|From:||Colin C. Rorrie, Jr., PhD, CAE
|Date:||August 25, 2003|
|Subj:||Action on 2000 Resolutions|
This report summarizes the actions taken by the Board of Directors on the 25 resolutions adopted by the 2000 Council and the six resolutions that were referred to the Board.
Resolution 4 Finance Committee
The resolution amended the Bylaws to eliminate the vice president and vice speaker as members of the Finance Committee and to allow the president-elect and the speaker to appoint a designee to participate in their absence. The Bylaws were revised in October 2000.
Resolution 5 Retired Membership
The resolution amended the Bylaws to include a retired membership category and also amended the College Manual to include the specifications for retired membership and the related processes. The Bylaws and the College Manual were revised in October 2000. The Board approved the amount for retired dues at their September 2000 meeting, pending approval of the resolution by the Council. Chapters were notified of the new retired category and were encouraged to also consider creating a retired category for chapter dues.
Resolution 8 Prudent Parent
RESOLVED, That ACEP continue to support prudent layperson legislation, reinforcing the concept that the prudent layperson definition applies to all patients including the parents/guardians of children 18 years of age or younger; and be it further
RESOLVED, That ACEP continue to support legislation for universal healthcare coverage.
The resolution was assigned to the Federal Government Affairs Committee. The intent of the resolution was met through ongoing initiatives. The Federal Government Affairs Committee also worked with the State Legislative/Regulatory Committee to identify issues and develop strategies regarding implementation of the prudent layperson standard. The State Legislative/Regulatory Committee assisted chapters in planning, developing and implementing solutions to health care safety net issues, including prudent layperson enforcement, through state legislative and regulatory action. A report was developed that summarized problems arising from delay of payment or non-payment, use of emergency department approved lists, downcoding, and prior authorization. Many of these issues are ongoing problems that ACEP continues to monitor. Thirty-two states and the District of Columbia have enacted state prudent layperson laws. Arizona, California, Florida, and Michigan have statutes that are very similar to prudent layperson.
Resolution 9 Medicare Participating Agreement
RESOLVED, That ACEP develop a strategy that includes incentives and sanctions to encourage each hospital and medical staff to provide an ED on-call panel that reasonably reflects the capabilities of the hospital; and be it further
RESOLVED, That the Board report back at the 2001 Leadership/Legislative Issues Conference.
The resolution was assigned to the Emergency Medicine Practice Committee. A report was developed and distributed at the 2001 Leadership/ Legislative Issues Conference. The report was included in the 2001 Council notebook.
Resolution 13 Communities at Risk - ED Closures
RESOLVED, That ACEP will develop a strategy to monitor the effects of emergency department closures on communities.
The State Legislative/Regulatory Committee was assigned an objective to explore the need to develop a policy regarding ED closures and downsizing. The committee conducted a 50-state survey of chapters to assess the scope of the crowding and diversion problem. The results of the survey indicated that ED crowding was a problem in over 85 percent of the states surveyed and that most expect the crowding and diversion problems to increase. James Mitchiner, MD, FACEP, chair of the State Legislative/Regulatory Committee and a member of the American Public Health Association, submitted a resolution to the 2001 American Public Health Association meeting. The resolution, "Hospital Emergency Department Closures," was adopted by the APHA.
Resolution 15 EMTALA
RESOLVED, That ACEP work with appropriate organizations and agencies to improve EMTALA for emergency departments; and be it further
RESOLVED, That the Board report back to the members regarding progress on these endeavors at the 2001 Leadership/Legislative Issues Conference.
The resolution was assigned to the Federal Government Affairs Committee. A report was developed and distributed at the 2001 Leadership/Legislative Issues Conference. The report was included in the 2001 Council notebook.
Resolution 16 Support of the National Commission on Correctional Health Care
RESOLVED, That the American College of Emergency Physicians continue to support the liaison relationship with the National Commission on Correctional Health Care (NCCHC).
The liaison representative to the NCCHC was reappointed and was notified of the Board's adoption of the resolution.
Resolution 17 Federal Government Enforcement Activities in the Area of Medicare and Medicaid Billing Fraud and Abuse
RESOLVED, That the Board of Directors immediately form a task force to study the past, present, and potential future damage done by the fines, penalties and litigation that is a product of the federal medical billing fraud and abuse investigations and prosecutions; and be it further
RESOLVED, That the task force study federal investigative methods and the problems of medical billing compliance with an extraordinary burden of regulations, to determine whether the federal program is overlooking or ignoring mitigating factors; and be it further
RESOLVED, That the investigations and findings of the task force be completed within six months for review by the Board so that strategies might be developed to respond to this regulatory threat and protect the innocent as well as facilitate the discovery and proper proportionate punishment of real fraud.
