White House Says Reform Will Benefit EDs

ACEP News
July 2010

By Alicia Ault
Elsevier Global Medical News

WASHINGTON -- The Affordable Care Act contains provisions that are a direct result of lobbying efforts by emergency medicine, according to a White House official.

At a minimum, the law's focus on preventive care and its increased funding for community health centers, accountable care organizations, and primary care will let emergency physicians "focus on treating real emergencies," said Nancy-Ann DeParle, director of the White House Office of Health Reform, at the American College of Emergency Physicians Leadership and Advocacy Conference.

ACEP President-Elect Sandra Schneider, M.D., said that although the reform law is likely to create some positive developments for emergency medicine, she disagrees that physicians will be freed up to care for only emergencies. "No one really knows what's going to happen when everyone is insured," said Dr. Schneider, a professor of emergency medicine at the University of Rochester (N.Y.).

The shortage of primary care physicians and their inability to truly deliver episodic care means that emergency physicians are likely to continue to fill that gap, Dr. Schneider said in an interview.

Preliminary data from a University of Rochester study indicate that at least 40% of patients who have primary care physicians are being sent to the university's emergency room by those same physicians, she said. "For a fairly long time, and maybe forever, emergency physicians are going to do episodic care and true emergencies," Dr. Schneider said.

According to Ms. DeParle, the Affordable Care Act offers other emergency medicine-friendly benefits, including prohibiting prior authorization requirements or increased cost sharing for emergency services, no matter the setting. Emergency services also must be covered under the essential benefits package that insurers will be required to offer.

The law also creates pilot programs to determine how to improve emergency care, and supports research into best practices for emergency medicine.

Finally, the act will give trauma centers new funding to defray the costs of uncompensated care, Ms. DeParle said. The law did not directly address medical malpractice reform; but because President Obama heard from physicians who were concerned about liability, he used his executive authority to support a new round of grants to increase patient safety, she said.

"We're confident that this legislation will help you better serve your patients, bring down costs, and improve the quality of care for everyone," Ms. DeParle said.

"Now we have to implement the new legislation quickly, carefully, and efficiently," she noted.

Of course, that is no small undertaking. The Obama administration has begun to set up risk pools for people with preexisting conditions or who otherwise have been unable to purchase insurance, and small businesses are being informed how to get tax credits. Insurers have been asked to cease rescissions and move quickly to allow parents to keep young adults up to age 26 years on their policies. Sixty-five of the largest insurers have done so, said Ms. DeParle.

Finally, she said, the administration was asking emergency physicians to be partners in implementing the health reform law, as they had been in getting the law passed.

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