ACEP Develops Plan to Influence Reform

August 2010

By Nancy Calaway
ACEP Staff Writer

The Patient Protection and Affordable Care Act was signed into law in March, but as expected with such a massive piece of legislation, the details will be finalized in a regulatory process that could take years.

In an effort to be effective in promoting the interests of emergency medicine during this lengthy process, ACEP's Board of Directors approved a strategic list of priorities to guide ACEP's efforts to affect reform.

"This is just the start of a marathon to shape the implementation of health care reform through federal regulations," said Dr. Angela Gardner, ACEP President. "Be assured that ACEP is in this race and we now have a detailed plan to ensure that emergency medicine receives its share of appropriate resources."

The Board's health care reform priorities, approved at its June meeting, were based on an extensive analysis of the law's 2,000-plus pages by staff and leadership, as well as input from health policy analysts. As provisions of the law were reviewed, consideration was also given to how they fit into ACEP's strategic plan.

Some of the highest priorities include:

arrow redPatient Protections. This measure, which ACEP was successful in getting included in the law, extends the "prudent layperson standard" to group health plans, eliminates the need for prior authorization, and provides parity for in- and out-of-network coverage and patient copayments. We will urge expansion of these patient protections to grandfathered health plans, as well.

arrow redHospital Value-Based Purchasing Program. As this program advances, we want to ensure that measures to improve emergency department efficiencies are considered an essential component of this plan.

arrow redImprovements to PQRI System. Such improvements will ensure that emergency physician measures continue to be available in the PQRI program and that these measures promote integration of clinical reporting using electronic health records, as well as demonstrate both meaningful use of electronic health records and quality of care provided to the patient.

arrow redValue-Based Payment Modifier (Physician Fee Schedule). As CMS develops its own transparent episode grouper software, it must account for the unique delivery aspects of emergency services. In addition, it is critical that future risk-based measures developed by HHS are applied only to emergency department services that are within the control of the physicians.

arrow redMedicare Shared Savings Program and Payment Bundling. We will work with physician and hospital colleagues to recognize the important role emergency physicians play in providing the full continuum of care to Medicare beneficiaries. There must be commensurate recognition of these distinctive services as an integral part of any Accountable Care Organization (ACO) and through the coordination of bundled payments for an episode of care.

arrow redDistribution of Additional Residency Positions. Because of the statutory obligation to provide at least 75% of the redistributed residency positions to primary care or general surgery, it is even more imperative that CMS provide as many of the remaining slots to emergency medicine residency programs as possible. The expected immediate increase in emergency department visits demands that we accelerate the availability of residency-trained emergency physicians in our communities.

arrow redNational Health Care Workforce Commission. The growing trend of an increasing number of emergency department visits each year and a decreasing number of emergency departments is of great concern. We will encourage the Commission to highlight the education and training needs of emergency medicine as well as primary care and public health.

arrow redPatient-Centered Outcomes Research. Because emergency physicians provide for nearly 120 million visits per year, we will urge the outcomes research institute to include emergency medicine research priorities in its agenda.

arrow redExtension of Medical Malpractice Coverage. The law extends Federal Tort Claims Act liability protections to an officer, governing board member, employee, or contractor of a free clinic. Because of the unique requirements imposed on physicians who provide EMTALA-related services, we will continue to urge Congress to consider how the Federal Tort Claims Act may be applied to ensure the continued availability of these emergency and on-call physicians.

ACEP is actively monitoring and will continue to monitor the implementation process to promote the interests of emergency physicians and emergency patients. The complete list of the Board's health care reform priorities can be found online at

"We expect an even greater demand on emergency services during the next few years as emergency visits will increase despite health care reform and as financially strapped hospitals will continue to close the doors to their emergency departments," said Dr. Sandra M. Schneider, ACEP President-Elect.

"We must ensure appropriate resources are directed to the health care safety net services provided in America's emergency departments," she said.

ACEP will seek support from other advocacy groups and plans to send a joint letter to Health and Human Services Secretary Kathleen Sebelius outlining these priorities. The letter will also ask her to respond to a proposal to create a CMS working group to develop standards to reduce ED boarding and ambulance diversion, and to support statutory authorization of the Emergency Care Coordination Center.

After the November elections, ACEP will launch a national campaign to promote Congressional action to address these emergency care issues and enlist public support.

To make progress addressing these health care reform priorities, ACEP will likely need more resources in addition to the substantial funds already allocated in its current budget. At their June meeting, the Board also discussed ways to carry out these strategies and priorities for health care reform, which might include additional staff in our D.C. office, outside consultants, or other models.

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