A Fraud and Abuse Task Force was appointed to work on the issues identified in the resolution. The task force's report was provided to the Board of Directors in June 2001 and to the Council in the 2001 Council notebook. The issues identified in the report continue to be monitored with action taken as appropriate.
Resolution 19 ACLS and Similar Courses for Credentialing Emergency Physicians
RESOLVED, That ACEP open dialogue with the American Hospital Association, third party payers, and accreditation entities regarding the inappropriate use of ACLS and similar courses for credentialing of board certified emergency physicians.
The issue continues to be discussed with the American Hospital Association and the Joint Commission on Accreditation of Healthcare Organizations and ACEP policies are cited.
Resolution 20 Due Process in Contracts Between Physicians and Hospitals, Health Systems, and Contract Groups
RESOLVED, That ACEP endorse the right to have due process provisions in contracts between physicians and hospitals, health systems, health plans and contract groups.
The resolution was assigned to the Emergency Medicine Practice Committee to review and update the current policy statement. The committee recommended to the Board that current ACEP policies (Emergency Physician Rights and Responsibilities, Emergency Physician Contractual Relationships, and the Fairness Issues and Due Process Considerations in Various EP Relationships information paper) adequately address due process issues related to emergency medicine and a new policy was not necessary. The Board adopted the committee's recommendation.
Resolution 21 Peer Review and the Mandatory Federal Reporting of Errors
RESOLVED, That the American College of Emergency Physicians support the initiative that the individual healthcare professionals be afforded full disclosure of all peer review information and other out-of-hospital, hospital and third party payer information that is related to their individual practices subject to peer reviewer confidentiality; and be it further
RESOLVED, That ACEP believes that any and all information discovered or provided during the peer review process shall be privileged and confidential and shall not be discoverable in any legal action against a healthcare professional; and be it further
RESOLVED, That ACEP provide guidance in creating an enforceable mechanism of confidential error reporting.
The resolution was assigned to the Patient Safety Task Force. The task force developed the policy statement, "Reporting of Medical Errors," that was approved by the Board at their September 10-11, 2001 meeting. The Board endorsed the AMA's "General Principles for Patient Safety Reporting Systems" at their February 2001 meeting.
Resolution 24 Inpatient Restraint and Seclusion Orders
RESOLVED, That the American College of Emergency Physicians (ACEP) create a policy statement which opposes any requirement by hospital representatives or medical staffs that emergency physicians provide inpatient restraint or seclusion orders; and be it further
RESOLVED, That ACEP work to obtain the endorsement of this policy by the American Medical Association (AMA).
The resolution was assigned to the Emergency Medicine Practice Committee. The Board adopted a revised policy statement at their April 1-2, 2001 meeting. ACEP submitted the resolution at the AMA's June 2001 meeting; however, the ACEP resolution failed and the AMA House of Delegates passed a different patient restraint resolution.
Resolution 26 Leadership Challenge
RESOLVED, That ACEP will formally study and evaluate its leadership development process and leadership requirements in consideration of changing emergency physician practices and demographics; and be it further RESOLVED, That the Board of Directors will report back to the Council in one year with a report of that effort and recommendations for consideration based upon that assessment.
The resolution was assigned to the Board Nominating Committee. Since 1998 the committee has collected information provided by potential Board candidates regarding their reasons for not pursuing a nomination. The reasons most often cited included concerns about the amount of time required to serve on the board of directors, family considerations, and work considerations. The committee agreed that these reasons could be extrapolated to other leadership activities as well, such as committee chair responsibilities and section leadership. Additional barriers identified by the committee included the lack of compensation for Board service and other professional competing commitments, such as not having the support of a residency program chair or group members. Effective July 1, 2002 non-officer board members began receiving an annual stipend of $7,500. The amount of time required to perform Board duties was also discussed and the committee agreed that the Board should continue to consider whether certain duties, such as residency and chapter visits, should be extended to non-Board members. The committee also reviewed current leadership development activities and did not recommend any changes. These issues continue to be discussed each year by the Board Nominating Committee.
Resolution 27 Future Policy Leaders in Emergency Medicine
RESOLVED, That the American College of Emergency Physicians develop a financial mechanism to support residents to attend the legislative and leadership meeting; and be it further
RESOLVED, That the American College of Emergency Physicians explore partnerships in developing a specific leadership program for future leaders.
