It’s almost here! The annual Leadership and Advocacy Conference (LAC) in Washington, DC is next week, May 1 through May 3. For those of you who are unfamiliar with this conference, it allows you as emergency physicians to come together to hear from our nation’s leaders and meet directly with legislators and their staff on Capitol Hill to discuss important issues that directly affect you and your patients.
Highlights for this year’s conference include:
- A Health Policy Primer sponsored by the Emergency Medicine Residency Association (EMRA);
- A Leadership Summit featuring emergency physician experts addressing topics such as physician burnout, emergency department (ED) violence, physician collective action, and scope of practice issues in states;
- Comprehensive advocacy and issue training to prepare for visits with legislators on Capitol Hill; and (last, but definitely not least)
- FANTASTIC government speakers including Assistant Secretary for Health (ASH) Admiral Rachel Levine, Senator Tim Kaine (D-VA), and Senator Tammy Baldwin (D-WI).
Every year, ACEP chooses three issues that LAC attendees will focus on when meeting with their legislators on Capitol Hill. The three selected this year are extremely timely, critical topics, which probably look very familiar to you (since I have written about them in previous Regs & Eggs blogs!)
Protecting Emergency Physicians from ED Violence
As you all well know, violence in the ED is a serious, and unfortunately, growing concern that has only been exacerbated by the COVID-19 pandemic. In addition to the immediate physical threat to emergency physicians and other ED personnel, it causes significant stress for patients seeking treatment in the ED and contributes to job dissatisfaction and burnout.
Violence against emergency physicians must not be accepted as “just part of the job.” ACEP supports the “Workplace Violence Prevention for Health Care and Social Service Workers Act” (H.R. 1195), introduced by Rep. Joe Courtney (D-CT) and soon to be introduced in the Senate by Sen. Tammy Baldwin (D-WI), that takes critical steps to address ED violence. The bill requires the Occupational Safety and Health Administration (OSHA) to issue an enforceable standard to ensure health care and social services workplaces implement violence prevention, tracking, and response systems. H.R. 1195 passed the House on April 16, 2021, and attendees at LAC will be urging the Senate to swiftly consider and pass this important legislation to help protect emergency physicians from violence in the workplace.
It is important to note that although OSHA has the authority to issue a standard on its own, unfortunately, the agency has put this important issue on the back burner as it has continued to focus on COVID-19. Thus, legislation is definitely needed in order to compel OSHA to act!
Besides requesting that legislation related to an OSHA standard be enacted, attendees at LAC will also be urging Congress to examine other potential protections for emergency physicians and to work with the Biden Administration to implement and enforce appropriate penalties for violence against health care workers.
Medicare Physician Payment Reforms
I don’t need to remind you that Medicare physician payments are a mess! Congress has stepped in over the past few years to mitigate the majority of scheduled cuts to the Medicare Physician Fee Schedule (PFS), but systemic issues continue to create significant instability for emergency physicians. These substantial challenges include the flawed “budget neutrality” requirements in the PFS, the lack of an annual inflationary update, automatic payment rescissions called sequestration, and the inability for emergency physicians and other clinicians to meaningfully participate in alternative payment models.
Attendees at LAC will be asking Congress to begin formal proceedings to discuss potential long-term reforms to Medicare physician payment that will hopefully, at long last, provide some stability.
Emergency Physician Due Process Protections
Due process protections are a standard component of hospital medical staff bylaws, which outline disciplinary procedures and processes for fair hearings. The right to due process is critical to ensuring that you and your colleagues can practice in a fair, equitable, and supportive environment, free from undue threats of retribution or termination. These protections should cover all physicians who work under the hospital, but in reality, many emergency physicians are explicitly deprived of these rights for reasons outside your control. Hospitals, health systems, or physician groups can require a “waiver of due process rights” clause in the contracts they offer to emergency physicians. In many cases, if you want to practice, you simply have no alternative but to accept the terms of these contracts. This deprives you of your autonomy to make medical decisions, limits your ability to raise patient safety concerns, and leaves you vulnerable to retaliation for speaking out.
Notably, due process was a significant issue that ACEP members brought up in a questionnaire that assessed the impact of a recent merger or acquisition. As I noted in last week’s blog post, over fifty percent of respondents to the questionnaire indicated that their due process rights worsened or were eliminated after the merger of their practice.
While this has long been a problem, the COVID-19 pandemic highlighted how health care workers were threatened, silenced, or simply terminated for raising patient safety concerns or a lack of PPE to protect yourselves. Some physicians were terminated even when they were needed most during the greatest public health crisis of our time.
Safeguarding the right to due process helps sustain and advance quality patient care and safety. All emergency physician contracts should include a due process clause, regardless of whether you are directly employed by a hospital or you provide emergency medical services through a group or individual contract.
The “ER Hero and Patient Safety Act”, previously introduced by Senator Roger Marshall, MD (R-KS), and Representative Raul Ruiz, MD (D-CA), ensures that due process rights are protected for all emergency physicians, regardless of who employs them directly. Expected to be reintroduced soon, this straightforward legislation requires the U.S. Department of Health and Human Services (HHS), through regulations, to extend due process rights to emergency physicians employed by a third-party contractor. Attendees at LAC will be asking their legislators to cosponsor the “ER Hero and Patient Safety Act” when introduced.
All in all, if you attend LAC, you will have the chance to advocate on these three critical issues and truly make a difference in the lives of your emergency physician colleagues, other health care professionals, and patients.
And… it’s not too late to register! You can even participate in some of the conference virtually. Click here for more information and to register.
I hope to see you in DC next week!
Until next week, this is Jeffrey saying, enjoy reading regs with your eggs!