American College of Emergency Physicians Announces Leadership Nominations

Today the Board of Directors of the American College of Emergency Physicians released the slate of candidates seeking elected leadership positions in 2012.

President-elect

Dr. Alexander Rosenau

Dr. Andrew Sama

Dr. Robert Solomon

Council Speaker

Dr. Marco Coppola

Council Vice Speaker

Dr. James Cusick

Dr. Kevin Klauer

Dr. William Meeks

Board of Directors

Dr. Michael Gerardi (Incumbent)

Dr. Hans House

Dr. William Jaquis

Dr. David John

Dr. Mark Mackey

Dr. David Mendelson

Dr. John Rogers

Elections will be held during the annual Council Meeting in San Francisco in October. 

Independent Contractor Status At Risk For Emergency Physicians

As Congress tries to complete work for the year, several bills are being considered and funding must be found to offset their costs.  The Senate is considering a menu of funding mechanisms that could be used to pay for the legislation under consideration.   One source of offset funding under consideration is The Fair Playing Field Act of 2010.  Currently, the law allows businesses a safe harbor to treat workers as independent contractors for employment tax purposes if the company has had a reasonable basis for such treatment and has consistently treated such employees as independent contractors by reporting their compensation on Form 1099s.  

As proposed, The Fair Playing Field Act would require the Treasury Secretary to issue regulations or other prospective guidance clarifying the employment status of individuals for federal employment tax purposes.  It specifically allow the Internal Revenue Service the ability to individually question independent contractor status.

How would this impact the delivery of Emergency Care?


If enacted, this provision could have a negative impact on the delivery of emergency care by harming the ability of independent contractor emergency physicians to provide much-needed staffing of emergency departments throughout the country.  Restricting the ability of hospitals to staff their emergency departments using emergency physician independent contractors could have dire results for patients' access to lifesaving emergency care.


ACEP's Message:
Please contact your U.S. Senators and urge them not to attach The Fair Playing Field Act to any other bill during the lame duck period and/or use its provisions as an offset to legislation under consideration.

Thank you for your prompt action.

Questions: Contact Brad Gruehn in the ACEP Washington DC office.

NAIC will set medical-loss ratios by mid-August

Officials with the National Association of Insurance Commissioners (NAIC) last week said that they may be able to complete guidelines to define administrative and medical spending under medical-loss ratio (MLR) rules by mid-August. Under the overhaul bill, large health plans will be required to spend at least 85% of premiums on medical services and quality improvement, rather than administrative costs or profits,beginning on Jan. 1, 2011.  MLR for individual and small-group health plans must be at least 80%. Although the new law requires the recommendations to be made by year's end, federal health officials had urged the group to submit the draft guidelines by the end of May to give insurance companies ample time to adjust to the new regulations.
Earlier this week, Sen. John Rockefeller (D-WV) sent a letter to NAIC urging the group to resist lobbying efforts by insurers to ease the MLR standards. Following this letter, Sen. Al Franken (D-MN) and Rep. Bill Pascrell (D-NJ) held an event Thursday with "Health Care for America Now" to highlight the liberal group's report on industry lobbying efforts to influence medical loss ratio provisions in the health care reform overhaul law.

ACEP sends letter to Dr. Berwick, CMS

ACEP sent a letter to newly appointed CMS administrator Dr. Donald Berwick this week.  The letter outlines emergency physician concerns with several health care reform law implementation issues and highlights specific provisions of the new law that affect the delivery of emergency care.  The letter is as presented here:

 July 19, 2010

Donald M. Berwick, MD, MPP, FRCP 

Administrator Centers for Medicare & Medicaid Services

200 Independence Avenue, SW 

Washington, DC 20201

Dear Dr. Berwick:

On behalf of the American College of Emergency Physicians (ACEP) and our 28,000 members, I want to congratulate you on your appointment as Administrator of the Centers for Medicare & Medicaid Services (CMS). We look forward to working with you and your staff during this critical time that the new health care reform law regulations are being promulgated and we believe your clinical and health care policy experience give you a unique perspective on how these rules may impact the delivery of health care in America.