A budget modification was approved to provide a grant to EMRA to fund a travel stipend for four or more residents to attend the 2001 Leadership/Legislative Issues Conference. The resolution was also referred to the Grants and Development staff for exploration of potential partnerships and funding of additional initiatives. Travel stipends were also made available for the 2002 Leadership/Legislative Issues Conference as well as the upcoming 2003 conference.
Resolution 30 Commendation for Douglas M. Hill, DO, FACEP
A framed resolution was presented to Dr. Hill.
Resolution 31 Commendation for Donald Barry Kunkel, MD, FACEP
A framed resolution was mailed to Dr. Kunkel's family.
Resolution 32 Commendation for John C. Moorhead, MD, FACEP
A framed resolution was presented to Dr. Moorhead.
Resolution 33 Commendation for Michael T. Rapp, MD, FACEP
A framed resolution was presented to Dr. Rapp.
Resolution 34 Hospital Closures
RESOLVED, That the American College of Emergency Physicians develop guidelines for appropriate care and disposition of patients when a hospital's inpatient services close and an emergency care area remains open without full support services.
The resolution was considered as an additional objective for the Emergency Medicine Practice Committee for FY 01-02, however the objective was not assigned to the committee in consideration of other priority initiatives. The policy statement "Boarding of Admitted and Intensive Care Patients in the Emergency Department" was adopted by the Board at their October 20, 2000 meeting. The policy statement directly addresses the issue. It has also been discussed with the American Hospital Association and the Joint Commission on Accreditation of Healthcare Organizations. In June and December 2002 the JCAHO held roundtable discussions on the issue of ED crowding. ACEP was invited to participate in those discussions, which identified some of the major contributing factors to ED overcrowding. In February 2003 the JCAHO announced that proposed hospital leadership standards addressing ED overcrowding would be out for review. The standards establish expectations for hospitals regarding preparations for managing increased patient volume. In late February 2003 a JCAHO subsidiary convened a national symposium, "Condition Critical: Meeting the Challenge of ED Overcrowding" in Boston. More than 400 health care leaders from across the country attended, seeking solutions to the growing crisis. The initiatives by JCAHO are in large measure due to ACEP's work in bringing ED crowding to their attention. In April 2003 Dr. Molzen approved a public education communication on emergency department crowding to be distributed in ED waiting rooms. The document answered commonly asked questions from consumers about the causes of crowding and directs patients and family members to contact their legislators about the problem.
Resolution 36 Collective Bargaining
RESOLVED, That the American College of Emergency Physicians believes that medical professionals who choose to use collective bargaining should never use collective action that could delay or deny patients access to timely, quality emergency care; and be it further resolved
RESOLVED, That the American College of Emergency Physicians Board of Directors be directed to develop guidelines for the responsible and ethical use of professional collective bargaining.
The first resolved is a policy statement and was added to the Policy Compendium. The resolution was also assigned to the Emergency Medicine Practice Department staff for review and collection of information from the AMA. ACEP's 1997 policy "Guidelines Concerning Work Stoppages and Slowdowns" was reviewed by the Ethics Committee and the Emergency Medicine Practice Committee. The policy was combined with the policy statement of Resolution 36(00) into a new policy "Collective Bargaining, Work Stoppages, and Slowdowns" and was adopted by the Board in April 2002.
Resolution 37 Chapter Membership Database
RESOLVED, That ACEP chapters have access to their state membership database to conduct chapter business; and be it further
RESOLVED, That ACEP work with chapters to improve membership database access and chapter service concerns; and be it further
RESOLVED, That ACEP and chapters collaborate to improve membership database content and quality.
The resolution was assigned to the Member Services Department and the Chapter and State Relations Department to work with the chapters as needed. Chapters now have access to their state membership databases. Joint membership recruitment and retention activities are conducted between national ACEP and the chapters.
Resolution 38 Professional Staffing
RESOLVED, That ACEP investigate with appropriate entities such as the Emergency Nurses Association, American Hospital Association, and American Nurses Association, optimal emergency department professional staffing models currently in existence; and be it further
RESOLVED, That ACEP publish and distribute to the membership in a timely, and ongoing manner, its findings; and be it further
RESOLVED, That ACEP develop specific recommendations as to how hospitals and the various professions involved should address the workforce needs that exist and that are anticipated in the future in order to ensure continued access to quality emergency care; and be it further
RESOLVED, That a resolution be submitted to the American Medical Association House of Delegates to investigate hospital-wide professional staffing shortages.
