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Chapter 1. Insurance Basics

  1. Kaiser Family Foundation. Timeline: History of Health Reform in the U.S. https://kaiserfamilyfoundation.files.
  2. Klees BS, Wolfe CJ, Curtis CA. Brief Summaries of Medicare & Medicaid: Title XVIII and Title XIX of The Social Security Act as of November 20, 2017.
  3. Pear R. Medicare’s Trust Fund Is Set to Run Out in 8 Years. Social Security. The New York Times. June 5, 2018.
  4. Altman D, Frist WH. Medicare and Medicaid at 50 Years: Perspectives of Beneficiaries, Health Care Professionals and Institutions, and Policy Makers. JAMA. 2015;314(4):384-395.
  5. Kaiser Family Foundation. Medicaid Expansion Enrollment.,%22sort%22:%22asc%22%7D.
  6. Reports & Evaluations.
  7. Medicaid and Chip Enrollment Data Report.
  8. Kaiser Family Foundation. Status of State Action on the Medicaid Expansion Decision.,%22sort%22:%22asc%22%7D.
  9. Reinhardt UE. Is Employer-Based Health Insurance Worth Saving? The New York Times. May 22, 2009.
  10. Timiraos N. Elevated Level of Part-Time Employment: Post-Recession Norm? The Wall Street Journal. Nov. 12, 2014.
  11. Kaiser Family Foundation. State Health Facts: Total Marketplace Enrollment and Financial Assistance.
  12. Kaiser Family Foundation. Number of Issuers Participating in the Individual Health Insurance Marketplaces.,%22sort%22:%22asc%22%7D.
  13. Kaiser Family Foundation. Summary of the Affordable Care Act.
  14. Congressional Budget Office. Federal Subsidies for Health Insurance Coverage for People Under Age 65: 2018 to 2028.
  15. Liptak A. Supreme Court Upholds Health Care Law, 5-4, in Victory for Obama. The New York Times. June 29, 2012.
  17. Kaiser Family Foundation. The Coverage Gap: Uninsured Poor Adults in States that Do Not Expand Medicaid.
  18. Centers for Medicare & Medicaid Services. Information on Essential Health Benefits (EHB) Benchmark Plans.
  19. Kaiser Family Foundation. Key Facts about the Uninsured Population.

Chapter 2. Insurance Challenges

  1. Bahney A. 40% of Americans can’t cover a $400 emergency expense. CNN Money.
  2. Osborn R, Doty MM, Moulds D, Sarnak DO, Shah A. Older Americans Were Sicker And Faced More Financial Barriers To Health Care Than Counterparts In Other Countries. Health Aff (Millwood). 2017;36(12): 2123-2132.
  3. Covered California. The Roller Coaster Continues — The Prospect for Individual Health Insurance Markets Nationally for 2019: Risk Factors, Uncertainty and Potential Benefits of Stabilizing Policies.
  4. Commonwealth Fund. The Effect of Eliminating the Individual Mandate Penalty and the Role of Behavioral Factors.
  5. Health Payer Intelligence. Individual Insurance Premiums to Soar Without Policy Actions.
  6. Mangan D. Number of Americans without health insurance spiked by more than 3 million under Trump. CNBC. Jan. 16, 2018.
  7. Congressional Budget Office. The Effects of Terminating Payments for Cost-Sharing Reductions.
  8. Kaiser Family Foundation. Status of State Action on the Medicaid Expansion Decision.,%22sort%22:%22asc%22%7D.
  9. Goldsten A. Aetna exiting all ACA insurance marketplaces in 2018. The Washington Post. May 10, 2017.
  10. Kaiser Family Foundation. 2017 Premium Changes and Insurer Participation in the Affordable Care Act’s Health Insurance Marketplaces.
  11. Kaiser Family Foundation. Insurer Participation on ACA Marketplaces, 2014-2018.
  12. National Center for Health Statistics. High-deductible health plans and financial barriers to health care: Early release of estimates from the National Health Interview Survey, 2016.
  13. Rand Corporation. The Health Insurance Experiment: A Classic RAND Study Speaks to the Current Health Care Reform Debate.
  14. Cuckler GA, Sisko AM, Poisal JA, et al. National health expenditure projections, 2017-26: Despite uncertainty, fundamentals primarily drive spending growth. Health Aff (Millwood). 2018;37(3):482-492.
  15. Board of Governors of the Federal Reserve System. Report on the Economic Well-Being of U.S. Households in 2017.
  16. CDC National Center for Health Statistics. High-deductible Health Plans and Financial Barriers to Medical Care: Early Release Estimates from the National Health Interview Survey, 2016.
  17. Centers for Medicare & Medicaid Services. CMS announces new policy guidance for states to test community engagement for able-bodied adults.
  18. Centers for Medicare & Medicaid Services. Speech: Remarks by Administrator Seema Verma at the National Association of Medicaid Directors (NAMD) 2017 Fall Conference.
  19. Health Affairs. Administration Moves To Liberalize Rules On Short-Term, Non-ACA-Compliant Coverage.
  20. Presidential Executive Order Promoting Healthcare Choice and Competition Across the United States. Donald J. Trump, Oct 12, 2017.
  21. Avalere. Plans with More Restrictive Networks Comprise 73% of Exchange Market.
  22. Japson B. Employer Plans Join Obamacare in Narrowing Doctor Networks for 2018. Forbes. Aug 27, 2017
  23. Hing E, Decker SL, Jamoom E. Acceptance of new patients with public and private insurance by officebased physicians: United States, 2013. NCHS Data Brief. 2015;195:1-8.