As an elected member of the Institute of Medicine (IOM), we're sure you are familiar with the 2006 IOM reports on the "Future of Emergency Care in the United States Health System," which detailed the challenges and concerns this nation faces in maintaining access to emergency medical care. As articulated in the IOM reports, America's emergency medical system as a whole is overburdened, underfunded and highly fragmented. As a result, ambulances are diverted from emergency departments once every minute on average and patients in many areas may wait hours, or even days, for hospital beds causing admitted patients to be boarded in the emergency department and redirecting precious emergency care resources away from incoming patients.

Emergency departments in this country handle more than 120 million patient visits per year and utilization of our services continues to steadily increase. As we have learned from observing the evolution of the Massachusetts medical care system, and its near universal coverage, emergency department utilization has actually increased in that state, rather than decreased, as many projected. We believe this is the result of a number of factors, including the federal mandate applied by the Emergency Medical Treatment and Labor Act (EMTALA), the lack of internal medicine physicians and general practitioners in the state, injuries and illnesses that occur after normal physician office business hours, and the fact that emergency departments continue to be the sole source of access to the health care system for many in that state, despite their insurance status. The one true lesson from Massachusetts is that coverage does not equal access.

Frankly, we are concerned that the combination of health care law reforms and the general delay in producing more primary care physicians could potentially overwhelm America's emergency departments, many of which currently operate at or above capacity on a regular basis. In particular, we would like to focus your attention of the followingprovisions of the "Patient Protection and Affordable Care Act" and the "Health Care and Education Reconciliation Act:"

Patient Protections (§10101) - This measure extends the "prudent layperson standard" to group health plans, or issuers of group or individual health plans, which offer hospital emergency department services, as well as eliminates the need for prior authorization and provides parity in coverage and patient co-payments for in- and out-of-network providers. We urge you to consider expanding these important patient protections to grandfathered health plans as well.

Hospital Value-Based Purchasing Program (§3001) – As this program advances, we want to ensure measures that will improve emergency department efficiencies are considered an essential component of this plan.

Improvements to PQRI System (§3002) – Please assure emergency physician measures continue to be available in the PQRI program and that these measures promote integration of clinical reporting using electronic health records, as well as demonstrate both meaningful use of electronic health records and quality of care furnished to the patient.

Value-Based Payment Modifier (Physician Fee Schedule) (§3007) – As CMS develops its own transparent episode grouper software; it must account for the unique delivery aspects of emergency services. In addition, it is critical that future risk-based measures developed by HHS ensure emergency physician measures are applied only to services that are within the control of the physicians.

Medicare Shared Savings Program (§3022) and Payment Bundling (§3023) – We urge you to recognize the important role emergency physicians play in providing the full continuum of care to Medicare beneficiaries. There must be commensurate recognition of these distinctive services as an integral part of any Accountable Care Organization (ACO) and through the coordination of bundled payments for an episode of care.

Distribution of Additional Residency Positions (§5503) – Due to the statutory obligation to provide at least 75% of the redistributed residency positions to primary care or general surgery, it is even more imperative that CMS provide as many of the remaining slots to emergency medicine residency programs. The expected immediate increase in emergency department visits demands that we accelerate the availability of residency-trained emergency physicians in our communities.

National Health Care Workforce Commission (§5101) – The growing disparity between the increasing number of emergency department visits each year and the decreasing number of emergency departments is alarming and of great concern to us and our constituents. We strongly encourage you to highlight the education and training needs of emergency medicine as the commission proceeds.

Patient-Centered Outcomes Research (§6301) – Due to the integral role of emergency physicians in providing all types of care for elderly patients, we ask that the emergency medicine perspective be represented in the identification of research priorities and the establishment and implementation of the research project agenda.

