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June 16, 2022

June 2022 Board Blog - AMA Elections, ACGME, Scope, Consolidation, & More

Gillian Schmitz, MD, FACEP
ACEP President

Summer is here! It has been a very busy past couple months and I wanted to fill you in on some of the updates over the past few weeks.

I just wrapped up a few days at the AMA meeting and am excited to announce that it was a great event for emergency medicine. Marilyn Heine, MD, was elected to the Board of Trustees of the AMA and Steve Epstein, MD, was re-elected to the Council on Medical Service. Emergency medicine is well positioned to have a strong voice in the House of Medicine and I am incredibly proud of our whole contingent serving on our ACEP-sponsored AMA delegation. The AMA House of Delegates is an important arm of the advocacy that ACEP does on your behalf, and one that can be easy to overlook. Our delegation does incredibly great work for us, and the House of Delegates adopted a resolution ACEP developed and introduced to strengthen due process protections for both employed and contracted physicians. This is huge! It means that the entire House of Medicine and the AMA’s significant resources will now be fighting to ensure due process protections for us at both the federal and state level, rather than us going at this alone. As well, we were able to add strong language to specifically exempt EMTALA-related care from federal requirements to consult appropriate use criteria when ordering advanced imaging in a resolution that was also adopted today.

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I also attended an event called “House Call on the Mall” in DC last week to meet with Republican and Democratic leaders and physicians in Congress to discuss our advocacy issues, including new protections for you on workplace violence similar to those working in the airline industry already are afforded under federal law, and reforming Medicare physician payment.

ACGME Standards

ACEP led the discussion with all of the EM groups to come up with some consensus on how we can raise the bar for EM residencies. That workgroup concluded their work last month and I'm proud to say we reached consensus and endorsement of ALL the EM organizations (not an easy task!). A paper is being drafted for publication and will be shared with the ACGME writing group. It is anticipated the ACGME residency requirements will take 18-24 months to develop and be finalized.

Scope of Practice

ACEP is leading a campaign on the value of EM residency training. We're collecting stories from EM physicians who used to be RNs, NPs or PAs to capture their stories about the difference in training and value of EM residency when working in an ED. We’re working to update our website to have a toolbox on all of our resources, fact sheets, and information that can be used by state chapters in their advocacy. I attended the AMA Scope of Practice Partnership meeting this week. Shout out to ACEP member John Bailitz for finding a paper written by a healthcare economist that found increased costs and decreased quality of care in the VA when NPs were providing care relative to emergency physicians. We are hoping this paper will be published soon to support our advocacy efforts.

Workforce Projections

There is a paper in the pipeline for Annals on workforce that found a slightly higher pre-COVID attrition rate for EM (5%) based on slightly different methodology from the report last year. It is also likely that attrition went up significantly during COVID and post-COVID. This is encouraging news as workforce projections may not as bad as we may have initially thought. All this to say that workforce projections are simply that...projections. They are based on a number of assumptions and variables that are apt to change. And that's a good thing as things are already changing.

Increasing Demand

ACEP is leading a Task Force on New EM Practice Models to expand demand outside the four walls of the hospital. This is phase I of a multi-phase approach to study how we can expand our practice across the spectrum of acute unscheduled care. ABEM recently announced a new fellowship track for EM in hospital administration and we're looking into additional potential fellowship pathways for the future. There has also been an application for Focused Practice Designation in Emergency Psychiatry submitted to ACGME by the American Association for Emergency Psychiatry. This is one more opportunity to expand the realm of emergency medicine for those physicians interested in that aspect of our work.

Consolidation in Health Care

This continues to be a major topic of discussion across all medical specialties. There are a number of resolutions being discussed at the AMA meeting that relate to protecting physician owned practices, but many acknowledge that consolidation is being driven by decreased reimbursement, market forces, and physicians selling their practices that, frankly, medical societies have limited control over. It has been estimated that there are currently less than 150 small physician-owned groups left in EM that have volumes over 30,000 patients/ year. With the looming impact of further Medicare cuts, unclear impact of out of network billing legislation, and coding changes for 2023 that may make it harder to get reimbursed for Level 5 charts, many are concerned that this will drive even further consolidation of small practices. While some emergency physicians feel that small physician groups may not be sustainable or viable in this reimbursement environment, ACEP will continue to do everything we can to support different practice environments for emergency physicians. ACEP provided testimony last month  to the inquiry by the Federal Trade Commission (FTC) on the impact of consolidation on physicians. We met with several of the larger EM groups to discuss feedback from our members on our survey on the impact of consolidation. We discussed due process, contract fairness standards, staffing concerns and our new PA/ NP supervision requirements. ACEP is hosting the Independent EM Group Master Class to help groups who wish to remain independent to remain viable. ACEP is working tirelessly to address the reimbursement issue by advocating against Medicare cuts, suing the government for their flawed implementation of the No Surprises Act, and pushing back on insurers to simplify and expedite the dispute resolution process. By improving accounts receivable, ACEP is fighting to keep small group practice viable.

Education and Meetings

ACEP held a Design Thinking meeting with academic and educational leaders to strategize how we can reimagine meetings for the future and continue to provide high quality education and social events for our members. Lots of exciting ideas were proposed and I look forward to seeing what will be incorporated by our education team.

Mourning the Loss of our Colleagues

In the wake of several mass shootings, we saw several more cases of physician homicide and suicide in the past couple weeks. I am truly at a loss of words and am still processing the loss of one of my close colleagues and friends. If anyone out there is suffering in silence, please know ACEP offers free counseling with mental health professionals and also peer to peer support. I know many of us are heartbroken by these recent events.

Reducing Firearm Violence

Please see our recent Board Blog post dedicated to ACEP’s efforts on reducing firearm violence.

I hope everyone is staying safe and healthy and off to a good summer. Summer is a great time to slow down, take some family vacations, and recharge our batteries. Wear your sunblock, be careful with those fireworks on July 4th, and please keep an eye out for each other. We continue to face some challenges, but I am encouraged and inspired with the progress we are making to support one another and the specialty as a whole.

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