Chapter 3. Utilization of Emergency Services

  1. Shen Y, Hsia R. Association Between Emergency Department Closure and Treatment, Access, and Health Outcomes Among Patients With Acute Myocardial Infarction. Circulation. 2016;134(20):1595-1597.
  2. Centers for Disease Control and Prevention. National Hospital Ambulatory Medical Care Survey: 2015 Emergency Department Summary Tables.
  3. Finkelstein A, Taubman S, Allen H, Wright B, Baicker K. Effect of Medicaid Coverage on ED Use — Further Evidence from Oregon’s Experiment. N Engl J Med. 2016;375(16):1505-1507.
  4. Sommers B, Blendon R, Orav E, Epstein A. Changes in Utilization and Health Among Low-Income Adults After Medicaid Expansion or Expanded Private Insurance. JAMA Intern Med. 2016;176(10):1501.
  5. Morganti K, Bauhoff S, Blanchard J et al. The Evolving Role of Emergency Departments in the United States. RAND Corporation. 2013:1-79.
  6. Burke L, Wild R, Orav E, Hsia R. Are trends in billing for high-intensity emergency care explained by changes in services provided in the emergency department? An observational study among US Medicare beneficiaries. BMJ Open. 2018;8(1):e019357.
  7. Hsia R, Srebotnjak T, Kanzaria H, McCulloch C, Auerbach A. System-Level Health Disparities in California Emergency Departments: Minorities and Medicaid Patients Are at Higher Risk of Losing Their Emergency Departments. Ann Emerg Med. 2012;59(5):358-365.
  8. Hsia R, Shen Y. Rising Closures Of Hospital Trauma Centers Disproportionately Burden Vulnerable Populations. Health Aff (Millwood). 2011;30(10):1912-1920.
  9. Crandall M, Sharp D, Unger E et al. Trauma Deserts: Distance From a Trauma Center, Transport Times, and Mortality From Gunshot Wounds in Chicago. Am J Public Health. 2013;103(6):1103-1109.
  10. Anderson ML, Dobkin C, Gross T. The Effect of Health Insurance on Emergency Department Visits: Evidence from an Age-Based Eligibility Threshold. Rev Econ Statistics. 2014;96(1):189-195.

