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Introduction to Health Policy. Nathaniel Schlicher, MD, JD Legislative Advisor Emergency Medicine Residents’ Association Emergency Medicine Resident Wright State University Attorney at law Johnson, Graffe , Keay , Moniz & Wick, LLP. Why Are You Here?. Maybe… Cool Location

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Introduction to health policy

Introduction to Health Policy

Nathaniel Schlicher, MD, JD

Legislative Advisor

Emergency Medicine Residents’ Association

Emergency Medicine Resident

Wright State University

Attorney at lawJohnson, Graffe, Keay, Moniz & Wick, LLP


Why are you here
Why Are You Here?

  • Maybe…

    • Cool Location

    • Meet and Greet

    • Program Paid For it

  • Or Maybe…

    • Want to Make a Difference

    • Want to Guide Change

    • Care about an issue


History of this program
History of this Program

Where We Were

  • Resident Focused Track

  • Chair’s Challenge

  • Social Reception to Meet the Leaders

What We Have Added

  • Added First-Timers from YPS Section of ACEP

  • Integrated Media Training

  • Roundtable discussions


Today s speakers
Today’s Speakers

  • 1:00 – 1:40 Introduction

    • Nathaniel Schlicher, MD, JD

  • 1:40 – 2:20 Health Care Economics

    • James Eadie, MD, FACEP

  • 2:20 – 3:00 Current Issues

    • Jennifer Wiler, MD, MBA


Afternoon agenda
Afternoon Agenda

  • 3:00 – 4:00 Roundtable Discussion

    • 10 Hot Topics

  • 4:00 – 6:00 Media Training

    • Speakers Bureau Pre-Requisite

  • 6:15 – 7:15 Reception

    • Cocktails and Networking


Objectives
Objectives

  • What is Advocacy?

  • Legislative Process

  • Health Care Reform

  • Medical Malpractice Reform

  • Getting Involved


Advocacy

=

Politics


Advocacy is
Advocacy is…

speaking for a cause, often for a vulnerable person



What is advocacy to you
What is Advocacy to You?

  • Calling Consultants

  • Getting that Test

  • Free Care for All

  • Hospital Boards

  • Medical Staff Meetings

  • Overcrowding Solutions

  • State Laws

  • Regulations

  • Federal Policy

  • Reimbursement



$138,300 / year per ER Physician

$12, 300 / year Average Physician


On call Specialists

Medical Home

CLOSED


We need a seat at this table
We Need a Seat at this Table!

  • President Obama’s Health Reform Summit




The start
The Start

  • Bill is Introduced

  • Referred to Committee

  • Referred to a Subcommittee

  • Bart Gordon (HR 1188)

  • Energy and Commerce

  • Ways and Means

  • Subcommittee On Health in both Committees


The hearings
The Hearings

  • Subcommittee Hearings

    • Report out or Table it

  • Committee Hearings

    • Report out or Table it

  • Full Chamber Considers

    • Approve, Defeat, Refer Back, or Table it

  • Second House Consideration


The home stretch
The Home Stretch

  • Compromise

    • Amendments referred back to original chamber

    • Conference committee

  • Presidential Consideration

    • Sign

    • Veto

    • No Action Pass

    • Pocket Veto



The rationale
The Rationale

  • 46 million uninsured

  • 1 in 3 Americans under 65 without health insurance in 2007/2008

  • Bankruptcy every 30 seconds from medical costs

  • 72% of Americans favor increasing government control on costs


Obama campaign plan
Obama Campaign Plan

  • EHR 10 billion over 5 years

  • Increased Prevention

  • Align incentives for excellence – PQRI

  • Malpractice insurer reform

  • Competitive Insurance

  • National Health Ins. Exch.

  • SCHIP Expansion

  • Eliminate Medicare Advantage

  • Negotiate Drug Prices

  • Tax Credits


Moments of pause
Moments of Pause

  • Expanded Pay for Performance

  • SGR like cuts are likely

  • More Medicaid or Medicare unclear

  • Decrease specialist utilization via incentives


Funding the plan
Funding the Plan

  • Stimulus Bill

    • 17 billion for EHR

    • 60% subsidy for COBRA

    • 87 billion for 2 years of Medicaid

  • 50-65 billion / year via

    • Tax cut rollbacks on >$250,000

    • Keep the Estate Tax

  • 634 billion over 10 years

    • Reduced deductions

    • Medicare Advantage gone

    • Provider cuts


The wrinkle
The Wrinkle

Cost: $1.5 Trillion / 10 years

Areas of Savings:

Physicians

Hospitals

Insurers

Drug Companies


Hope and change
Hope and Change

  • Allocation for SGR Reversal in 10 year plan

  • “Restructuring” of payments to physicians

  • Can We Get a Bailout?



