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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.

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!

 

June 2019

New POC App is Transforming Bedside Care
ACEP worked with top experts in the field to develop emPOC, our new point of care app that provides clinical content and tools for EM physicians. Get five bedside tools in one app: AFIB (atrial fibrillation & flutter), BUPE (Buprenorphine use in the ED), ADEPT (agitation in the elderly), MAP (management of acute pain) and iCar2e (suicide assessment). This app was designed by EM physicians, for EM physicians, to provide helpful clinical tools in a native app for those who don’t have wifi access in their emergency departments. If you’re an ACEP member, you can get this free app on iTunes and Google Play.

Surprise Billing: ACEP President Testifies to Congress, New Toolkit Available
On June 13, ACEP President Vidor Friedman, MD, FACEP, testified on behalf of EM physicians in front of the House Energy and Commerce Health Subcommittee.“In a medical emergency, getting treatment as soon as possible is the number one priority—not verifying which providers are in-network, figuring out how much your deductible is, or worrying how much treatment will cost,” Dr. Friedman said. He explained how EMTALA affects emergency physicians and discussed ACEP’s proposed framework for out-of-network billing solutions. His full testimony can be found in the ACEP newsroom

For nearly a year, ACEP has been doing everything it can to advocate on behalf of emergency physicians and our patients on this rapidly-changing situation. Now that administrative and congressional attention to the issue is intensifying, we need you to raise your voice and help us advocate for the field. Our new toolkit provides messaging guidance and other resources to help promote ACEP’s advocacy position. Thank you for all you to do to fight for the millions of emergency patients who count on us every day. View the toolkit – only available to ACEP members.

Use Your Voice: Submit Council Resolutions for ACEP19
Did you know you can influence the ACEP agenda? It only takes two members to submit a Council resolution as part of ACEP’s democratic decision-making process. Submit your resolution by July 27, and the Council will vote during its annual two-day meeting in conjunction with ACEP’s Scientific Assembly. The Board of Directors will also vote on the resolutions. Learn more about the process and submit your resolution.

Holliman Honored with Lifetime Achievement Award
Jim Holliman, MD, FACEP, was honored with the Guata Bodiwala Lifetime Achievement Award at the 2019 International Federation for Emergency Medicine conference in Seoul. This is IFEM’s highest honor, recognizing an individual who has demonstrated an extraordinary commitment to both IFEM and the specialty of emergency medicine in his/her home country.

Holliman has devoted his career to the international development of EM, including past service as IFEM’s president. In 1994, he founded the Center for International Medicine at Penn State University’s Hershey Medical Center, which operated a fellowship program to train future international leaders for EM. In 2008 he became a professor of military and emergency medicine with the Uniformed Services University of Health Sciences, where he was deployed to Iraq and Afghanistan to develop an emergency health care system and to train first responders.

New Blog Updates You on Federal Regulations Affecting EM
New resource alert! ACEP members can now get quick summaries of ACEP’s ongoing regulatory work through Regs & Eggs, a blog written by ACEP’s Director of Regulatory Affairs, Jeffrey Davis. Davis will provides a heads-up about new proposed or final regulations, demonstrations, grant opportunities, or other announcements from federal agencies, like CMS or the VA. As we fight against burdensome new requirements, we’ll be asking for member input to help us alleviate administrative burden for emergency physicians. Read the blog

 

 

May 2019

LAC Attendees Advocate for Mental Health Care Access, Surprise Billing Framework
More than 550 emergency physicians from 47 states conducted 350 meetings with federal legislators and staff on Capitol Hill on Tuesday, May 7 during the ACEP 2019 Leadership and Advocacy Conference in Washington, DC. Attendees had the opportunity to educate and present solutions directly to legislators and their staff on hot-button issues like surprise billing and psychiatric patient boarding in the ED. 

ACEP to Host Event with Key Health IT Stakeholders
ACEP is hosting the HIT Summit July 8 to bring the industry together to build a collaborative 10-year vision for emergency care through digital transformation. Stakeholders from diverse groups have been invited to participate, including physicians, hospitals, societies, research, academia, IT vendors, EHR vendors, government, quality, standards, consultants and payors. This collaborative vision aims to address some of the biggest issues facing technology in health care, including interoperability and data liquidity, HER usability and workflow, big data and what it means in emergency medicine. Look for a recap of the event in an upcoming edition of ACEP Now.

