• Popular Recommendations

  • PEER
  • ultrasound
  • LLSA
  • sepsis

ACEP Leadership Report

Our monthly Leadership Report is the best way to stay apprised of how ACEP leaders are working on your behalf to advance emergency medicine. We know the challenges our members face, and we are continually taking steps to protect your interests and make it easier for you to provide the highest quality care for your patients. Keep reading for the latest updates from the national office.

September 2019

ACEP Executive Director Announces 2020 Retirement
Dean Wilkerson, the executive director of ACEP for more than 15 years, announced on Sept. 3 that he plans to retire in 2020. “I’m grateful to have the opportunity to work with so many talented emergency physicians and dedicated staff to make progress in ACEP’s mission,” Wilkerson said in the press release. “Together, we have transformed the organization over the years and made a profound difference in the lives of millions of Americans seeking emergency care.” Read more about ACEP’s growth during Wilkerson’s tenure in an article recently published in ACEP Now.

Reimbursement Changes for Emergency Care of Veterans
The Veteran’s Emergency Care Fairness Act of 2009 provided payment for veterans enrolled in VA care who used a non-VA facility for emergency care, but an internal VA regulation blocked those payments. Recently, the U.S. Court of Appeals ruled that the Department of Veterans Affairs must reimburse for emergency care of veterans at non-VA facilities.
 
It’s important to identify veterans who are receiving care at a VA facility, plus those who would qualify for care if they enrolled. The eligibility rules are complicated, and the process is not always straightforward. Once enrolled, the veteran can receive many benefits, including pharmacy, home care and end-of life care. Many veterans use non-VA EDs because of distance or not knowing they are eligible for care. Now that the VA system has been ordered to reimburse EDs for this care, it may be reasonable to add questions about veteran status to your patient registration process and encourage identified veterans to check their eligibility with the VA.  

EM Physician’s Name Added to 9/11 Memorial Wall
Michael G. Guttenberg, MD, who passed away in October 2017 from pancreatic cancer attributed to his work as a first responder at 9/11 Ground Zero, was added to the FDNY World Trade Center Memorial Wall in Brooklyn during a ceremony Sept. 6, 2019.Despite his diagnosis, Dr. Guttenberg served as medical director of Northwell Health’s clinical preparedness and Center for EMS until days before his death.

ACEP Launches New Website for External Audience
ACEP has reimagined Emergency Care For Youto create a new, comprehensive external website. EmergencyPhysicians.org is as a one-stop-shop for the public to get the latest news, advocacy updates, and public health and safety tips directly from emergency physicians.
 
ACEP Urges Policymakers to Remove Obstacles to Treatment for Opioid Use Disorder
As the U.S. Department of Health and Human Services (HHS) compiles a report to Congress on treating opioid use disorder, ACEP urges policymakers to consider steps to remove obstacles to appropriate care in the ED, including removing the “X-waiver,” modifying the “three-day rule” and removing preauthorization requirements. Read the full comment letter.

Regulatory News: Patient Confidentiality for Substance Use Disorder
The U.S. Department on Health and Human Services (HHS) recently released the Substance Abuse and Mental Health Services Administration (SAMHSA) proposed reg to modify 42 CFR Part 2, which governs the confidentiality of patient records for the treatment of substance use disorder (SUD). One of the major policy debates around 42 CFR Part 2 has been whether this set of regulations should be modified to align more closely with HIPAA, and the proposed reg does not do so. Instead, SAMHSA proposes smaller modifications to 42 CFR Part 2 aimed at advancing care coordination for patients with SUD and clarifying existing policies for 42 CFR Part 2 treatment Programs (federally assisted alcohol or drug abuse programs) and other health care providers. Read more at on our weekly regulatory blog, Regs & Eggs

Breaking Down the AUC Program and its Emergency Exemption
You may have heard about the upcoming Medicare requirement to consult Appropriate Use Criteria (AUC) through approved clinical decision support mechanisms prior to ordering advanced imaging services. You may have even heard that you have to do this for all your Medicare patients in order to comply with federal regulations. Visit our EHR advocacy page to read how ACEP advocated for and received an exemption for individuals with emergency medical conditions and to download a sample letter to help explain this exemption to your hospital administrators. 

