide critical stability for the individual health insurance marketplace, ensuring that millions of Americans have continued access to the health coverage they need and deserve.

    This legislation is a good-faith bipartisan effort that will help limit increases in health insurance premiums and preserve important consumer protections, such as the Essential Health Benefits (EHBs) package that includes emergency services, while also providing additional flexibility for states to implement innovative approaches to coverage. For the tens of millions of patients that receive care in the emergency department each year, the Alexander-Murray agreement provides much-needed assurance that their care will continue to be covered.

    Further, this approach is proof that lawmakers on both sides can collaborate on patient-centered solutions that help improve our entire health care system. By providing this important short term stability, policymakers, physicians, providers, and other stakeholders and experts can continue working to address the other challenges facing our health care system. ACEP applauds Senators Alexander and Murray for their bipartisan agreement and urges Congress to act quickly to enact this vital legislation.

Week of Oct. 9, 2017

  • ACEP President Dr. Rebecca Parker talks about the latest attempt to repeal and replace the Affordable Care Act, a high-level meeting ACEP had with the Department of Health and Human Services and work that ACEP members are currently doing in hurricane-ravaged Puerto Rico. This it the latest that ACEP is working on in Washington, D.C., for emergency physicians and their patients. See the Capital Minute here.
       
  • On Oct. 2, ACEP President Dr. Rebecca Parker met with the leadership of the Department of Health and Human Services and the Centers for Medicare and Medicaid Services to discuss innovations in Medicare that benefit emergency patients and Physicians.
       
  • On Sept. 29, ACEP President Dr. Rebecca Parker, President-Elect Dr. Paul Kivela, and Immediate Past President Dr. Jay Kaplan, along with ACEP’s senior management team, met with senior staff of the American Hospital Association in Chicago at AHA headquarters. A variety of things were discussed, but ACEP and the AHA have agreed to work together on a series of projects to address workplace violence, patient flow and boarding, the opioid crisis, EMTALA and protecting the prudent layperson standard. Other areas in which the two organizations have expressed interest in working together include physician resilience and wellbeing, geriatrics, quality measures, and the future of the ED.
       
  • ACEP, along with every major Emergency Medicine organization, participated in a summit meeting convened by the American Board of Emergency Medicine (ABEM) to discuss modifications and alternatives to the ABEM Continuous Certification (ConCert™) Examination. ACEP Vice President Dr. William Jaquis attended the meeting, which took place October 2-3 and reviewed the role of the ConCert™ Examination in maintaining a credential that would best serve the interests of both the public and emergency physicians. ABEM will continue to solicit input from stakeholder organizations and ABEM-certified physicians. ABEM anticipates announcing specific examination options and a timeline for implementation, in spring 2018.
       
  • ACEP Chair of the Board Dr. John Rogers was interviewed on Top Docs about the new Anthem BCBS policy about emergency visits and their refusal of claims for what they consider non-emergent visits. To see the entire interview, click here.
       
  • 
On Oct. 2, the Nevada College of Emergency Physicians & ACEP issued a joint statement about the mass shooting in Las Vegas, which reads in part, "The incredible emergency response in such a short timeframe — from the physicians, nurses and emergency medical services in Nevada, as well as law enforcement — has been nothing less than miraculous. While the shock and grief from yet another heinous mass killing and wounding are still fresh, we remain devoted to preparing our nation to best manage the consequences of such violent active incidents. Our prayers go out to the many injured who are still fighting for their lives." Watch ACEP President Dr. Parker comment on the incident.

Week of Sept. 25, 2017

  • ACEP President-Elect Dr. Paul Kivela met with the Board of Directors of the Emergency Nurses Association (ENA) recently and addressed the General Assembly of the ENA at their annual meeting. Dr. Kivela discussed with ENA leadership the need to work more closely together on issues of workplace violence and other issues of mutual concern to our members.
       
  • CMS released the most current version of its proposed ED Patient Experience of Care (EDPEC) survey for feasibility testing. CMS has been developing this survey of the last few years due to the Consumer Assessment of Healthcare Providers & Systems (CAHPS) that is currently used in hospital outpatient settings being largely inappropriate for the ED setting. ACEP shared strong concerns with CMS on initial versions of EDPEC, and due to these efforts, the questions regarding pain have been changed to be much more appropriate to how care is delivered in the ED. CMS will be testing this new version, and ACEP will continue to monitor these efforts and provide feedback to the agency as the survey moves closer to implementation. 
       
  • ACEP played an active role in defeating the proposed Graham-Cassidy Senate health care reform bill. ACEP sent a letter to Congress, issued a press release, and was featured in many high-profile media reports about opposition to the bill, including Meet the Press, The New York Times, The Washington Post and others. ACEP President Dr. Rebecca Parker was quoted in an article in MedPage Today.
       
  • ACEP President-Elect Dr. Paul Kivela, members Dr. John Proctor and Dr. Les Zun (representing the American Association for Emergency Psychiatry) and ACEP staff sat on The Joint Commission’s Technical Expert Panel on universal suicide screening in the ED. Others at the meeting included the American Psychiatric Association, National Institute for Mental Health, American Federation for Suicide Prevention and SAMSHA. There was support for continuation of The Joint Commission standard that limits mandatory screening in the ED to those patients who present with mental health problems. However it was noted that there is significant progress being made to develop more reliable screening tools. It is recognized that screening alone does not reduce suicide rates. There was support for an increase in mental health resources 24/7, and evidence based treatment alternatives to hospitalization. Hospitals with available and accessible resources for rapid referral to mental health follow-up should consider screening of additional high-risk populations for suicide such as adolescents and, when feasible and referral resources are available, screen all patients for suicide ideation. 

 

 
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