ACEP Meets with SAMHSA Leadership
On May 15, ACEP met with Dr. Elinore McCance-Katz, who leads the Substance Abuse and Mental Health Services Administration (SAMHSA) at the U.S Department of Health and Human Services (HHS). We discussed issues important to emergency physicians and our patients, including the ability to administer buprenorphine in the ED for patients with opioid use disorder and how to improve care for patients with mental health illnesses. ACEP mentioned the resources and tools we have created to help our physicians and patients, highlighting the EM-specific Drug Addiction Treatment Act (DATA 2000)/Medications for Addiction Treatment waiver training course that is now being offered to our members, as well as new web-based and mobile device applications around opioids and the management and treatment of suicidal patients. One of SAMHSA’s major goals is to boost community resources available to help clinicians across specialties treat patients with substance abuse disorders and mental illnesses. We expressed our commitment to helping SAMHSA achieve the goal and identified opportunities to work together going forward.

Opposing Medical Merit Badges
As part of the Coalition Opposed to Medical Merit Badges, ACEP continues to work at a state level on reducing/eliminating the need to take merit badge courses.

Grant to Fund Accreditation of 20 VA Facilities as Geriatric EDs
With a grant from the John A. Hartford Foundation and West Health, ACEP is offering to accredit 20 VA facilities as geriatric EDs at no cost. ACEP’s Geriatric ED Accreditation Program was developed by leaders in EM to ensure our older patients receive well-coordinated, quality care at the appropriate level at every ED encounter. 

Addressing Protected Faculty Time with the ACGME
As one of its sponsoring bodies, ACEP leaders attended the ACGME Review Committee Meeting. The meeting featured considerable discussion about the proposed removal of protected time for faculty to teach, which continues to be a major issue for faculty at EM residency programs.

ACEP Meets with OSHA to Expand Protections from ED Violence
This week, ACEP held a meeting with the Occupational Safety and Health Administration (OSHA) in order to discuss strengthening protections for healthcare workers, especially those in the ED, from workplace violence. Currently, no such federal regulation exists, but OSHA has begun to explore its development. ACEP has long advocated for such protections; most recently, ACEP drew attention to the issue by releasing results of a survey it held that reported nearly half of emergency physicians polled had been physically assaulted, with more than 60 percent occurring in the past year. ACEP worked with Congressional offices to refine H.R. 1309, The Workplace Violence Prevention for Health Care and Social Service Workers Act, and last recently sent a letter of support asking Congress to consider how EDs in particular are staffed to ensure the important provisions of this legislation are implemented appropriately. Read more.

 

April 2019

Want to catch up fast? Here's the latest edition of ACEP's Capital Minute: 

Board of Directors Considers Influenza, Firearm Safety Research, Protected Time and More During April Meeting
ACEP’s Board of Directors convened April 10-11 and discussed several issues related to clinical topics and practice trends. Among their decisions, they voted in favor of:

  • Surveying the Council for a representative viewpoint on firearm-associated research, safety and policy

  • A policy statement about Salary and Benefits Considerations for EMS Professionals, which will provide justification for fair compensation regarding the dangers and risk as well as the out-of-hospital environment in which EMS providers operate.

  • A policy statement about Violence Prevention & Intervention in EMS System, which will provide the needed guidance regarding implementing steps to attain and maintain an EMS culture of patient and personnel safety

  • Hosting ACEP24 in Las Vegas

  • Creating a national Wellness award to celebrate institutions or organizations that demonstrate best practices when it comes to physician wellness, with the inaugural award presented during ACEP20

  • Partnering with the Center for Improvement in Healthcare Quality to develop an accreditation process for freestanding emergency centers

  • Approving an Influenza ED Best Practices information paper

  • Submitting a white paper to Annalsabout the potential impact of the Accreditation Council for Graduate Medical Education’s proposed policy that would restrict protected time for core faculty

 

Candidates Announced for Board, Council
The following candidates are running for ACEP leadership positions in 2019. Elections will take place during ACEP Scientific Assembly in Denver. More information on the candidates will be forthcoming.