Chapter 4. The Impact of EMTALA

  1. Rosenbaum S, Cartwright-Smith L, Hirsh J, Mehler PS. Case studies at Denver Health: ‘patient dumping’ in the emergency department despite EMTALA, the law that banned it. Health Aff (Millwood). 2012;31(8):1749-56.
  2. Rosenbaum S. The enduring role of the Emergency Medical Treatment and Active Labor Act. Health Aff (Millwood). 2013;32(12):2075-81.
  3. Research ACfHP. Physician Marketplace Report: The Impact of EMTALA on Physician Practices. 2003.
  4. Examination and treatment for emergency medical conditions and women in labor act. 42 U.S.C. § 1395dd et seq, 1986.
  5. 42 U.S.C. § 1395dd(a).
  6. 42 C.F.R. § 489.24(d).
  7. 42 USC 1395dd(e)(1).
  8. Medicare program; clarifying policies related to the responsibilities of Medicare-participating hospitals in treating individuals with emergency medical conditions. Final rule. Fed Regist. 2003;68(174):53222-64.
  9. Medicare Program; Emergency Medical Treatment and Labor Act (EMTALA): Applicability to Hospital Inpatients and Hospitals with Specialized Capabilities. Fed Regist. 2012;77(22):5213-5217.
  10. EMTALA: Emergency Medicine Risk Management. Irving, TX: American College of Emergency Physicians.1997;353-377.
  11. Bryant v. Adventist, infra note 28 at 1166.
  12. Moses v. Providence Hospital and Medical Centers, Inc. 561 F.3d 573 (6th Circuit, 2009).
  13. 42 C.F.R. § 489.24(a)(1)(i).
  14. 42 C.F.R. § 489.24(a)(1)(ii).
  15. 42 C.F.R.Section 1867 [42 U.S.C. 1395dd].
  16. 42 C.F.R. § 489.24(b).
  17. Torretti v. Main Line Hospitals Inc. 3rd Circuit. Sept. 2, 2009.
  18. Bryant v. Adventist Health System West. 9th Circuit. May 20, 2002.
  19. Llewelyn v. Schneck Medical Center. (S.D. Ind.) Nov. 9, 2007.
  20. Medicare and State Health Care Programs: Fraud and Abuse; Revisions to the Office of Inspector General’s Civil Monetary Penalty Rules. Final rule. Fed Regist. 2016;81(235):88334-65.
  21. Terp S, Wang B, Raffetto B, Seabury SA, Menchine M. Individual Physician Penalties Resulting From Violation of Emergency Medical Treatment and Labor Act: A Review of Office of the Inspector General Patient Dumping Settlements, 2002-2015. Acad Emerg Med. 2017;24(4):442-446.
  22. Zuabi N, Weiss LD, Langdorf MI. Emergency Medical Treatment and Labor Act (EMTALA) 2002-15: Review of Office of Inspector General Patient Dumping Settlements. West J Emerg Med. 2016;17(3):245-251.
  23. Personal communication from Mary Ellen Palowitch MHA RN, EMTALA Technical Lead - Hospital Program Analyst Survey & Certification Group – Division of Acute Care Services Centers for Medicare & Medicaid Services.
  24. Institute of Medicine, supra note 18, at xv (“An unintended but predictable consequence of this legal duty [created by EMTALA] is a system that is overloaded and underfunded to carry out its mission.”).
  25. TRENDWATCH CHARTBOOK, supra note 22, at A-20 (reporting the number of community hospitals in the U.S. declining by 7% from 1991 to 2011); Michelle Nicole Diamond, Note, Legal Triage for Healthcare Reform: The Conflict Between the ACA and EMTALA, 43 COLUM. HUM. RTS. L. REV. 255, 283 (2011).
  26. TRENDWATCH CHARTBOOK, supra note 22, at A-20, A-28. 63. Id. at A-28. Compared to the loss of 7% of hospitals during this same time period. See supra note 33 and accompanying text.
  27. Fosmire S. EMTALA FAQ.
  28. Rudkin SE, Langdorf MI, Oman JA, Kahn CA, White H, Anderson CL. The worsening of ED on-call coverage in California: 6-year trend. Am J Emerg Med. 2009;27(7):785-91.
  29. § 2590.715-2719A Patient protections. (b)(4)(i).
  30. Patient Protection and Affordable Care Act, 42 U.S.C. § 18001 et seq.
  31. Centers for Medicare & Medicaid Services. State Operations Manual Appendix V - Interpretive Guidelines — Responsibilities of Medicare Participating Hospitals in Emergency Cases. Rev 60.
  32. Lipton S. EMTALA - Why Don’t We Have All the Answers?: Remaining Areas of Concern for Hospitals and Physicians. J Compliance Health Care. 2005;1:13-20,83.
  33. Relias Media. Remove Non-emergent Patients from the ED with Care.
  34. Friedrich et al v. South County Hospital Healthcare System et al. 1st Circuit.
  35. 28 U.S.C. § 1346(b).
  36. 28 U.S.C. Pt.VI Ch.171.
  37. U.S. General Accounting Office. EMTALA Administration and Enforcement Issues.
  38. P.L. 106-554. A future study will examine providers’ uncompensated care burden.
  39. ACEP. EMTALA Fact Sheet.
  40. McKinsey Global Institute. Report: Accounting for the cost of US health care: A new look at why Americans spend more.
  41. Agency for Healthcare Research and Quality. Emergency Room Services-Mean and Median Expenses per Person With Expense and Distribution of Expenses by Source of Payment: United States, 2006. Medical Expenditure Panel Survey Household Component Data. Generated interactively. (March 04, 2013).
  42. Hsia RY, Niedzwiecki M. Avoidable emergency department visits: a starting point. Int J Qual Health Care. 2017;29(5):642-645.
  43. Rui P, Kang K. National Hospital Ambulatory Medical Care Survey: 2014 Emergency Department Summary Tables.

