Join your emergency medicine colleagues in person in Washington, DC for the ACEP Leadership & Advocacy Conference (LAC) from May 1-3, 2022. Highlights include a Health Policy Primer sponsored by EMRA; Leadership Summit featuring emergency physician experts addressing topics such as Physician Burnout, ED Violence, Physician Collective Action, and Scope Battles in the States; and comprehensive advocacy and issue training to prepare for visits with legislators on Capitol Hill.
Confirmed government and Congressional speakers include Admiral Rachel Levine, Assistant Secretary for Health (ASH), Sen. Tim Kaine (D-VA), and Sen. Tammy Baldwin (D-WI). Additional opportunities will be offered to interact directly with legislators during NEMPAC-hosted events with confirmed participants Rep. Larry Bucshon, MD (R-IN), Rep Ami Bera, MD (D-CA), and Sen. Tim Kaine (D-VA).
Barring any unforeseen circumstances, registrants meet with legislators and staff in person on Capitol Hill the afternoon of May 3. Click here for more information and to register.
Resident & YPS Reception Co-hosted by NEMPAC Sunday, May 1 from 5:00 - 6:00pm at the Grand Hyatt Washington Hotel
Following the Health Policy Primer sessions, join your colleagues to network and learn more about NEMPAC!
Women in Politics Session with Sen. Tammy Baldwin (D-WI) Monday, May 2 from 12:30 - 1:30pm at the Grand Hyatt Washington Hotel
Join us for an engaging conversation with Sen. Tammy Baldwin (D-WI) and hear firsthand about her pathway to a political career, how she stays focused on making an impact, and her take on the future of diversity in politics. This is a unique, limited-space opportunity - register today! Refreshments will be served.
NEMPAC VIP Reception Monday, May 2 from 5:30 - 7:00 pm at the Grand Hyatt Washington Hotel
NEMPAC's VIP Reception is an excellent chance to network with your ACEP colleagues who understand and support a strong, unified advocacy effort on behalf of emergency medicine and patients. This year the reception will feature special guest Rep. Ami Bera, MD (D-CA)!
NEMPAC donors at the Sterling level or above ($600 for attending physicians/$60 for residents and medical students annually) are invited and encouraged to attend. Donors who are currently eligible will receive an invitation via email.
Click here to contribute to NEMPAC and secure your invitation.
Questions about your donation status?Click here to email us.
Congressional Dine-Around Events Sponsored by NEMPAC
Join your ACEP Board members and colleagues! The NEMPAC Board has identified congressional leaders deserving of special recognition and support for their work on national health policy impacting emergency medicine and patients. NEMPAC is hosting in-person dinners during LAC22 as a unique opportunity to discuss health care policy and the national political environment in small group settings. NEMPAC is donating to these legislators' campaigns and attendees are asked to donate personally as well. Food and drink are included with your contribution. An RSVP is required to attend the dine-arounds - click here to email us.
Confirmed dine-arounds*: Sen. Tim Kaine (D-VA) Monday, May 2, Dinner at 7:00 pm, L'Ardente, 200 Massachusetts Ave, NW, Washington, DC
Rep. Larry Bucshon, MD (R-IN-08) Monday, May 2, Dinner at 7:00pm, Ocean Prime, 1341 G St, NW, Washington DC
*The dine-around schedule is subject to change and additions.
Contributions or gifts to NEMPAC are voluntary and are not tax deductible for federal income tax purposes. The amount given or refusal to donate will not benefit or disadvantage you. By law, we may only use your contribution to support federal candidates if your contribution is made using a personal credit card or personal check. We are required to provide your employer name, your occupation, and to obtain an original signature of the ACEP member if contributing by credit card. NEMPAC encourages personal contributions. All non-personal contributions to NEMPAC will be used to defray costs of educational programs for NEMPAC and other activities permissible under federal law.
On Thursday, the Federal Trade Commission (FTC) and Department of Justice (DOJ) held a listening session on the effects of mergers and acquisitions in the healthcare industry in conjunction with their request for information on merger enforcement. ACEP President Dr. Gillian Schmitz and ACEP Executive Director Sue Sedory, along with other emergency physicians, spoke during the public comment period. Dr. Schmitz and Ms. Sedory noted numerous anti-competitive labor-related effects associated with mergers and acquisitions in emergency medicine including:
Reduced wages and/or non-cash benefits.
Infringement of due process rights.
Interference with physician autonomy to make independent medical decisions benefiting patients.
Inability to find a job or undue imposed restrictions on ability to switch jobs.
A shift to use of a less-skilled health care workforce jeopardizing patient care.
Dr. Schmitz and Ms. Sedory shared results from a questionnaire we distributed to ACEP members. More than half of respondents indicated that their medical decision-making autonomy was negatively impacted by a merger or acquisition of their employer, and many said the current working conditions in their large, national physician groups or hospital systems have them considering quitting medicine altogether.
In response to the comments shared in the listening session, FTC Chair Lina Khan noted that the testimonies underscored "how it's not just patients that are suffering, but it's also health care workers that are suffering" as mergers in the healthcare sector are "allowing employers to dictate wages and degrade working conditions." She assured that the FTC and the DOJ "are really going to be learning from everything" shared in the listening session.
