From The President: Assessing the Impact of Health Care Reform

May 2010

By Angela Gardner, M.D., ACEP President

So, now what? The Patient Protection and Affordable Care Act of 2010 was signed into law in March, and despite the movement to repeal and replace it, there is the very real chance that these statutory changes will remain.

Be assured that ACEP will continue to fight for issues like physician payment and meaningful medical liability reform as regulations are developed to fulfill the intent of the legislation.

The ACEP membership was divided sharply during the health reform debate that played out in Congress, in the media, and in living rooms across the nation. For that reason, ACEP did not take an official stand on the bill as a whole, but chose to work for provisions that would benefit our patients, our future patients, and all emergency physicians.

Several provisions in the law--many of which originated with ACEP lobbying efforts--could impact your practice.

  • Inclusion of emergency services as part of an essential health benefits package offered by health plans. This concept was a key element of ACEP's Access to Emergency Medical Services Act.
  • Extension of prudent layperson language to group health plans. This has been a tenet of ACEP's work on Capitol Hill for years.
  • Establishment of emergency/trauma regionalization pilot projects will design, implement, and evaluate innovative models of regionalized, comprehensive, and accountable emergency care and trauma systems. ACEP has been a strong advocate for this kind of program.
  • Trauma center grants will assist in defraying substantial uncompensated care costs and provide emergency financial relief to ensure the availability of trauma services.
  • Expansion and enhancement of timeliness of emergency medicine research from federal programs administered by the National Institutes of Health, the Agency for Healthcare Research and Quality, the Health Resources and Services Administration, the Centers for Disease Control and Prevention, and other agencies will be expanded and accelerated.
  • Expansion and coordination of pediatric emergency medicine research will be coordinated and expanded.
  • Reauthorization of the Emergency Medical Services for Children (EMSC) program for 5 years.
  • The National Health Care Workforce Commission is established to review current and projected health care workforce supply and demand.
  • There will be Medicaid reimbursements for EMTALA services provided at private psychiatric hospitals through a 3-year demonstration program.
  • There will be Medical liability reform in the way of state grants for development, implementation, and evaluation of alternatives to current medical tort litigation.

Regardless of your personal view on health care reform, these provisions are "wins" for emergency medicine. However, there are still much-needed changes that were not addressed in the legislation:

  • There has been no resolution to the SGR, which determines Medicare rates. Despite a temporary reprieve of the 21% cut facing emergency physicians through the end of May, there is no permanent fix to the flawed formula to determine these rates.
  • Boarding was not addressed in any way.
  • The Emergency Care Coordination Center (ECCC) within the Department of Health and Human Services was not authorized.
  • Payment for services provided to illegal immigrants (formerly Section 1011) was omitted, but remains a substantial concern for many emergency departments.

As several hundred emergency physicians visit Capitol Hill this month during the Leadership and Advocacy Conference, these and many more issues will be brought up with the lawmakers.

Because most of the provisions of the Patient Protection and Affordable Care Act of 2010 don't take effect for months or years, there is still time for us to constructively improve it with additional legislation or regulatory language.

Emergency physicians are innovators and problem-solvers by nature. No matter the issue that faces us--be it a legislative decision or a regulatory interpretation--I have absolute confidence that our specialty and our members have significant contributions to make in the effort to provide better health care for all Americans.

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