On Tuesday, Representatives Madeleine Dean (D-PA) and Larry Bucshon, MD (R-IN) introduced the Safety From Violence for Healthcare Employees (SAVE) Act (H.R. 7961), legislation to establish federal criminal penalties for individuals who assault or intimidate health care workers (with protections for individuals who may be mentally incapacitated for various reasons), modeled after existing protections for airline or airport employees. It provides for enhanced penalties for acts involving dangerous weapons or that result in bodily harm and injury, or for acts committed during emergency declarations.

The legislation also establishes grants (through the Department of Justice) to assist hospitals and facilities in implementing their own violence prevention and reduction programs and other related efforts. These grants are authorized at $25m per year for fiscal years 2023-2032. ACEP worked closely with Rep. Dean's office to help inform the legislation and strongly supports the bill.

Help ensure this legislation moves forward: contact your Representative today.  

ACEP was quoted in the press release announcing introduction of the legislation:

"We continue to hear terrifying and disheartening stories from health care workers who have been assaulted on the job," ACEP President Gillian Schmitz, MD, FACEP said. "Just the other day, our worst nightmares were realized once again when two physicians, an employee, and a patient were killed in a medical office. Physical and verbal attacks are not tolerated in any other workplace - they should not be allowed in a health care setting. Emergency physicians deeply appreciate Rep. Dean and Rep. Bucshon's bipartisan leadership and others in Congress who are leading important efforts to protect the professionals on the front lines so that they can focus on patient care without worrying about their personal safety." 

This new legislation is especially timely given recent violence against health care workers, such as the knife attack against an emergency physician and two nurses just a week ago in Encino, CA, as well as the mass shooting in Tulsa, OK, at a medical office where two physicians, a receptionist, and a patient were killed. This bill expands ACEP's extensive efforts to curb health care workplace violence, including H.R 1195/S. 4182, Rep. Joe Courtney (D-CT) and Senator Tammy Baldwin's (D-WI) "Workplace Violence Prevention for Health Care and Social Service Workers Act" to create an enforceable OSHA standard for workplace violence prevention plans.

On Wednesday, the House of Representatives Committee on Oversight and Government Reform held a hearing, entitled "The Urgent Need to Address the Gun Violence Epidemic." The hearing featured two panels of witnesses, including several survivors and families of victims of the recent mass shootings in New York and Texas. Chairwoman Carolyn Maloney (D-NY) held the hearing to shed light on the effects of firearms violence and "...the urgent need for Congress to pass commonsense legislation that a majority of Americans support."

The hearing preceded a vote on H.R. 7910, the "Protecting Our Kids Act," a package of several legislative proposals to address and prevent firearms violence that was marked up by the House Committee on the Judiciary last week. ACEP submitted a statement for the record for last week's markup, reiterating our member-determined policy and priorities laid out in the "Firearm Safety and Injury Prevention" policy statement. The letter also outlines legislative proposals that ACEP has advocated for that are in line with this policy. H.R. 7910 passed in a nearly party-line 223-204 vote, with five Republicans voting for the package and two Democrats voting against it. The House also held separate votes on individual titles of the bills, some of which garnered more GOP crossover votes than others.

As previously reported, H.R. 7910 includes:

• Raising the age limit to purchase certain semiautomatic centerfire rifles from 18 to 21 years old;
• New prohibitions and penalties for straw purchases, gun trafficking, or other unlawful transfers/disposition of firearms to certain individuals;
• Additional efforts to ensure all firearms are traceable and modernize the existing prohibitions on undetectable firearms (so-called "ghost guns");
• Safe storage laws;
• Statutory ban on "bump stocks" that accelerate the rate of fire of semiautomatic firearms to closely replicate the fire rate of fully automatic firearms (these were banned by the Trump Administration after the 2018 Las Vegas mass shooting, but this rule has recently been challenged in court and remains in flux); and,
• Restrictions on large capacity magazines and ammunition feeding devices.

And on Thursday, the House voted on H.R. 2377, the "Federal Extreme Risk Protection Order Act," an ACEP-supported combination of two bills offered by Reps. Lucy McBath (D-GA) and Salud Carbajal (D-CA), that would help expand the use of "red flag" laws nationwide and incentivize and assist states in establishing their own red flag laws. This bill passed in a 224-202 vote, with five Republicans again crossing party lines and one lone Democrat voting against the package.

In the Senate, negotiations continue between a working group led by Sens. Chris Murphy (D-CT) and John Cornyn (R-TX). While the group hoped to have an outline of agreed-upon principles by today, a deal remains elusive. Legislators involved remain hopeful and meet again today to continue their work virtually. To date, the discussions have focused on background checks, red flag laws, laws around assault or assault-like weapons, safety resources (e.g., gun locks), as well as provisions regarding mental health and school safety. It is unclear which policies can garner enough support to overcome a filibuster, but the working group hopes to craft some package of provisions that can clear the 60-vote threshold.

ACEP President Gillian Schmitz, MD, FACEP spent time in Washington, DC this week representing ACEP at the second annual "House Call on the Mall. The event brought 80 physician leaders from 15 medical specialties to DC for bipartisan events to educate Members of Congress on issues of importance to the physician community as a whole and improving access for patients. Dr. Schmitz met with 19 Members of Congress while in DC, including members of the GOP Doc Caucus and leaders of both parties. 