The resolution was considered as an objective for FY 01-02 for the Emergency Medicine Practice Committee and the Medical-Legal Committee. After consideration of the numerous initiatives being undertaken concerning staffing issues, and ACEP's involvement with many of these organizations, additional work on this issue was not assigned. The AMA Section Council on Emergency Medicine determined that a resolution should not be submitted to the AMA because of the work already prepared by the AMA Council on Medical Services. Reports and studies on the nursing shortage issue have been developed by various organizations including the US General Accounting Office, US Department of Health and Human Services Health Resources and Services Administration (HRSA), Congressional Research Service, American Medical Association, American Nurses Association, and Emergency Nurses Association.
Resolution 39 Commendation for Richard C. Wuerz, MD, FACEP
A framed resolution was mailed to Dr. Wuerz's family.
Resolution 40 Ambulance Diversion
RESOLVED, That ACEP ask appropriate professional organizations and agencies to develop a data collection system to monitor emergency department patient overload and ambulance diversion; and be it further
RESOLVED, That ACEP develop a plan, including best practice guidelines, to help individual emergency departments to respond to the crisis within their own hospital; and be it further
RESOLVED, That ACEP seek short and long term solutions through partnering and coalition building with appropriate organizations; and be it further
RESOLVED, That ACEP consider the development of an effective communications plan to the public explaining that emergency department patient overload occurs when the demands on the health care system exceeds its capability and capacity, and how this impacts the individual and public health, and recommend solutions.
The Task Force on Health Care and the Uninsured developed a report that was distributed at the 2001 Leadership/Legislative Issues Conference. The report was included in the 2001 Council notebook.
Resolution 42 Crisis at the Cartside
RESOLVED, That with respect to the allocation of financial, leadership, and staff resources, ACEP will give high priority to supporting emergency departments' ability to function in the face of growing health care safety net demands; and be it further
RESOLVED, That ACEP will develop a comprehensive intra-organizational plan of action to define and address the serious threats to the health care safety net; especially those that adversely affect the ability of emergency physicians to provide quality emergency care; and be it further
RESOLVED, That ACEP will present its findings and strategies for action at the next Legislative and Leadership meeting.
The Task Force on Health Care and the Uninsured developed a report that was distributed at the 2001 Leadership/Legislative Issues Conference. The report was included in the 2001 Council notebook.
Resolution 2 Honorary International Member
RESOLVED, That the ACEP Bylaws be amended to create an Honorary International Member; and be it further
RESOLVED, That a benefit of Honorary International Membership include a waiver of tuition for the ACEP Scientific Assembly and Winter Symposium; and be it further
RESOLVED, That ACEP automatically confer Honorary International Membership for the term of office of the president of any International Federation of Emergency Medicine (IFEM) full or affiliate member organization.
The resolution was assigned to the Bylaws Committee. The committee determined that the Bylaws currently allow for honorary membership status to be conferred on a temporary basis (such as for the term of the office of president) and that a Bylaws amendment was not required. At their June 13-14, 2001 meeting the Board approved granting honorary membership to the presidents of the International Federation of Emergency Medicine upon their election to office for the term of their presidency. Recognition activities have been incorporated into Scientific Assembly planning.
Resolution 10 Health Care Financing Administration
RESOLVED, That ACEP work with the federal government to modify the claims forms used for Medicare, Medicaid, and FEHBP beneficiaries in order to capture presenting signs and symptoms data.
The resolution was referred to the Public Affairs and Reimbursement staff to provide a report on the feasibility of success and analyze whether resources should be devoted to this effort. Relevant committees also provided input for the report. The Board accepted the report at their June 13-14, 2001 meeting and it was included in the 2001 Council notebook.
Resolution 11 Funding the Mandate
RESOLVED, That National ACEP work with state chapters to provide and promote model legislation to establish an emergency medical services (EMS) fund in each state whose purpose shall be to provide appropriate reimbursement for emergency care provided by emergency physicians and on-call specialists to the uninsured; and be it further RESOLVED, That National ACEP work with state chapters to promote the funding of emergency care through a variety of mechanisms including, but not limited to, tobacco settlement money, and tax subsidies; and be it further
RESOLVED, That National ACEP work with federal HCFA representatives to encourage health plans that contract with Medicare and Medicaid to fulfill their financial obligations by appropriately reimbursing emergency and on-call physicians for emergency care provided; and be it further
RESOLVED, That National ACEP create a task force to explore alternative funding sources for emergency care including the establishing of regional case rates and the creation of a public utility model for the delivery of emergency care and to report back to the Council of their progress at the 2001 Council meeting.