Extension of Medical Malpractice Coverage (§10608) – The law extends Federal Tort Claims Act liability protections to an officer, governing board member, employee or contactor of a free clinic. This is an important recognition of the unique role of those individuals who provide medical services without requiring compensation from the patient. As you know, the federal mandate of the Emergency Medical Treatment and Labor Act (EMTALA) requires emergency department physicians and many on-call specialists to provide similar, and in fact more comprehensive, services as those provided at free clinics with a substantial burden of uncompensated care. We urge you to review the unique requirements on physicians who provide EMTALA- related services and consider how the Federal Tort Claims Act may be applied to ensure the availability of these emergency and on-call physicians.

In addition, we are writing to request your assistance with another matter of significant importance to the coordination and delivery of high-quality medical care in America's emergency departments. Senator Debbie Stabenow (D-MI) has requested a formal response from HHS on her proposal to create a CMS working group that would be responsible for reviewing issues affecting access to emergency care and for developing standards and measures to reduce emergency department boarding and crowding, as well as ambulance diversion. Both of these issues can have dire consequences for patient care and we urge you to develop your response to her request as soon as possible.

Thank you for your consideration of these important issues. As you know, enactment of health care reform was only the first step. We look forward to working with you to ensure the implementation of these laws help our patients receive the best medical care possible, including maintaining access to lifesaving emergency medical services that are so vital to our communities.

Sincerely,

Angela Gardner, MD, FACEP

President

Am I A Traitor To Shake Hands With President Obama?

Photo courtesy of Dr. Andrew Bern

Yesterday I had the great pleasure of attending an event at the White House at the invitation of President Obama. I was surprised to learn that my attendance at the recent Presidential address in the East Room has caused some members to threaten to leave ACEP. It is of concern to me that some members feel this way, in spite of the existence of a well-publicized advocacy agenda that focuses on improved access to health care for all Americans. Being invited to and attending an event at the White House in no way implies wholesale endorsement of the President’s health care reform proposal or any other proposal.

Let me say that being invited to attend an event at the White House, being able to have a few words and shake the hand of the President of the United States, being able to have a short conversation with Secretary Sebelius, and having the opportunity to meet and discuss strategy with my counterparts in the major specialty organizations in medicine was a unique and productive opportunity. I think it important that representatives of the college be able to take advantage of such opportunities without fear of members quitting the college over the action, not the substance, of the visit.

A dose of reality is needed here. We are a 28,000 member organization. It is a matter of pride that we have developed a respected and requested voice in Washington D.C. health policy. However, declining an invitation to the White House would gain nothing for our patients and for our members. Hopefully, our members will understand and respect that fact.

Lastly, attending the President’s announcement of his new health care reform plan and applauding his request that Congress take action sooner rather than later does not imply that the American College of Emergency Physicians endorses carte blanche every aspect of that proposal. We will continue to work tirelessly to ensure that health reforms include provisions that improve the health and well-being of our patients and our member physicians.

It is a challenge to lead an organization as diverse and as divided as ours is at this moment in time. We are a representative organization, and I ask those of you with concerns about the policies of the college to speak up, get involved, make your perspective known to your Chapter president, the Council, your Board of Directors, and to me. One opinion will not have the opportunity to be heard in the density of Washington politics, but many voices joined together to promote better emergency care for all can change the course of history.

Please join me in that pursuit.

Personal thoughts on DC's latest

Just want to share a few thoughts with you ......

First - Take a deep breath.

Next - Remember the reason that health reform is being debated. The present system is NOT SUSTAINABLE. The status quo is not an option because the status quo cannot continue unchanged. The most generous optimists project that government sponsored health programs will be completely depleted by 2017.

As for what is going on in D.C., here are the latest options being discussed, along with my personal (editorial) comments:

1.) Include persons between 55 and 64 in the Medicare program.

Does this include everyone between the ages of 55 and 64, or just those who cannot obtain employer-sponsored coverage?

Does this mean that reimbursement will be at Medicare rates or at another rate?