Why?

  • Insurance Premiums

    • $26 billion annually

    • 12% / year growth rate

  • Cases more expensive

    • 52% exceed 1 million

    • Average verdict 4.7M

  • Defensive Medicine??

    • $70-124 billion estimates


What are the issues
What are the issues?

  • Malpractice Caps

  • Statute of Limitations

  • Statute of Repose

  • Attorney Fee Limits

  • Expert Witness Qualifications




Data from the cbo 2004
Data from the CBO (2004)

  • Caps improved costs

    • Decreased costs of health insurance

    • Decreased cost of malpractice coverage

    • Increased insurance premiums

    • Increased physicians

  • Collateral Source Reform

    • Limited decline


Many issues remain
Many Issues Remain

  • State or Federal Issue?

  • Clumping of tort reform

  • Stigma of greed

  • Powerful Plaintiff Bar



EMRA

  • 35th year of existence

    • 8457 Members

    • 33% of all ACEP

  • Health Policy Committee

  • Legislative Advisor

  • Advocacy Handbook


Acep projects
ACEP Projects

  • 911 Network

  • Speakers Bureau

  • Access to Emergency Medical Services Act of 2009

    • S. 468 / H.R. 1188

    • Jen Wiler


Acep committees
ACEP Committees

  • Federal Governmental Affairs Committee

  • State Legislative / Regulatory Committee

  • Medical-Legal Committee


Nempac
NEMPAC

  • Election Cycle 2 years

    • 2 million dollar goal

  • Ranking

    • 1 – Anesthesiology (3.12M)

    • 2 – Orthopaedics (2.37M)

    • 3 – Radiology (1.70M)

    • 4 – Ophthamology (1.69M)

    • 5 – Emergency Med (1.68M)

  • Give-a-shift Goal

    • $1000 / attending

    • $100 / resident


You may be involved but
You May Be Involved But…

  • Rally your group / residency / friends

  • Give a Lecture / Journal Club on Advocacy

  • Become a Spokesperson

  • Give your Time and Money


Want more information
Want More Information?

2009 EMRA Advocacy Handbook


Thank yous
Thank Yous

  • Anthony Foianini, MD,

    • Maine Medical Center, Portland, ME

  • Christopher S. Jones, MD

    • Eastern Virginia Medical School, Norfolk, VA

  • Eric Goralnick, MD

    • Yale New Haven, New Haven, CT

  • Daniel Freess, MD

    • University of Connecticut, Farmington, CT

  • George Leach MD

    • Emory University, Atlanta, GA

  • Edwin F. Lopez, MD

    • Sinai-Grace Hospital, Wayne State University, Detroit, MI

  • Chet Schrader, MD

    • Washington University in St. Louis, St. Louis, MO

  • Michael Dorrity, MD

    • MSU-Sparrow Hospital, Lansing, MI

  • Erin E. Schneider, MD

    • Oregon Health and Science University, Portland, OR


Thank yous1
Thank Yous

  • Kaedrea Jackson, MD, MPH

    • SUNY Downstate Medical Center, Kings County Hospital Center, Brooklyn, NY

  • Malika Fair MD, MPH

    • Carolinas Medical Center, Charlotte, NC

  • Stephen Tantama, MD

    • Naval Medical Center San Diego, San Diego, CA

  • Thomas Masters, MD

    • Wright State University, Kettering, OH

  • Jamie “Akiva” Kahn, MA, MSIV

    • University of California at Irvine, Irvine, CA

  • Marisa L Oishi, MD

    • Mount Sinai School of Medicine, New York, NY

  • JawadKassem, MD

    • SUNY Upstate Medical University, Syracuse, NY

  • Yogin Patel, MD, MBA

    • Apollo MD, Atlanta, GA


Upcoming advocacy events
Upcoming Advocacy Events

  • Advocacy Webinar – May 21st at 2pm EST

    • Target Audience – Junior Faculty

    • Speakers – Nathan Schlicher and Gordon Wheeler

  • ACEP Blog:

    • Thecentralline.org

    • Rotating Bloggers

  • Twittering with LAC

    • Emresidents

    • LAC09


Take away points
Take Away Points

  • Advocacy is a core competency for us

  • Get involved, we need you!

  • Medical Malpractice Liability Reform may live

  • Health Care Reform Details Coming Soon!

    • Stay involved



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