ACEP plans on following up on the listening session by submitting a letter next week that formally responds to the FTC and DOJ request for information.
The first few months since the No Surprises Act has gone into effect have been a bit bumpy. There have been multiple lawsuits over the Departments of Health and Human Services (HHS), Labor, and Treasury's (the Departments') policy regarding how an arbiter must resolve billing disputes for out-of-network services in the federal independent dispute resolution (IDR) process. Specifically, the policy in question stated that the arbiter must consider the qualifying payment amount (QPA) to be the presumptive payment amount for out-of-network services and should weigh that factor more heavily than other factors the arbiter was also supposed to consider. This policy is flawed for a plethora of reasons and, much to ACEP's delight, a federal judge in Texas invalidated the policy nationwide through a court order issued in February.
In early March, the Departments issued a public statement about how they planned to conform with the Texas court's order. The Departments removed all references to the IDR process in regulations and took down previously published IDR guidance from their webpage. They stated that they intended to "promptly" repost the IDR guidance documents once they had been updated to conform with the Texas court's order. They also said they would wait until the revised IDR guidance documents were posted to launch the "IDR Portal"- the main system that will be used to facilitate disputed claims through the federal IDR process.
Over the last week, there have been some important updates on the IDR process:
IDR Portal Launch: First, the Centers for Medicare & Medicaid Services, or CMS (one of the main agencies implementing the No Surprises Act), announced that the IDR portal is expected to launch this week (at the time the blog was written, it has not been launched yet).
Revised IDR Guidance: CMS also released the IDR guidance that removes references to the flawed QPA presumptive policy (guidance for arbiters can be found here and guidance for disputing parties can be found here).
Read the Regs & Eggs blog to learn more about these important updates and what steps to take now that the IDR Portal is opening.
Thursday, ACEP responded to a request for information (RFI) on a number of issues related to Medicaid and the Children's Health Insurance Program (CHIP). The Centers for Medicare & Medicaid Services (CMS) will use the responses from the RFI to help inform future policies. Please note that ACEP responded to the RFI via an online form.
CMS specifically sought input on the following five objectives:
The best strategies to reach people who are eligible for Medicaid and CHIP
The best strategies to maintain Medicaid and CHIP beneficiaries' health care coverage and ensure that beneficiaries are not inappropriately disenrolled due to transitions
The minimum standards that should be set in both the fee-for-service and managed care delivery systems and across various types of services and providers to ensure Medicaid and CHIP beneficiaries have access to timely, high-quality, and appropriate care that is aligned with the beneficiary's needs as a whole person.
The types of data, both current and new, that CMS should utilize to measure, monitor, and support improvement efforts related to equitable access to services in the Medicaid and CHIP programs.
The best strategies to connect minimum provider access standards and payment rates in the Medicaid and CHIP programs to enlist and retain enough providers so that covered services are accessible to Medicaid and CHIP beneficiaries to the same extent that comparable services are accessible to the general population within the same geographic area.
In our response, ACEP particularly focused on the need for CMS to address mental health parity and ED boarding, reimburse for culturally and linguistically appropriate services, enforce strong network adequacy requirements in Medicaid Managed Care, and increase Medicaid payment rates to ensure that Medicaid enrollees have access to care. With respect to payment, we also discussed some of the bad payor behavior we have experienced in Medicaid Managed care, including violations to the prudent layperson standard.
With about half of state legislatures having concluded their sessions for the year, and others narrowing their focus as they look toward the November elections, it seems like a good time to assess where things stand, particularly as related to the scope of practice issue that was seen as the key issue coming into the year. At the start of 2022, many believed that attacks on physician-led care would continue, as other types of practitioners would seek to build on hasty and ill-thought progress granted to their cause over the course of the pandemic-induced health care emergency. Indeed, they proceeded with such efforts, but the scope expansion juggernaut was largely repelled this year by the collaborative efforts of the house of medicine, including significant contributions from emergency medicine.
At the start of the year, South Dakota achieved national attention as the collective gaze of the medical community focused on a scope expansion bill there that appeared headed for passage. South Dakota ACEP joined with the state medical society and other specialty organizations, both state and national, to register concerns about the bill, which ultimately got out of committee but was voted down by the state senate in spite of vigorous efforts by the sponsor to gain enough votes to pass it. The strategy in South Dakota, which included both action alerts sending messages to policymakers and a vigorous use of social media advocacy, has been replicated successfully in a number of other states.
In Indiana, efforts at scope expansion were defeated as the state legislature also took a positive step by passing truth in advertising legislation that requires advertisements to include the licensure or professional designation of the practitioner. A coalition that included Indiana ACEP helped move this legislation. The Colorado chapter helped defeat a major effort to undermine physician supervision of PA's in that state. In Kentucky, scope expansion legislation passed by a wide margin in the House but stalled in the Senate as the medical community mounted a successful grassroots advocacy effort. Multiple scope bills in Maryland also have stalled, and Virginia and Washington were able to stop efforts as well.
Other states appear to be on the verge of victory as deadlines for movement loom. That said, considerable work remains in some states. In Wisconsin, efforts continue to urge a gubernatorial veto of a negative bill that passed the legislature. In Louisiana, scope expansion legislation involving NP's, PA's, and pharmacists is ongoing.