President-Elect
Jon Mark Hirshon, MD, FACEP (MD)
Mark Rosenberg, DO, FACEP (NJ)

Speaker
Gary Katz, MD, FACEP (OH) – unopposed

Vice Speaker
Kelly Gray-Eurom, MD, FACEP (FL)
Andrea Green, MD, FACEP (TX)
Howard Mell, MD, FACEP (IL)

Board of Directors (four open positions)
Michael Baker, MD, FACEP (MI)
Jeffrey Goodloe, MD, FACEP (OK)
Rachelle Greenman, MD, FACEP (NJ)
Gabor Kellen, MD, FACEP (AACEM)
Pamela Ross, MD, FACEP (VA)
Gillian Schmitz, MD, FACEP (incumbent – GS)
Ryan Stanton, MD, FACEP (KY)
Thomas Sugarman, MD, FACEP (CA)

EM Physician Named Chief Executive Officer of AOA
ACEP Board member Kevin Klauer, DO, EJD, FACEP, has been appointed chief executive officer of the American Osteopathic Association, the professional membership organization for more than 145,000 osteopathic physicians and medical students. As CEO, he will be responsible for strategy, operating results, organizational growth and advocacy.
 
“We are thrilled for Dr. Klauer to join the AOA as our next CEO,” said AOA President William S. Mayo, DO. “The DO profession is undergoing significant growth, with approximately one in four medical students attending a college of osteopathic medicine. This is a pivotal moment for the osteopathic profession and health care overall, and we are confident in Dr. Klauer’s experience to lead us through a dynamic and evolving landscape.”
 
Dr. Klauer, an ACEP member since 1992 and current Medical Editor-in-Chief of ACEP Now, will finish his current term on the ACEP Board of Directors in October 2019 and will help transition a new emergency physician into the role of ACEP Now Medical Editor-in-Chief

 

ACEP Advocateas for Workplace Violence Protections for Health Care Workers
Violence in the ED is a serious and growing concern. ACEP’s 2018 survey reported that nearly half of EM physicians polled had been physically assaulted, with more than 60 percent occurring in the past year. ACEP recently worked with congressional offices to refine H.R. 1309: The Workplace Violence Prevention for Health Care and Social Service Workers Act, and sent a letter of support asking Congress to consider how EDs in particular are staffed to ensure the important provisions of this legislation are implemented appropriately. ACEP's letter requested additional clarity of the legislation's wording to ensure any new federal requirements do not create any unintentional burdens for entities that do not directly control the health care workplace. Read more at www.acep.org/EDsafety.

 

ACEP Submits Statement on Surprise Billing, Bundled Payments
On April 2, ACEP submitted a statement for the record to the House Committee on Education and Labor's Subcommittee on Health, Employment, Labor, and Pensions that urged legislators to take into account the unique nature of emergency medicine while examining the surprise billing issue. The letter explains how EMTALA has disincentivized health plans from entering into fair and reasonable contracts to provide services at appropriate in-network rates.

This letter also explains ACEP’s stance on recent proposals related to bundled payments being discussed as part of negotiations to develop federal balance billing legislation: “We also note our strong concerns with proposals that would either provide a single bundled payment from a hospital for emergency services or would set a benchmark payment at a certain level of Medicare rates. A bundled payment would not actually address the underlying cost issues, but instead merely shift the venue for negotiation under the assumption that hospitals would somehow be able to better negotiate with physicians than insurers.”

 

ACEP, NAEMT Partner to Celebrate EMS Week
The 45th National EMS Week is May 19-25, bringing together local communities and medical personnel to publicize safety and honor the dedication of EMTs. In 1974, President Gerald Ford authorized EMS Week to celebrate EMS practitioners and the important work they do in our nation's communities. Presented by ACEP and the National Association of EMTs (NAEMT), our EMS 2019 theme is “BEYOND the CALL.”

 

ACEP4U

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

June 2019 Highlights

Our clinical affairs department produced a geriatric ED case study on the Louis Stoke Cleveland VA Medical Center, the first VA to achieve GEDA accreditation, describing the multiyear process the VA has gone through to implement best practices and decrease ED visits for their 12,274 annual senior visits in their ED. The case study is being shared within the VA system as an aid for the 19 additional sites working toward GEDA accreditation.

Our quality department worked with the Registry Coalition on public comments related to prevention of data blocking by EHR vendors, furthering our work to help EM practices access their data.

Our reimbursement team interpreted legislation and provided resources for states that were facing immediate threats from last minute OON and balance billing legislation that could have drastically affected physician reimbursement.

Our regulatory affairs team organized a meeting with Dr. Elinore McCance-Katz, who leads the Substance Abuse and Mental Health Services Administration (SAMHSA) at the U.S Department of Health and Human Services (HHS) where they discussed the ability to administer buprenorphine in the ED for patients with opioid use disorder and how to improve care for patients with mental health illnesses.