Chapter 5. Crowding and Boarding

  1. Kulstad EB, Kelley KM. Overcrowding is associated with delays in percutaneous coronary intervention for acute myocardial infarction. Int J Emerg Med. 2009;2(3):149-154.
  2. Reznek MA, Murray E, Youngren MN, Durham NT, Michael SS. Door-to-Imaging Time for Acute Stroke Patients Is Adversely Affected by Emergency Department Crowding. Stroke. 2017;48(1):49-54.
  3. Gaieski DF, Agarwal AK, Mikkelsen ME, et al. The impact of ED crowding on early interventions and mortality in patients with severe sepsis. Am J Emerg Med. 2017;35(7):953-960.
  4. Smith GB. Lincoln Hospital under investigation over patient who went into coma hours after ER staff lost track of him. New York Daily News. Sept. 26, 2017.
  5. The Associated Press. Esmin Green, who died on Brooklyn hospital floor, perished from sitting. New York Daily News. July 11, 2008.
  6. Association of American Medical Colleges. Research Shows Shortage of More than 100,000 Doctors by 2030.
  7. HCUP US. Trends in Hospital Emergency Department Visits by Age and Payer, 2006-2015 #238.
  8. Nikpay S, Freedman S, Levy H, Buchmueller T. Effect of the Affordable Care Act Medicaid Expansion on Emergency Department Visits: Evidence From State-Level Emergency Department Databases. Ann Emerg Med. 2017;70(2):215-225.
  9. Joint Commission. Standard LD.04.03.11.
  10. Farley HL, Kwun R. Emergency Department Crowding: High Impact Solutions. Reviewed by the ACEP Board of Directors, June 2016.
  11. Saxe M. Best practices: improving patient satisfaction by posting wait times. Urgent Matters. Dec. 17, 2013.
  12. Limb M. Quarter of hospital emergency visits are due to inability to get appointments. BMJ. 2014;348:g4332.
  13. Sadowski LS, Kee RA, VanderWeele TJ, Buchanan D. Effect of a housing and case management program on emergency department visits and hospitalizations among chronically ill homeless adults: a randomized trial. JAMA. 2009;301(17):1771-1778.
  14. Young GP, Wagner MB, Kellerman AL, et al. Ambulatory visits to hospital emergency departments. JAMA. 1996;276(6):460-465.
  15. Patient Protection and Affordable Care Act. P.L. 111-148 as amended.
  16. University of Rochester. Telemedicine Could Eradicate Many Expensive ED Visits.
  17. Wiler JL, Gentle C, Halfpenny JM, et al. Optimizing emergency department front-end operations. Ann Emerg Med. 2010;55(2):142-160.
  18. McNaughton C, Self WH, Jones ID, et al. