ACEP Takes Sides in its Annual Report

Also: Behavioral health boarding crisis, subsidizing ED addiction care, moral injury, unions at Harvard & 18 million soon to lose Medicaid coverage.

Top of the Week

How many of the American College of Emergency Physicians’ Board of Directors do you think are employed clinically by a private equity-owned practice (eg: TeamHealth, Envision, SCP, etc)? The answer: zero. None out of 13.

When most physicians were practice owners (or on a partnership track), organizations representing emergency medicine could represent both the interests of physicians and their practices. However, only 27.9% of emergency physicians are practice owners, per the AMA’s 2020 survey. The other 72.1% are in a labor-owner relationship with the employer group. 

ACEP has had to make a choice between primarily representing the practice owners or the physicians (labor). ACEP’s 2022 Annual Report, published last week, makes it clear that ACEP has sided with practicing emergency physicians. To summarize key points of the report:

Scope of Practice: ACEP commissioned a survey, which showed that 79% of US adults most trust a physician to lead their medical care. State chapters have been (mostly) successfully combating scope-creep bills in state legislatures.

Boarding: ACEP collected stories from >150 physicians, which led to a high-profile letter to the White House about solving the hospital boarding crisis. 

Access to Reproductive Healthcare: ACEP issued a policy statement denouncing “legislative, regulatory, or judicial interference in the physician-patient relationship.” ACEP has been involved on the side of physicians in multiple related lawsuits. 

Physician Autonomy: ACEP filed an amicus brief in the AAEM-PG vs Envision case, supporting AAEM’s position that Envision violated California’s corporate practice of medicine laws. ACEP created the Independent EM Master Class to train physicians to start and lead new EM practices. 

Workforce: ACEP organized a Workforce Task Force, which has a 5-point initiative to address EM’s workforce challenges. This includes raising EM residency standards and “ensuring business interests do not supersede needs of educating the workforce.”

Reimbursement: As a member of the RUC, ACEP helped craft the new documentation process (de-emphasizing HPI & ROS elements) to better connect reimbursement with work done by EM physicians. 

Physician Wellness: ACEP advocated for the Lorna Breen Health Care Provider Protection Act (appropriating $135m for clinician mental health), which was passed into law in 2022. 

EM Practice

Special report in EM News: Tackling the Behavioral Boarding Crisis

AAEM strongly supports the FTC’s proposed ban on non-competes. 

ACEP’s 8-page letter about workforce issues was sent to the US Senate Health, Education, Labor, and Pensions Committee. “We appreciate the opportunity to share some of the key workforce issues for emergency medicine that also affect the entire healthcare workforce. These include stabilizing the healthcare safety net by addressing conditions and factors that lead to ‘boarding’ and crowding in emergency departments, a crisis overwhelming EDs across the country, straining the physician and nursing workforce and even causing avoidable patient deaths; protecting emergency physicians, nurses, and staff from violence in the ED; preserving high-quality emergency care; improving access to care for those in a mental health crisis, providing more pathways to recovery for patients with substance use disorders; and, ensuring fairness and stability in Medicare physician payments through necessary reforms and improvements, among many others.”

Pennsylvania is subsidizing opioid addiction care in the state’s EDs. 

Report from Vanderbilt Children’s Hospital after the Nashville school shooting. 

Layoffs at Envision

House of Medicine

Deep dive into the 2023 Residency Match, with Drs. Bryan Carmody & Jeremy Faust.

Residents at Mass General Brigham are moving towards unionization.

Exploration of moral injury in medicine. 

An under-discussed cause of physician burnout and early retirement: malpractice lawsuits against physicians.

Physicians now are working fewer hours compared with twenty years ago.

What will happen to the 18 million people who will lose Medicaid coverage due to the Public Health Emergency’s expiration? Urban Institute report

Hospitals & Health Systems

Most of Mississippi’s hospitals are under financial strain, partly due to the state choosing not to accept Medicaid expansion funds. 

Exploration of financial options for unprofitable rural hospitals. (Podcast version)

Billings Clinic is cutting physician pay. 

Hospital price transparency efforts still have a long way to go. 

Nursing & Allied Health

Several state legislatures are considering nurse staffing ratio bills.

Travel nurse fees are decreasing, partly due to state-level pushback vs staffing agencies.  

The Dispo

When non-clinicians run hospitals:

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