2.) Private insurers would be required to spend 90% of premiums on clinical services and programs to improve care.

The obvious answer to this for insurers is to increase premiums so that the bottom line remains the same.

3.) The Office of Personnel Management, which currently oversees health policies for federal employees, would manage a new system of national health plans available in every state to people who do not receive coverage through their employer.

Absent from this discussion is the personal mandate. As I see it, there is no way increase the risk pool. In addition, there would need to be a considerable ramp-up of the OPM.

4.) The Office of Personnel Management would be empowered to negotiate rates with insurers.

OK. This is better than the House bill? This "renames" the public option and puts it squarely in the Executive sector, beyond the control of the Legislative Branch. Hmmmm..

5.) Buried in there somewhere is a "trigger" for the public option.

I am unable to verify the existence of this "trigger," so will refrain from comment.

This is a piecemeal approach to a public option, and much like Frankenstein, may exceed the expectations of the creators.

Lastly - What happens next is that CBO will have to score the various options. (Insiders say that several different combinations were sent for scoring.) That may take a week. In the meantime, Reid is looking for cloture on the manager's amendment, which includes compromises he has worked on for the past 10 days. Other cloture votes will be required subsequently. More concerning to me than all the above is the rumor that if the Senate is unable to reach an agreement by the end of the year, the Democrats would push for bypassing a conference bill and call for a direct endorsement of the House bill.

Just a few thoughts to help you sleep tonight,

Angela (Angela F. Gardner, MD, FACEP)

PS Discussions continue on an amendment that would allow direct importation of drugs from countries approved by the FDA. Obviously Pharma opposes.......but the savings could be immense.

Help with Health Care Reform

http://www.youtube.com/emergencycareforyou

Here's how you can help with health care reform.

Senate Stall

Tuesday in the Senate each political party offered an amendment to the chamber’s health reform bill. A partisan floor discussion ensued, delaying actual votes on the amendments. Two-and-a-half days after discussion of the bill began, not a single vote has been taken. One amendment addresses the need for better women’s health screening services and the other eliminates billions of dollars of spending in Medicare cuts.

This is D.C. politics at it’s best. The Republican strategy seems to be to draw out the discussions as long as possible, knowing that the longer the stall, the less chance that any form of health care reform will pass. The Democrats are working on a strategy to overcome the Republican parliamentary tricks. Sen. Tom Harkin (D-IA) confirmed in Roll Call today that one idea under consideration is the motion to table the Republican amendments, this requires only 51 votes instead of the 60 votes needed for cloture.

On this third day of debate without a single vote taken, frustration is mounting in the Chamber as well as among those whose lives and livelihoods are affected by the outcome.

Senate Begins Debate On Health Reform

The Senate began debate this afternoon on the Senate version of the health care reform legislation. Opening statements came from Majority Leader Harry Reid (D-NV) and Minority Leader Mitch McConnell (R-KY). The debate is expected to heat up tomorrow as the parties offer alternating amendments. Rumor on the Hill is that Reid will conduct much of the work for consensus on the bill in the privacy of his office. According to American Health Line (11/30/09) four moderate members of the Democratic Party have been requested to attend private meetings to discuss the public option - Sens. Mary Landrieu (D-LA), Joseph Lieberman (I-CT), Blanche Lincoln (D-AR), and Ben Nelson (D-NE).

Of interest to emergency physicians is an amendment proposed by Sen. Charles Schumer (D-NY) that would add 2,000 residency positions to the current cohort of 100,000. Although it is unclear from the amendment which specialties would benefit from the additional training positions, physicians have conveyed their concern to lawmakers that health reform legislation will increase the demand for medical care.

Separating reality from rhetoric is always a major task in Washington D.C., and the debate over health care in America has only made that task more difficult. What IS apparent, however, is that the White House has decided to weigh-in with its own public relations campaign. The following is a video featuring Vice President Joe Biden and the presidents of the American Association of Family Physicians and the American Nurses Association. You tell me.....reality or rhetoric?

http://www.youtube.com/watch?v=Ek8mkIt-IJo

Swine Flu Outbreak

The United States has seven confirmed cases of Swine Influenza A/H1N1, five in California and two in Texas, and nine suspect cases.  All of the seven confirmed cases had mild Influenza-Like Illness (ILI).  No deaths have been reported. 

 

Mexico reports three separate event locations – Mexicali, San Luis Potosi, and the Federal District of Mexico.  The government of Mexico began surveillance of ILI March 18, 2009.  Since then, 854 cases of pneumonia have been reported in Mexico City, with 59 deaths.  San Luis Potosi, in central Mexico, reports 24 cases of ILI, with three deaths.  Mexicali, near the border with the United States, has had four cases of ILI, with no deaths.  The majority of these cases have been in healthy young adults.

 

Of the Mexican cases, 18 are confirmed Swine Influenza A/H1N1.  Twelve of the 18 are identical to the Swine Influenza A/H1N1 viruses isolated from the patients with confirmed cases in California.  Swine flu viruses do not normally infect humans.  However, sporadic human infections have occurred in persons with direct exposure to pigs and in health care workers caring for persons with swine flu.  The Centers for Disease Control and Prevention (CDC) report 12 cases of human infection with swine flu between December 2005 and February 2009. 

 

The Swine Influenza A/H1N1 viruses isolated in this outbreak appear to be a strain not previously detected in pigs or humans, although these reports are preliminary.  Because there is reported spread of an animal virus in humans, and because of the geographical spread of multiple community outbreaks, these events are of concern, and the CDC is working to further characterize the viruses and provide guidance for treatment and prevention.

 

The symptoms of swine flu in humans are expected to be similar to the symptoms of seasonal human influenza, and include fever, malaise, lack of appetite, and coughing.  Some patients with the swine flu have reported runny nose, sore throat, nausea, vomiting, and diarrhea.  The H1N1 swine flu viruses are antigenically different from human H1N1 viruses, and vaccines for the human seasonal flu are not expected to provide protection from the swine flu viruses. 

 

To diagnose swine influenza A infection, a respiratory specimen must be collected and sent to the CDC for testing.  The specimen must be collected in the first 3-4 days of the illness, when the virus is shedding.  Testing may require an additional 3-4 days.  The CDC has not yet made recommendations for treating patients with an antiviral medication while the testing is pending, although these recommendations are expected later today. 

 

There are four different antiviral medications available for use in the United States for influenza:  amantadine, rimantadine, oseltamivir and zanamivir.  The most recent swine influenza viruses isolated from humans are resistant to amantadine and rimantadine.  At this time, the CDC recommends the use of oseltamivir or zanamivir for the treatment of infection with swine influenza viruses. 

 

The outbreak of “swine flu” in North America is a growing cause of concern in the World Health Organization (WHO) and in scientists worldwide concerned with pandemic prevention.  Recent improvements in pandemic preparedness may be tested by this emerging threat.   

 

 

 

HAPPY 100TH EPISODE!

This is my 100^th blog for the American College of Emergency Physicians.  For television shows, the 100^th episode is a cause for celebration.  One hundred broadcast episodes means that the show is a success for everyone involved, the producers, the sponsors, the actors, AND the writers. 

 

I began this “blogging” project in November of 2006, as the first official “blogger” for the American College of Emergency Physicians.  It was my idea that the leadership of the college should investigate ways to reach out to younger physicians using newer technologies and communication media.  Having a blog seemed so hip, so young, so whatever-the-word-of-the-moment is.

 

It has been a learning experience.  I learned how to host a blog.  I learned to write without an editor.  I learned that writing without an editor means everyone feels entitled to offer advice on your writing, both style and substance.  I learned that the harshest critics did not want to criticize me in the “comment” section, where others could see, but wished to make their views known via email.  I learned that being a blogger for an organization means that everyone has your email address.

