Introduction to the American College of Emergency Physicians

1. Introduction to the American College of Emergency Physicians Presented by: Insert Name: Insert Date:

2. Your Questions Answered: Today’s Agenda • Why does ACEP Matter? • What are the issues ACEP is working on? • How is ACEP making an impact? • How does ACEP decide where to focus its efforts? • What is ACEP doing to make it easier for me to practice EM and provide the highest quality care for my patients? • How is ACEP advancing my career? • What is the value of my membership?

3. ACEP’s Mission Statement • The American College of Emergency Physicians promotes the highest quality of emergency care and is the leading advocate for emergency physicians, their patients, and the public.

4. Why Does ACEP Matter? • The health care landscape is changing. • ACEP has been, and continues to be, involved in shaping the future of Emergency Medicine. • Health care reform and regulatory implementation • Letters to CMS and other high-level agencies • Residency slots and GME re-distribution • Loan forgiveness options

5. Future income

6. CMS= Centers for Medicare and Medicaid Services

7. CMS= Centers for Medicare and Medicaid Services

8. Uninsured

9. Coverage Rates by Type of Insurance

10. CMS-Physician fee Schedule 2014 Physician Fee Schedule CY 2014 Physician Fee Schedule Final Rule with Comment Period The CY 2014 PFS final rule with comment period was placed on display at the Federal Register on November 27, 2013. In addition to policies affecting the calculation of payment rates, this final rule identifies potentially misvalued codes, adds procedures to the telehealth list, modifies the telehealth originating site definitions, finalizes a policy for chronic care management services for CY 2015, applying therapy caps to outpatient therapy services furnished by CAHs, requires the compliance with state law as a condition of payment for services furnished incident to physician and other practitioner services.  This final rule includes discussions and policy regarding revising the MEI based on MEI TAP recommendations, budget neutrality for the chiropractic services demonstration, physician value-based payment modifier and the physician feedback reporting program, and updating the Ambulance Fee Schedule regulations, Clinical Lab Fee Schedule, physician compare website, physician quality reporting system, electronic prescribing (ERX) incentive program, and Medicare shared savings program.

11. Average Annual Worker and Employer Contributions to Premiums and Total Premiums for Family Coverage, 1999-2010 $5,791 $6,438* $7,061* $8,003* $9,068* $9,950* $10,880* $11,480* $12,106* $12,680* $13,375* $13,770* * Estimate is statistically different from estimate for the previous year shown (p<.05). Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 1999-2010.

12. ACA passed 2010

13. Why Does ACEP Matter? -- Health Care Reform • The Health Care Reform law -- ACEP worked hard to get specific items included: • Prudent layperson language extended to group plans • No more “prior approval” needed • Expansion of research opportunities • Regionalization projects

14. ACA being challenged in USSC

17. Why Does ACEP Matter? -- Health Care Reform

18. Why Does ACEP Matter? -- Health Care Reform Under the new federal rules, patients also can still pick their primary doctors or pediatricians, and prior approval requirements for emergency care will be prohibited

19. Why Does ACEP Matter? -- Health Care Reform

20. Why Does ACEP Matter? -- Health Care Reform

21. Why Does ACEP Matter?-- Letters to Regulatory Agencies • Anesthesia guidelines revised (Jan. 2011) • Quality measures (PQRI) • Accountable care organizations • Value-based purchasing • Demonstrate the specialty's value • Preserve EM practice models

22. Why Does ACEP Matter?-- Residency Slot Redistribution • At least 75% of the redistributed residency positions must go to primary care or general surgery. • It is even more imperative that CMS provide as many of the remaining slots to EM residency programs to meet the expected increase in ED visits.

23. Why Does ACEP Matter?-- Loan Forgiveness Options • ACEP understands the incredible burden of debt incurred to become residency trained in EM and support the idea of loan forgiveness if graduates are willing to work in underserved areas.

24. What are the issues that ACEP is working on?The Perfect Storm: Health Care Braces for a Crisis ED Volume Increases  Operational Costs Nurse Shortage Technology On-call Liability Inflation  Revenue Medicaid / Medicare Managed care Uncompensated care Stock market EMERGENCY DEPARTMENT Foreign Nationals On-Call Specialty Physician Shortage Inpatient Bed Shortage EMTALA Ambulance Diversion Balanced Budget Act of 1997

25. What are the issues that ACEP is working on? -- EMTALA • In America,We regard healthcare as a FUNDAMENTAL RIGHT • But we fund healthcare AS A PRIVILEGE • Worse, we do so in a “free enterprise system”

26. What are the issues that ACEP is working on? -- EMTALA Specialty Physicians Affected Average Bad Debt from EMTALA Emergency Med 100% $138,300 General Surgery 76% $25,600 Anesthesiology 69% $16,500 OB\GYN 52% $4,100 Radiology 47% $22,000 Internal Medicine 34% $7,000 Gen \ Family Prac 31% $4,700 Pediatrics 23% $2,400 Pathology 13% $3,400 Psychiatry 11% $1,200 Other Specialties 5% $4,500 All Physicians 42% $12,300 Source: American Medical Association

27. What are the issues that ACEP is working on? -- ED as the Safety Net

29. Changing perceptions in D.C.

30. What is your guess? What is the value of access to care 24 - 7 - 365 Protected under Federal law And without any guaranteed reimbursement?