August 2019

#ACEPNation Hits Membership Milestone
Back in August 2011, ACEP hit the 30,000 member mark. In August 2019, we reached 40,000 members for the first time in our history. We’re so proud to stand beside you. Here’s to the next 50 years!

Medicare Payment Rule Adjusts Value of EM Services
The Centers for Medicare & Medicaid Services (CMS), the agency responsible for running Medicare and Medicaid, recently issued its proposed Medicare physician fee schedule for 2020. CMS included a proposal to revalue the ED Evaluation and Management Codes, the most commonly billed services for EM physicians.

As the only EM organization represented on the AMA Relative Value Scale Update Committee that develops values for physician service codes, ACEP advocated strongly for this revaluation. The RUC accepted our recommendations, and CMS is proposing to accept the RUC’s recommended values. If finalized, this revaluation would increase Medicare reimbursement for ED visit codes by approximately $137 million in 2020, when the policy becomes effective. The increased values would become the new standard for each year after that. View EM-specific highlights of the rule.

ACEP Shares Opioid Resources with FDA
The FDA is interested in the development of resources to reduce the use of opioids where alternatives exist, so ACEP shared its extensive opioid resources. Our two opioid-related point of care tools, MAP (managing acute pain) and BUPE (buprenorphine) are now available on our new app, emPOC, available through the Apple Store and Google Play.

Update on Firearm Violence Initiatives
In response to the mass shootings in July, ACEP President Vidor Friedman, MD, FACEP, provided the ACEP membership with an update on ACEP’s firearm safety initiatives that span the last several years. Several key pieces will be discussed or debuted at ACEP19 in Denver:

  • A resolution has been submitted to the Council for consideration that will be discussed at the Council Meeting Oct. 25-26.
  • The results of our Council Survey about a variety of policy positions related to gun injury prevention will be available by the Council Meeting.
  • Until Help Arrives, our training program designed to help EM physicians provide basic first responder training in their communities, will officially launch at ACEP19.
  • ACEP will host a preconference course on assessing threat and identifying patients at risk for causing harm entitled “Care Under Fire: EDs, Gun Violence and Threat Asssessment.

View all of ACEP’s active shooter resources, including policy statements, podcasts and more.

Working to Decrease Your Documentation Burden
In August, ACEP sent official comments to CMS related to its call for suggestions for how to reduce administrative burden for health care providers. On August 12, ACEP responded to a CMS request for information (RFI) on additional ways to reduce administrative burden through the “Patients over Paperwork” Initiative. In summary, we asked CMS to take the following actions:

  • Postpone the Appropriate Use Criteria (AUC) Program. Although we got a clarification to the exemption for emergency medical conditions, we need more time to educate our members and hospitals about when the exemption for is applicable.
  • Make electronic health records easier to use and increase the ability to receive and exchange information about our patients.
  • Require hospitals to share clinical data with clinical data registries to fulfill MIPS reporting requirements.
  • Simplify MIPS requirements for hospital-based clinicians.
  • Revise existing criteria for adding new codes to the list of approved telehealth services to make it easier to add emergency telehealth codes to this list.
  • Implement emergency medicine-specific alternative payment models (APM) and specifically adopt ACEP’s APM, the Acute Unscheduled Care Model.

Learn more about ACEP's work to reduce your administrative burden.

ACEP Hosts Health Care IT Summit
In July 2019, ACEP hosted thought-leaders from health IT for a one-day collaborative summit designed to foster important discussions about the future of healthcare IT in the acute care setting. More than 100 outside-the-box thinkers discussed both aspirational and immediately actionable ways to make healthcare IT more intuitive and functional for EM physicians and your patients.