 

I learned that producing three to five hundred coherent, intelligent-sounding words that will live in cyberspace forever on a consistent basis is a challenge not unlike rearing children - tedious, relentless, and unimaginably joyful.

 

I learned the distinct joy of trying on, trying out, and wearing out new technologies.  I have “pages” on every social network imaginable. I facebook, myspace, pulse/plaxo, link-in and now, I tweet on twitter.  (Writing without an editor also allows me to create brand-spanking-new verbs.)  I have thousands of friends-of-friends.  I actually believe that epidemiologists could learn a thing or two about communicable diseases from observing the spread of information through social networking devices.  I have even appeared on youtube more than once, and more than Mom watched it........or else Mom spent most of the last few months clicking and reclicking.

 

So, to my several hundred loyal readers, my occasional readers, and even my first-time readers, I say thank you.  Thank you for the chance to learn, to grow, to express myself, and to be a part of something much, much larger than myself.  Thank you for allowing me just another mature adult trying to stay connected to a rapidly changing world.  Most of all, thank you for birthing the inevitable result of 100 hundred successful episodes.......a spin-off!

 

ACEP now has bloggers from all walks of the (emergency physician) profession expressing themselves on The Central Line.  Check it out now at thecentralline.org.

 

.....and stay tuned for next season’s premiere.

 

 

 

Disclaimer:  Because I do believe in telling the truth, I have to admit that The Central Line is not my project.  It was lovingly crafted by very skillful ACEP staffers, and is written by a host of VERY talented emergency medicine professionals.  They are allowing me to link to the site and to claim credit for the idea because THIS IS MY BLOG AND THEY CAN’T STOP ME!  Seriously, they are allowing me to post to The Central Line during the debut at the Legislative and Advocacy Conference in Washington D.C. this week.  Check it out......and thanks for stopping by.     

ACEP Report Card Released Today

Economic woes and a failing health care system mean more people than ever before are relying on emergency care at a time when the nation is receiving a substandard C- grade for it support of emergency patients, according to the 2009 Report Card on the State of Emergency Medicine.  Dr. Nicholas Jouriles, president of the American College of Emergency Physicians (ACEP), which released the report, said policymakers can no longer remain oblivious to what is happening in emergency departments and called on President-elect Obama and the new Congress to make emergency patients a top priority in health care reform proposals.

 

“Emergency medical care is the most overlooked part of our health care system, and also the one that everyone depends on in their hour of need,” said Dr. Jouriles. “Policymakers must make strengthening emergency departments a national priority. The role of emergency care has never been more critical to this nation.  It is an essential community service that can no longer be taken for granted.  Ninety percent of the states in this Report Card earned substandard or near-failing grades!  That is a national disgrace. The nation’s emergency physicians have diagnosed the condition and prescribed the treatment. It’s time to get serious and take the medicine.”

 

States that showed the best support for emergency patients are Massachusetts, which ranked first with the highest overall grade and the only B, followed by the District of Columbia and Rhode Island (tied for 2nd) and Maryland (ranked 4th), which earned a B-.  States showing the least support for emergency patients are Arkansas, which ranked last (51^st) with the only overall D-, followed by the D states of Oklahoma (ranked 50^th), New Mexico (ranked 49^th), Oregon (ranked 47^th) and Idaho ranked 46^th).

 

The national grades are based on population-weighted averages for each of the categories, calculated using the same methodology used to calculate the overall state grades.  The overall grade for the nation is a weighted average of the nation’s category specific grades.  The Report Card measures state support for emergency patients — not the quality of care provided at specific emergency departments or hospitals.  The national category grades are: 

Access to Emergency Care:  D-

Quality and Patient Safety:  C+

Medical Liability Environment:  C-

Public Health and Injury Prevention:  C 

Disaster Preparedness:  C+.

