ACEP 2019 Update

1. ACEP 2019 Update

2. Strategic Plan Goal 1: Reform and improve the delivery system for acute care Goal 2: Enhance member value and engagement

5. National and Chapter Representation Members have a valued voice at both levels VALUABLE PARTNERSHIP ACEP collaborates with its 53 chapters to make sure we present a unified voiceas we advocate for emergency physicians and grow the profession. ACEP Chapter Services offer: • Advocacy support • Financial assistance • Marketing/publishing tools • Leadership development • Leader visit program BETTER TOGETHER

7. ACEP Committees, Powered by Volunteers • Academic Affairs Committee • Audit Committee • Awards Committee • Bylaws Committee • Bylaws Interpretation Committee • Clinical Emergency Data Registry (CEDR) Committee • Clinical Policies Committee • Coding & Nomenclature Advisory Committee • Compensation Committee • Disaster Preparedness & Response Committee • Education Committee • EM Practice Committee • EMS Committee • Ethics Committee • Federal Government Affairs Committee • Finance Committee • Medical-Legal Committee • Membership Committee • National Chapter Relations Committee • Pediatric EM Committee • Public Health & Injury Prevention Committee • Public Relations Committee • Quality & Patient Safety Committee • Reimbursement Committee • Research Committee • State Legislative/Regulatory Committee • Well-Being Committee

8. ACEP Sections: Resources Tailored to Your Interests 32,927 total section members Largest sections: Young Physicians: 15,230 International: 2,563 Women Emergency Physicians: 1,360 Emergency Ultrasound: 1,346 Critical Care: 1,089 EMS: 1,086

9. Federal Advocacy • A leading voice on the opioid crisis • Addressing drug shortages • Battling dangerous insurance policies • Developing alternative payment models

10. Four EM-Focused Bills Signed into Law in 2018 • The Protecting Patient Access to Emergency Medications Act  • The Sharing Health Information to Ensure Lifesaving Drug Safety (SHIELDS) Act • The Alternatives to Opioids (ALTO) in the Emergency Department Act  • The Preventing Overdoses While in Emergency Rooms (POWER) Act

11. 18 Comment Letters Submitted in 2018 • 2019 Medicare Advantage and Part D Proposed Rule • 2019 Medicare Part C and D Advance Notice and Draft Call Letter • Definition of Employer for Association Health Plans (AHPs) Proposed Rule • Reimbursement for Emergency Treatment Interim Final Rule • Protecting Statutory Conscience Rights in Health Care Proposed Rule • Short-Term, Limited-Duration Insurance Plans Proposed Rule • DEA Proposed Rule on Controlled Substances Quotas • Exemptions to Methods for Assuring Access to Covered Medicaid Services Proposed Rule • Response to Request for Information on Direct Provider Contracting Models • CY 2019 Medicare Inpatient Prospective Payment System (IPPS) Proposed Rule • 2019 Medicare PFS and MACRA/QPP Proposed Rule • CY 2019 OPPS Proposed Rule • Proposed Rule on Medicare ACO Program • FDA Proposed Rule on Bulk Drug Substances • Inadmissibility on Public Charge Grounds Proposed Rule • FDA Public Meeting on Community Use of Naloxone • State Relief and Empowerment (i.e. Section 1332) Waivers • IPI Drug Pricing Model

12. Due Process Legislation and Regulations • Sent letters and helped introduce legislation • ACEP, AAEM, ACOEP, AOA, ACMT, CORD, EMRA, and SAEM join together to support the introduction of federal legislation to protect emergency physicians’ right to due process in the workplace • Due process for EMS leaders • Signed on to a letter to CMS administrator to urge her to take action to guarantee due process rights for physicians

13. State Advocacy • Mandatory CME • Prudent layperson • Out-of-network legislation • Opioid /PDMP • Medical liability reform • Strike teams to assist

14. State Advocacy • Attacks in 26 states on prudent layperson/OON • Ohio passed an updated “apology” law last year; Missouri legislation this year would require proof of “gross negligence” • Opposition to CME mandates (pain management and opioids, domestic violence, cultural sensitivity mandatory training, etc.) ongoing in many states

15. Payment Battles • OON billing/surprise coverage • RUC review of ED E/M Codes • Down-coding violating prudent layperson • ERISA failure to pay • APM (AUCM)(Acute Unscheduled Care Model) • Sued Anthem • ECG and -25 modifiers • Documentation Guideline Reform

16. Out-of-Network Billing Battle ACEP’s Framework for Protecting Patients When Emergency Care is Out-of-Network • Expanded patient protections that truly take the patient out of the middle • Take the patient out of insurer-provider billing disputes • Alternative Dispute Resolution (ADR) • Commission on Access to Quality and Affordable Emergency Care

17. Let’s Eat! ACEP worked with The Joint Commission to clarify that eating and drinking in ED workstations is permissible. Resources to help you advocate at your hospital available at www.acep.org/letseat.

18. Quality Measure Development and Defense • Sepsis bundle • NQF chief complaint measures • Appropriate use criteria • MIPS/MACRA compliance through CEDR and quality measures • ED throughput/wait-time measures

19. Improving Patient Care ASA developed a new statement on procedural sedation that would limit our practice. ACEP countered with a new consensus practice guideline for unscheduled procedural sedation. New clinical policies related to: • Non–ST-Elevation Acute Coronary Syndromes • Acute Venous Thromboembolic Disease • Reperfusion Therapy for STEMI • Psychiatric Patient • Early Pregnancy

20. New bedside tools Improving Patient Care New bedside tools app launching for members Spring 2019!

21. Advancing patient care, together.

22. Coalition to Oppose Medical Merit Badges ACEP has longstanding policy stating that board certified emergency physicians should not be required to take short course medical merit badges. • ACLS • APLS • PALS • ATLS "The Coalition finds no rational justification to require medical merit badges for board-certified emergency physicians who maintain their board certification. Our committed professional organizations provide the best opportunities for continuous professional development, and medical merit badges dismiss the quality of those educational efforts." Because of ACEP, you no longer need to take ATLS each year and do 15 hours of CME to work in a Level 1 Trauma Center. ACEP|AAEM |AAEM/RSA |ABEM|ACOEPAOBEM|AACEM|CORD|EMRA|SAEM

23. Until Help Arrives • Course for citizen bystanders of traumatic incidents • HO-CPR • Scene safety

24. Workforce Initiatives Are we training the right number of emergency physicians? With the right skillset? New: EM Workforce Task Force New: Scope of Practice Task Force Supervision and scope of practice of Advanced Practice Providers? Emergency Telemedicine Section What is the role of telemedicine? EMS-Prehospital Care Section What is the future role of EMS?

25. Communication • acep.org • ACEP Now • EngagED • EM Today • Weekend Review • Social Media • Leadership Report • Videos • Podcasts

26. ACEP Board Diversity and Inclusion • Most diverse Board in ACEP history • 2018: Most women ever elected to the Board • Settings represented: • 10 academic • 6 small group • 5 large group • 2 military

27. Leadership Development • Emergency Department Directors Academy • Reimbursement/Coding/RUC Fellowship • AMA leadership grid • LAC2019 Leadership Program

29. Social Media PROS CONS Say anything Anonymous No accountability Immediate Anyone can comment

30. Advice in the Social Media Age • Follow conversations. • Acknowledge significant concerns. • Listen and learn. • Quickly correct false assertions/accusations. • Respond, or things will grow. • Have strong and resolute accountability measures. • Be polite and respectful.

31. Questions?