COMMITTEE REPORTS
ACEP President’s Message By Vidor Friedman MD, FACEP ACEP President • FCEP Past-President
I am now nine months into my 13-month term as ACEP president. What a ride it has been! It feels like I am living in D.C.: I have been there once or twice a month since October, advocating for our specialty regarding out-of-network billing (surprise bills). While this advocacy is not the only thing I am doing as president this year, it is the most important by far! At the beginning of June, the “STOP Surprise Medical Bills Act” (S. 1541) was released in the Senate by the Price Transparency Workgroup (led by Sen. Bill Cassidy, R-LA). Additionally, draft language for the “Lower Health Care Costs Act” (S. 1895) passed through the Senate Health, Education, Labor and Pension committee (HELP Committee), the committee of jurisdiction. In the House, we have the “Protecting People from Surprise Medical Bills Act” (HR 3502) from Congressmen Ruiz & Roe, with a number of co-signers already and draft language from the Energy and Commerce Committee (E&C Committee). Of course, the White House has also chimed in with their suggestions. ACEP is working with all the leading proponents to bring our voice and perspective to the debate. We have a totally different economic model than all other physician specialties: one that is defined by our obligations under EMTALA (the Emergency Medicine Treatment and Labor Act of 1986). Emergency physicians are the only physicians who provide diagnosis and treatment prior to determining payment, 100% of the time. Because of this unique arrangement, we also provide far more uncompensated care than any other physician specialty. In 2010,
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We advocate for our patients every day at work, and now we must advocate for ourselves.
this pro bono care averaged $140,000 per year for each emergency physician, more than four times the next highest specialty. I am confident that today, the gap is even bigger. In 1986, the vast majority of people covered by commercial insurance had essentially first dollar health insurance coverage paid for by their employer. Over the past 10 years, this has changed considerably. The percentage of employed individuals with a high deductible plan has increased from 15% to 45%, and even those who do not have a high deductible plan have significant deductibles for emergency and out-of-network care. The unfunded public mandate of EMTALA requires that those who have commercial insurance essentially pay for those who cannot (uninsured & Medicaid patients). No one wants to pay for healthcare they have not directly received, and now that individuals are having to pay out-of-pocket for that care, they are understandably frustrated, upset and angry. So why is this so important to us in emergency medicine? Because this really is an effort by insurers to define all emergency billing, both in- and out-of-network. Huh? If you look at the language in the current HELP and E&C committee bills, the focus is on capping outof-network bills at the median in-network rate, which would have EMpulse Summer 2019
the effect of driving all contracts to the median in-network rate in short order. While that does not sound bad to policymakers, it would have a devastating impact on emergency medicine groups’ ability to contract at a reasonable rate. The effect of this legislation would be to rapidly shift all contracts to the median in-network rate or below, and the median would decrease every year thereafter. Fortunately, the Protecting People from Surprise Medical Bills Act (HR 3502) contains much more favorable language that mirrors the New York state legislation. ACEP is working hard to quickly garner as much support as possible for HR 3502 in the House and from other specialty societies within medicine. It is essential that there is strong support within the House for HR 3502, as we would like this bill to be adopted by the E&C committee. I urge you to contact your representative to support HR 3502, and ask your senator to support Sen. Cassidy’s amendments to the Lower Health Care Costs Act in the Senate. We advocate for our patients every day at work, and now we must advocate for ourselves. Please add your voice to ACEP’s in this fight. Protecting your future in emergency medicine—it’s what ACEP does for you every day! ■
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