Dr. Schmitz specifically advocated for bipartisan solutions to reduce workplace violence and firearm injuries. She shared ACEP members' stories about caring for victims of gun violence while consoling their families, along with the realities of the violence and assaults they have faced personally in the emergency department. 

All of the events attended by Dr. Schmitz were arranged through the National Emergency Medicine PAC (NEMPAC), ACEP's political action committee. NEMPAC works closely with many physician specialty PACs to sponsor events to educate legislators and supports the election of candidates on both sides of the aisle who will work to advance the concerns of emergency medicine.

Today, ACEP participated in a roundtable discussion on current COVID-19 therapeutic options and challenges with the U.S. Surgeon General, Dr. Vivek Murthy, and leaders from the Office of the Assistant Secretary of Preparedness and Response (ASPR) within the U.S Department of Health and Human Services (HHS). Chris Kang, MD, FACEP, President-elect of ACEP and Melissa Fiorini, MD, FACEP, an emergency physician in Albany, New York, represented the views of ACEP and its members. Drs. Kang and Fiorini were able to share the emergency physician experience finding the appropriate treatment options for patients presenting to the emergency department with COVID, make suggestions to improve access and utilization of COVID medicines, and highlight concerns that impact patient care. This closed-door session will inform a virtual discussion planned for next Friday, June 17 at 12 pm EST with broader clinical participation.

In a victory for emergency physicians and their patients, the Center for Consumer Information and Insurance Oversight (CCIIO) within the Centers for Medicare & Medicaid Services (CMS) released a checklist Monday directed at health insurers that lists out in detail all requirements related to the Open Negotiations and independent dispute resolution (IDR) processes under the No Surprises Act. 

As background, ACEP has been hearing from many emergency physicians that health insurers are not providing the information required by law and/or regulation that is needed to accurately bill patients for out-of-network services and to proceed with the federal Open Negotiations and IDR processes. To advocate on your behalf, we wrote a letter to federal agencies in April that provided: 1) specific examples of health plan non-compliance; and 2)  policy recommendations that would help address these non-compliance issues. A couple of weeks ago, ACEP and the Emergency Department Practice Management Association (EDPMA) met with staff within CCIIO to follow-up on our letter. 

The checklist specifically acknowledges that health insurers are not complying with these requirements and addresses many of ACEP's advocacy priority items that we highlighted in our letter and follow-up meeting. These items include:

• The notice of denial of payment must be in writing, state that payment for the item or service will not be made by the plan or issuer, and explain the reason for the denial of payment. The term "notice of denial of payment" does not include a notice of benefit denial due to an adverse benefit determination/
• Insurers must provide the qualifying payment amount (QPA) for each item or service involved and a statement certifying that the insurer has determined the QPA applies for the purposes of the recognized amount and each QPA was determined in compliance with the agencies' methodology specified in the first rule.
• Contact information, including a telephone number and email address [emphasis by CCIIO], for the appropriate person or office of the plan or issuer to initiate open negotiations for purposes of determining an amount of total payment (including cost sharing) for the item or service.
• To initiate the open negotiation period, the initiating party must provide the standard open negotiation notice (found here) to the other party. Note that, if the initiating party submits the standard open negotiation notice to the non-initiating party, the open negotiation period begins on the day that the initiating party sends the open negotiation notice regardless of whether the non-initiating party "accepts" the notice or not. 
• Details of what information needs to be included to initiate the federal IDR process following the 30-day open negotiation period.
   

The release of the checklist represents an important step in ensuring compliance with the requirements of the No Surprises Act and its implementing regulations. 

The Centers for Medicare & Medicaid Services (CMS) released an agency-wide Strategic Plan White Paper and Agency Accomplishments fact sheet highlighting key agency "impacts and accomplishments over the past year" on Wednesday. The Strategic Framework emphasizes the agency's strategic pillars to advance equity, expand access, engage partners, drive innovation, protect programs, and foster excellence. CMS summarized its ongoing initiatives, including efforts focused on: 

• Behavioral health; 
• Drug affordability; 
• Maternity care; 
• Benefit expansion; 
• Rural health; 
• Preparation of the health care system for a post-pandemic environment; 
• Coverage transition; 
• National Quality Strategy; 
• Nursing homes and choice in long-term care; 
• Data to drive decision-making; and 
• Integration of Medicare, Medicaid and CHIP, and Affordable Care Act plans. 

The Medicare "Trustees" issue a comprehensive report annually that outlines the financial outlook for the Medicare program in both the short-term and the long-term. This year's report was released last week.

Most people look out for one main thing in the Trustees report each year: the insolvency date for the Hospital Insurance (HI) Trust Fund. The year's report estimates that the HI Trust Fund, which covers costs under Medicare Part A, will be depleted by 2028, two years later than estimated in last year's report.

However, for the last couple years, the Medicare Trustees have also raised a stark warning related to the inadequacy of Medicare physician payments-and they did it again this year.

Read the Regs & Eggs blog to learn what the Trustees said about the long-term impact of insufficient physician payments in Medicare and how this fits in with our ongoing effort to fix a broken payment system.  

Maine, Nevada, North Dakota, and South Carolina are up next with primary elections on Tuesday, June 14! Have you confirmed your current polling location and voting requirements in your state? ACEP can help: Click here and enter your address information for voter resources and to see the list of candidates in your area.