Our educational products team contracted with EBSCO to make ACEP eBooks available for medical libraries and institutions around the world. Approximately 115,000 institutional libraries around the world use EBSCO to order books.

Our public affairs team worked with Rep. Bill Pascrell (D-NJ) to gain House approval of an amendment that would fund ALTO at $10 million in fiscal year 2020.
 

May 2019 Highlights

Our clinical affairs team developed an abbreviated algorithmic pathway to assist in the administration of Buprenorphine in the ED. This point-of-care tool is now available online for all ACEP members. They also worked with Dr. Christopher Baugh to develop and build out the Atrial Fibrillation tool, online now.  


Our quality department statistically analyzed variance in raw ED performance data collected across 25 measures in our registry, with the goal of highlighting performance gaps (e.g. head CT utilization for minor head injury) that support the necessity of a measure that helps emergency clinicians provide higher-quality patient care.
 

Our grant development team worked on the creation of value sets that will be used to create electronic measures for EMS on behalf of NEMSQA. Once these EMS-specific value sets and electronic measures are created, they will be the first electronically specified measures endorsed for primary use in the field of EMS. 
 

Our clinical affairs team worked with members and Ed Products staff to develop free eCME for ACEP members for two clinical policies.
 

Our reimbursement team lobbied for EM-friendly CPT rulings on fracture care and behavioral health coding guidance and alerted 12 states about a potentially damaging reimbursement policy by a large insurer which allowed ACEP to begin a rapid response to our members and their groups in the affected states.
 

Our regulatory affairs team responded to a request for information (RFI) on how to enhance the ability of health care insurers to sell health insurance coverage across state lines. In the response, ACEP supported increasing access to affordable health insurance but explained concerns about the potential impact this could have on the coverage of emergency services and access to care for higher risk populations. Davis and the PR team also issued a press release in reponse to the final rule released by the Department of Health and Human Services (HHS) that enhances conscience protections for health care providers who refuse to provide care that violates their religious beliefs. The final rule is extremely concerning and violates our core beliefs and ethical and legal duty as emergency physicians. 
 

April 2019 Highlights

Our clinical affairs team helped persuade United Healthcare to change a Managed Medicaid policy that denied or down-coded emergency claims based on final diagnosis in 23 states - a violation of the Prudent Layperson Standard ACEP fought hard to establish. By writing letters to UHC and helping ACEP members turn up the heat, the policy has been reversed in all but two states, potentially saving ACEP members millions in lost reimbursement.

Our reimbursement department assisted hundreds of members with coding and reimbursement information and published the 2019 edition of "What Every Graduating Resident Needs to Know About Reimbursement."

Our clinical affairs team is working with The Joint Commission to create a survey on onerous regulations. 

Our educational products team worked with Amazon to make the second edition of the ECG book on Amazon’s print-on-demand in six new marketplaces: UK, France, Italy, Germany, Spain, and Japan. This improvement greatly reduces shipping fees for our international customers. 

Our quality team provided CMS with MIPS program leadership concerns with the program that directly affect EM practitioners who participate in MIPS, along with ideas to improve the program for EM and other clinicians.

Our legislative team in ACEP's DC office drafted legislation to create a grant program that will facilitate moving psychiatric/mental health patients out of the ED and into more appropriate treatment settings. This language is currently being reviewed by House and Senate lawmakers for possible sponsorship.

Our member communications team compiled salary information from ACEP and external sources to make a one-stop-shop online resource for members trying to negotiative appropriate compensation. 

Our legislation team met with the Occupational Safety and Health Administration to discuss workplace violence and continued working on responses to regulations on interoperability and data blocking that will have a big impact on EM physicians. They helped respond to EMTALA-related questions around the treatment of psychiatric patients and are drafting responses to frequently asked questions on surprise billing.

Our clinical affairs team is leading a work group of Facility Guideline Institute Revision Committee Members on the review of the Emergency Services section of the guidelines to propose revisions.

Our grants development team led a review of candidate quality measures for the National EMS Quality Alliance (NEMSQA) that allowed experts in the EMS field to provide their input in how to improve the measure set in an organized and methodical method. 

Our Annals of Emergency Medicine team worked with the husband of an Annals author to surprise his wife by framing a copy of her article. 

Our clinical affairs team is liaisoning with the groups working to revise clinical policies on opioids, blunt trauma, appendicitis and mild traumatic brain injury. 

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