ACEP Leadership Report

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 

  • At the Board of Directors meeting during the ACEP17 conference, the board discussed many topics of action moving forward, including:
    • Health Care System Surge Capacity Recognition, Preparedness, & Response
    • Hospital Disaster Physician Privileging
    • Writing Admission and Transition Orders
      • This Admission and Transition Orders policy statement was revised and approved –the final wording is still pending review, and will be available soon.
  • At the ACEP17 Conference Council Meeting, the following resolution was passed:
    • Resolution 49: Participation in ED Information Exchange and Prescription Drug Monitoring Systems 

      RESOLVED, That the American College of Emergency Physicians collaborate with the Department of Veterans Affairs, Department of Defense, the Indian Health Services, and potentially legislatures to encourage and facilitate their participation in state prescription drug monitoring programs; and be it further

      RESOLVED, That the American College of Emergency Physicians collaborate with the Department of Veterans Affairs, Department of Defense, the Indian Health Services, and potentially legislatures, to encourage and facilitate their participation, to the extent consistent with federal law, a system for real-time electronic exchange of patient information, including recent emergency department visits and hospital care plans for frequent users of emergency departments.
      • A task force is already hard at work meeting with member of congress. Look to the Leadership Reports for further updates.
    • Elections:
      • Board of Directors: 
        Alison Haddock, MD, FACEP
        Stephen H. Anderson, MD FACEP (re-elected)
        Jon Mark, Hirshon, MD, PhD, MPH, FACEP (re-elected)
        Aisha T. Liferidge, MD, FACEP
        • Stephen H. Anderson, MD, FACEP is the 2017-18 Secretary/Treasurer
        • Vidor E. Friedman, MD, FACEP is the 2017-18 Vice President
        • Debra G. Perina, MD, FACEP is the 2017-18 Chair of the Board

      • 2017-2018 President-Elect:
        John J. Rogers, MD, CPE, FACEP

      • Council Officers:
        Vice Speaker: Gary R. Katz, MD, MBA, FACEP
        Speaker: John G. McManus, Jr., MD, MBA, FACEP
  • On Thursday, the House of Representatives unanimously accepted a modified version of the ACEP-supported “Protecting Patient Access to Emergency Medications Act of 2016” (H.R. 304). ACEP has been working to develop and enact this bill since 2015 in response to a DEA letter that questioned the legality of standing orders in EMS. This led ACEP to establish and lead a coalition of EMS-affiliated organizations that developed and promoted this important legislation. 
    The bill would ensure continued access to pain and anti-seizure medications for patients suffering medical emergencies. It will explicitly permit physician medical directors to issue standing orders to EMS personnel so they may administer controlled substances to their patients. In addition, the legislation clarifies and codifies who is authorized to provide verbal orders for controlled substances; provides the option for a single EMS agency registration; and clarifies receipt, movement and storage rules for EMS agency controlled substances. To read more, click here
  • ACEP issued a statement in response to the shooting in Sutherland Springs, Texas. Dr. Paul Kivela states: "On behalf of the nation's emergency physicians, I want to express our heart-felt sympathy to the families and friends of those who were murdered at a Texas church last night. I am proud of my emergency physician colleagues and first responders in San Antonio and the neighboring communities who sprang into action last night and implemented a mass casualty plan that opened up resources to care for those who were injured…In accordance with its policies, ACEP continues to call for restrictions on the sale and ownership of weapons, munitions, and large-capacity magazines designed for military or law enforcement use.  In addition, ACEP has called for increased access to mental health services, expanded background checks, adequate support and training for the disaster response system, as well as increased funding for firearm safety and injury prevention research." To read the full release, click here
  • At the ACEP17 Conference, Dr. Paul Kivela, along with Drs. Scott Weiner and Krista Brucker, held a press conference to discuss recent opioid research and its overall impact on the public health crisis. To watch the full conference, click here. To read the press release, click here.

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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