The resolution was assigned to the EMS Committee, Reimbursement Committee, Federal Government Affairs Committee, and the State Legislative/Regulatory Committee. ACEP has addressed the resolution through ongoing legislative and regulatory activities, both nationally and at the state level. The committees continue to work on the issues identified in the resolution.
Resolution 14 Childhood Firearm Injuries
RESOLVED, That National ACEP support legislation mandating that all new guns sold in the United States must be equipped with safety locks; and be it further
RESOLVED, That National ACEP supports legislation that holds the adult owner of a gun that accidentally injures a child legally responsible for carelessness that results in child access to firearms.
The resolution was assigned to the Violence Prevention Committee to consider as they reviewed all of the College's policies related to firearms. The Board adopted the comprehensive policy statement "Firearm Injury Prevention" at their February 2001 meeting. The ten previously adopted firearm policies were rescinded.
Resolution 23 Medical Legal Expert Opinion Peer Review
RESOLVED, That ACEP should establish an independent peer review committee for expert medical legal testimony, based on referral by members, for expert opinions which appear to be outside the realm of reasonable practice standards of guidelines, and that this review consist of a peer review opinion of emergency medicine experts, not intended for use during the active legal case, but available for review, by member request, in preparation for future testimony by that expert.
The resolution was considered as a Medical-Legal Committee objective for FY 01-02. Due to other priority initiatives for the committee in FY 01-02 an objective was not assigned. "The Principles of Ethics for Emergency Physicians" addresses the issue of questionable expert testimony. The policy statement "Expert Witness Guidelines for the Specialty of Emergency Medicine" sets forth the criteria for expert witness testimony. In September 2002 the Board adopted a new policy statement, "Board Member and Council Officer Expert Testimony." Additionally, articles highlighting ACEP's expert witness guidelines have appeared in ACEP News and EM Today Digital. The Medical-Legal Committee considered various options for collecting and maintaining a database of expert witness testimony but concluded that the resources required by such an endeavor and the potential liability to ACEP did not make it feasible. ACEP's Practice Management Department provides a number of educational resources to members and their attorneys regarding expert witness testimony and standards of care including articles, guidelines, and advice. ACEP's Clinical Policies are extremely well respected by the courts and set the standard of care in a number of areas. ACEP's State Legislative and Regulatory Office maintains information on professional liability issues in various states and is available to assist the efforts of chapters on this issue. An option to explore at the state level is initiating legislation that requires expert witnesses to be licensed in the state in which they provide testimony. This law exists in Florida and other states and prohibits "hired guns" being flown in from other states that are not familiar with the local practice environment and are not subject to the jurisdiction of the state licensing board. In January 2002 a work group was appointed to investigate the affordability and availability of professional liability coverage and to make recommendations to the Board on the next step(s) that should be taken. In February 2002 ACEP filed an amicus brief in an appeal of a Louisiana case in which an expert witness was qualified by the court but did not qualify under ACEP's guidelines. In April 2002 the work group presented a completed survey on professional liability insurance affordability and availability and their recommendations to the Board. Based on the work group's recommendations, a Professional Liability Task Force was appointed to address issues in the areas of tort reform, expert witness, and patient safety. Their recommendations were presented to the Board on October 3, 2002. The Board accepted the task force recommendations, including the continuation of the task force for the next year. In February 2003 the task force presented a preliminary report to the Board and sought guidance on recommendations that should be implemented immediately and those that warrant further development. The task force is also exploring the development of an expert witness deposition repository. A recommendation is expected for the September or October 2003 Board meeting.
Resolution 41 Emergency Department Safety Net in Peril
RESOLVED, That ACEP send the following two resolved clauses along with the aforementioned whereas clauses to the AMA interim meeting in the form of a resolution:
"RESOLVED, That the AMA recognize the impending crisis facing the emergency departments' function as the health care safety net; and be it further
RESOLVED, That the AMA study and report back on the factors that have resulted in this overwhelming demand on emergency services and the impact the collapse of this safety net would have on the health delivery system."
The Board discussed the resolution at their February 2001 meeting and reviewed current efforts in addressing the issues related in the resolution, including the work of the Task Force on Health Care and the Uninsured. The Board agreed that they did not want another organization to work on the issue for ACEP and that the task force should continue its work. Emergency medicine as an essential public service continues to be advocated by ACEP. In March 2003 the Institute of Medicine (IOM) announced its intent to conduct a study on the Future of Emergency Care in the United States Health System. In July 2003 the ACEP Board of Directors allocated funds to publish and distribute the IOM report, which is anticipated to be available in about 18 months.