 

ACEP’s first Report Card was released in 2006, and it contained 50 measures in four category areas.  The new Report Card has more than double the measures (116) and a new category for disaster preparedness, which makes it more comprehensive and useful, but not directly comparable to the previous Report Card.  It was made possible, in part, by funding from the Emergency Medicine Foundation, which gratefully acknowledges the support of The WellPoint Foundation and the Robert Wood Johnson Foundation.

 

The focus of health care reform efforts has been on the distant future at the expense of the right here, right now.  The emergency care system is a "ticking time bomb," accelerated by the financial crisis, plus physician shortages that won’t be solved for at least a decade.  Economic woes and a failing health care system mean more people than ever before will be relying on emergency care.  In an ideal world, everyone will have a medical home, but this won’t happen for many years to come, if ever.  Meanwhile, every minute of every day in this country people need emergency medical care, and that need is growing  our population ages and lives longer.  Emergency departments are already crowded to the point where patients experience life-threatening delays in care.  With crowding forecasts described as ‘catastrophic’ in the near future, the time for action is now.

 

Too Many Patients !?!

Visits to American emergency departments have reached a record high of 199.2 million in 2006, according to the “National Hospital Ambulatory Medical Care Survey: 2006 Emergency Department Summary”, published by the CDC (Centers for Disease Control and Prevention) this week. This is an increase of 4 million people coming to emergency departments for care since the previous report from 2005. That’s as if the entire city of Los Angeles went to the emergency department on top of the patients that were already being seen.

Over the past decade, the number of patients coming to the emergency department has increased 32%, from 90.3 million to 119.2 million. Emergency departments are now averaging 227 visits per minute. At the same time, the number of hospital emergency departments has dropped, from 4109 to 3833.

Here are some of the COMMON MYTHS:

It’s because of people being treated for “minor” complaints.

Actually, only 12.1% of the visits were characterized as patients who could wait 2 to 24 hours to be seen. (Nonurgent)

It’s because people without insurance are crowding the emergency department.

Actually, patients WITH private insurance represent the largest category of patients, 39%. Uninsured patients represented 17.4% of the patient pool.

It’s just because the population has grown.

Actually, the population-based ED utilization rate increased by 18%, from 34.2 visits per 100 persons in 2005 to 40.5 visits per 100 persons in 2006.

Here are some HARD TRUTHS:

There aren’t enough beds in the hospitals.

People wait hours and days in the ED after they have been admitted because there is no hospital room available for them. This is called boarding.

There aren’t enough nurses to take care of patients.

According to a report released by the American Hospital Association in July 2007, U.S. hospitals need approximately 116,000 RNs to fill vacant positions nationwide. This translates into a national RN vacancy rate of 8.1%.

There aren’t enough doctors.

Eleven (11) percent of all ambulatory medical care visits in the U.S. occur in the emergency department, and yet emergency physicians represent only 3.3% of active physicians.

As the population ages and as the economic situation worsens, these problems are unlikely to be corrected without purposeful, thoughtful change in the healthcare system.

Greetings from D.C.

Linda Lawrence, President of the American College of Emergency Physicians, opened the Leadership and Advocacy Conference today in Washington D.C. Over 400 leaders in emergency medicine gathered to discuss healthcare reform in today's political climate and to meet with elected officials on Capitol Hill. Dr. Lawrence recounted the numerous successes of the college over the past year, including the launching of a public website, the production of a consumer magazine (Vitalcare), the inception of a new Workforce Study, and the production of a second National Report Card on the State of Emergency Medicine. She spoke at length about ACEP's growing media presence. In 2004-2005, ACEP had 8,365 media hits. Media hits include television, radio, and newspaper items. During the past year, ACEP has had more than 35,000 hits, and is projected to have more than 50,000 hits by the end of the year. She exhorted the attendees to join ACEP's Spokesperson's Network and left the crowd energized and ready for the week's work.
Eleanor Clift, a Contributing Editor from Newsweek Magazine, spoke to the group at lunch, capping a morning of excellent speakers. The afternoon sessions were round table workshops covering issues important to emergency medicine, including boarding, quality measures, Medicare cuts, expert witness/ethics charges, disaster preparedness, and healthcare reform.
The evening began with "The Insider's Insider. Analysis 2008," delivered by Richard Clark. A reception followed, allowing the physician attendees from across the country to network and exchange ideas.
Tomorrow and Wednesday focus on advocacy, concluding with 300 scheduoled visits to Senators and Representatives. It promises to be an exciting week.