The HIT Summit included prominent EM informatics experts and representatives from the CDC,  the ONC, the VHA, Cerner, Epic, and more, brainstorming about the future of care delivery and data sciences. What’s the ideal future state of healthcare IT, and how do we get there?  How does data acquisition, AI, data transparency, population health, quality initiatives, policy, advocay, predictive modelingand data-driven networks factor into future plans?

The work product of this summit will be summarized to serve as a guidebook for ACEP’s future planning, policy and advocacy related to administrative burden and EHR.

Longevity & Tenure Awards
ACEP's Careers in EM section has announced its 2019 award winners. Longevity Awards went to Kenneth T. Larsen, Jr., MD, FACEP, who has been practicing EM for 46 years, and George Edward Malcom, Jr., MD, FACEP, who has been practicing for 44 years. The 2019 Tenure Award winner is Kashmir Singh, MD, FACEP, for 30 consecutive years in the ED. 

 

July 2019

June Board Meeting Addresses Key Issues
ACEP’s Board of Directors convened June 26-27, approving ACEP’s FY2019-20 budget and discussing several topics related to policy and practice. Among their decisions, they approved the following new or revised policy statements:

The Board also reaffirmed the Disaster Medical Response policy statement and the Point of Care Utrasonography by Pediatric Emergency Medicine Physicians policy statement and its associated technical report that was developed jointly with the American Academy of Pediatrics, SAEM, and the World Interactive Network Focused on Critical Ultrasound.
 
The following items were also approved during the June meeting:

  • New clinical policy: Critical Issues in the Evaluation and Management of Adult Patients Presenting to the ED with Acute Headache
  • Governance Charter for the ED Pain and Addiction Management Accreditation Program
  • Revised criteria for the ED Pain and Addiction Management Accreditation Program
  • Taking no further action on Resolution 20(18) Verification of Training – the Emergency Medicine Practice Committee reviewed the resolution and staff compiled information on standardized methods for verification of training. A standardized form for verification of training was developed by the National Association of Medical Staff Services. This information will be posted on ACEP’s website.
  • 2019 Compendium of ACEP Policy ACEP Policy Statements on Ethical Issues.
  • Revised Procedures for Addressing Charges of Ethical Violations and Other Misconduct. The revised procedures must be approved by the Council. The Board approved cosponsoring a College Manual resolution that will be submitted to the 2019 Council for consideration.
  • Taking no further action on Referred Resolution 35(18) ACEP Policy Related to Immigration. The resolution is addressed by ACEP’s policy statement “Delivery of Care to Undocumented Persons.” In December 2018 ACEP sent a letter to the Department of Homeland Security expressing objection to the proposed rule that would change the definition of public charge. Policies already exist throughout the health care community to protect patient information, unless disclosure is required by law, and creating additional policy specific to providing information to immigration authorities would essentially be superfluous.
  • Taking no further action on Referred Resolution 42(18) Expert Witness Testimony for the Specialty of Emergency Medicine. The resolution requested that ACEP revise the “Expert Witness Guidelines for the Specialty of Emergency Medicine”’ policy statement to define an expert witness as a person actively engaged in the practice of medicine during the year prior to the initiation of litigation who has the same level or greater training in the same field as the subject of the tort for a majority of their professional time. Theone-year requirement would eliminate many qualified experts who recently retired from practice. The requirement would also apply to defense experts, which could have the unintended consequence of limiting the number of qualified experts available to defend emergency physicians.
  • Not seeking access to malpractice data from the National Practitioner Data Bank directly but review relevant aggregate NPDB data that may be made available. This information will be used to explore opportunities to develop educational materials that may reduce medical errors and improve patient safety.
  • 2018 Section Grant projects for funding (five grants awarded)
  • Formation of the Aerospace Medicine Section
  • Disseminating the MITIGATE Antimicrobial Stewardship Toolkit
  • Referred the revised policy statement “Firearm Safety and Injury Prevention” back to the Public Health & Injury Prevention Committee for additional revisions
  • Petitioning the Office of Coverage and Analysis Group at CMS to reconsider the addition of the ED as a place of service for Hepatitis C testing (in response to Referred Resolution 41(17) Reimbursement for Hepatitis C Virus Testing in the ED)
  • Expert Witness Testimony Model State Legislation
  • Endorsing the American College of Medical Toxicology’s “ACMT Position Statement Recommending Removing the Waiver Requirement for Prescribing Buprenorphine for Opioid Use Disorder”
  • Distributing a survey to the membership regarding The Joint Commission regulations
  • Further assessment of the Broselow Blue Code product for potential endorsement consideration
  • Revised Clinical Ultrasound Accreditation Program Governance Charter
  • Distributing a survey to the Council on firearms research, safety, and policy
  • Revised Geriatric ED Accreditation Program Criteria
  • Supporting the preliminary 2019-20 committee objectives
  • Completing the work already in process to review membership data and developing a report to the Board