31. What are the issues that ACEP is working on? -- Value of Emergency Medicine

32. What are the issues that ACEP is working on? -- Perception of “Unnecessary Visits”

33. What are the issues that ACEP is working on? -- Perception of “Unnecessary Visits”

35. What are the issues that ACEP is working on? -- Crowding & Diversion • ED crowding has become a “national epidemic, says the Institutes of Medicine. • An ambulance is diverted away from a crowded ED approximately once every minute nationwide. • ED patients have faced increasingly long average wait times and ED visit lengths over the past decade. • Especially for those with the most acute illnesses. • In 2006, the average wait time = 37 minutes.Recommended maximum = 15 minutes.

36. What are the issues that ACEP is working on? -- Reimbursement Even if you belong to ACEP for no other reason than to support reimbursement efforts, your membership has more than paid for itself • ACEP has the only EM representative on the RUC • ACEP filed compliance disputes against Anthem/Wellpoint and Humana to stop bundling separately billable services in the ED E/M codes. • After California prohibited balance billing, ACEP rapidly created model legislation for states to fight balance billing prohibition laws. The fiscal impact to you = about 30% of revenue comes from balance billing charges for non-contracted payers.

37. What are the issues that ACEP is working on? -- Reimbursement • Replace the flawed Medicare payment formula • Enact stable, annual physician payment updates

38. What are the issues that ACEP is working on? -- On-Call Issues • On-call specialty shortage resources on www.acep.org

39. What are the issues that ACEP is working on? -- Medical Liability Reform • Specifically addresses the unique environment of the emergency department. • ACEP is working with a coalition of on-call specialty societies to achieve this goal. HR 157 -- Health Care Safety Net Enhancement Act • Would amend the Public Health Service Act to deem ED physicians as Public Health Service employees for purposes of lawsuits stemming from EMTALA-related services.

40. What more can ACEP due to make an Impact?..........NEMPAC • A voluntary, non-profit, unincorporated association operating as a separate segregated fund of ACEP.  • Empowered to solicit, directly or indirectly, and accept voluntary personal contributions from ACEP members. • Makes expenditures in connection with the election of candidates for federal office. 

41. How does ACEP’s PAC rank?

43. How can ACEP members make animpact? Join the 911 Network • The 911 Network goes into action when there are critical bills pending and support is needed.

44. How else is ACEP Making an Impact? -- EM Action Fund EMAF • What is the EM Action Fund? • A collective body that can pool limited resources and work to impact health care reform's regulatory implementation. • Designed to allow our specialty to speak with one voice and one message • Why should you get involved? • The 2010 health care reform law could force you to make a choice – become a hospital employee or end your practice. • Proposed regulatory changes could reduce your reimbursements by 20 to 40%. • Who is on the EM Action Fund Board? • EMRA, ACEP, AAEM, ACOEP, SAEM • Physician groups , companies, individual emergency physicians • www.acep.org/EMActionFund

45. How does ACEP decide what to do? -- Democratic Representation

46. How does ACEP decide what to do? -- Resolutions & Council Meeting

47. How does ACEP decide what to do? -- The Board of Directors Andrew E. Sama, MD, FACEPChair of the Board and Immediate Past President Michael J. Gerardi, MD, FAAP, FACEP President-Elect Robert E. O’Connor, MD, FACEP Vice President Paul D. Kivela, MD, FACEP Secretary-Treasurer James J. Augustine, MD, FACEP Vidor E. Friedman, MD, FACEP Hans R. House, MD, FACEP William Jaquis, MD, FACEP Jay A. Kaplan, MD, FACEP Mark L. Mackey, MD, MBA, FACEP Rebecca B. Parker, MD, FACEP Debra G. Perina,MD, FACEP John J. Rogers, MD, FACEP Alexander M. Rosenau, DO, FACEPPresident

48. How does ACEP decide what to do? -- Actions Become Policy Council

49. How does ACEP decide what to do? -- The “Alphabet Soup” of EM

50. First EM physician to become AMAleader Steven J. Stack, MD, FACEP Chair-Elect, Board of Trustee