Emergency Medicine Heroes

This is ACEP's 40th anniversary..........40 years of advancing emergency care. As part of the year-long celebration, ACEP is honoring the unsung heroes of emergency medicine. Through a simple online process, anyone who has made a significant contribution to patients, to the community, to the specialty, or to others can be nominated for the honor.

Among those honored so far are:

Bernard Beckerman, MD, FACEP
Anthony J. Billittier, IV, MD, FACEP
Representative Douglas C. Cox, MD, FACEP
Michael I. Greenberg, MD, MPH, FACEP
Peter J. Jacoby, MD, FACEP
Mark J. Lowell, MD, FACEP
Edward A. Panacek, MD, MPH, FACEP
Carol Rivers, MD, FACEP
Ron M. Walls, MD, FACEP
Alan C. Woodward, MD, FACEP

For the full story on these honorees, check out the ACEP website at http://www.acep.org/

Greetings from Denver

Last week I had the opportunity to speak to the Colorado ACEP Chapter at their annual meeting in Denver. It was a pleasure to meet with the chapter members and hear their concerns for and about emergency medicine. The Colorado chapter has 490 members and about 40 of them are active leaders in national ACEP. Their concerns mirror those of many other areas of the country and include crowded emergency departments, lack of on-call specialists, and declining reimbursement. Fortunately, they have a decent professional liability environment for the time being.

I presented an ACEP update to the chapter, and we had an energetic discussion of national healthcare reforms, the ACEP Foundation, the new consumer magazine, and the national legislative agenda. We ended the day with a tour of Coors Field, the home of the Colorado Rockies. Our tour coincided with the press conference announcing that shortstop Troy Tulowitzki had signed a record-31-million-dollar-six-year contract. It seems that being in the World Series is good for the local economy.

Perhaps there are lessons to be learned from professional sports………..

In any case, it was a wonderful chapter visit, and I appreciate the hospitality of the Colorado chapter.

Board Considers Strategic Plan

The American College of Emergency Physicians Board of Directors spent their second full day in retreat mode today. The Board’s main item of business today was the development of the Strategic Plan for 2008-2009. The sessions involved small group brainstorming sessions and large group activities. The Priority Objectives identified for the coming year involve these main intentions:

1.) Ensure access to emergency medical care
2.) Promote quality care and patient safety
3.) Work to eliminate crowding and boarding
4.) Achieve meaningful medical liability reform
5.) Promote fair and equitable reimbursement
6.) Promote emergency medical preparedness for disasters
7.) Strengthen organizational vitality

Innovative as well as traditional strategies were discussed. Over the next few months, strategies and tactics will be added to the Strategic Plan, and it will be finalized.

The Board concluded its business day by meeting with the members of the Hawaii Chapter to discuss the issues important to the chapter. They had concerns about liability reform and the development of a trauma system on the island.

ACEP Retreat

The ACEP (American College of Emergency Physicians) Board of Directors is in retreat mode this week, developing a strategic plan for 2008. Pictured here are newly elected Board members Dr. Andy Sama (seated, left) and Dr. Andy Bern (standing). They are accompanied by newly-elected Council Vice-Speaker, Dr. Arlo Weltge (seated, right). The Board retreat kicked off with an orientation for these new members.

One of the first items on the busy agenda is a presentation of the 2007 membership survey. Twenty percent of ACEP members responded to a recent email survey asking them to evaluate ACEP, along with many of the related goods and services. The Board will then be challenged to find ways to improve the organization based on member needs. This promises to be an exciting week for the college as they grapple with the problems of access to care, professional liability, and department overcrowding.