ACEP Hosts Health Care IT Summit
ACEP recently hosted thought-leaders from health IT for a one-day collaborative summit designed to foster important discussions about the future of healthcare IT in the acute care setting. More than 100 outside-the-box thinkers discussed both aspirational and immediately actionable ways to make healthcare IT more intuitive and functional for EM physicians and your patients.

The HIT Summit included prominent EM informatics experts and representatives from the CDC,  the ONC, the VHA, Cerner, Epic, and more, brainstorming about the future of care delivery and data sciences. What’s the ideal future state of healthcare IT, and how do we get there?  How does data acquisition, AI, data transparency, population health, quality initiatives, policy, advocay, predictive modelingand data-driven networks factor into future plans?

The work product of this summit will be summarized to serve as a guidebook for ACEP’s future planning, policy and advocacy related to administrative burden and EHR.

Surprise Billing Toolkit Updated
Work continues on surprise billing, and our advocacy team has updated its Member Advocacy Toolkit in response to the changing environment. You must be logged in as an ACEP member to view this resource

Teaching Award Winners Announced
Congratulations to the winners of the 2019 teaching awards, who will be honored during ACEP19 in Denver!

ACEP4U

Whether your needs are big or small, your ACEP staff is here to help. Need our assistance? Contact our membership team.

August 2019 Highlights

Our Finance, IT and Quality departments worked together to solve invoice issues for CEDR customers, greatly reducing the timeframe for invoice generation, adding helpful invoice information and offering real time GP reports to improve CEDR customer service. 

Our Reimbursement team led the group of EM physicians and staff that convinced the AMA’s RUC to increase the values of ED/EM codes. If finalized, this revaluation would increase Medicare reimbursement for ED visit codes by approximately $137 million in 2020, when the policy becomes effective.

The IT department added the Mx. Prefix to ACEP user account creation to promote inclusivity, and he created a searchable council resolution archive.

Our Grants team developed clinical measure workflows for EMS Compass measures that will help end users query in the correct and logical order to properly calculate the measures. They also spearheaded a funding proposal to develop stroke and sepsis measures.

Our Quality department attended a CMS conference and was awarded a challenge coin on behalf ACEP for the success of the E-QUAL program.

The Regulatory and Reimbursement teams worked together to write EM-specific summaries of the Medicare Physician Fee Schedule proposed rule to make it easier for members to catch up on the latest developments and better understand how this rule affects them.

Our Geriatric Accreditation department started discussions with both the Institute for Healthcare Improvement (IHI,) and the American College of Surgeon’s new Geriatric Surgery Verification (GSV) program to begin building conceptual agreements for both GEDA/IHI and GEDA/GSV programs to work together to get the word out about increasing the standard of care in the ED for our nations seniors. Our goal is to make it easy for EDs and health systems/hospitals to access useful and relevant program information about serving older patients and families no matter which program they learn about first.

The Educational Products team is working on a new performance improvement (PI) pathway and educational module about opioids for our eCME platform. It’s a 20 question assessment of the user’s treatment of opioid use disorder so they can identify gaps between their treatment and current best practices.

LIVE CHAT
[ Feedback → ]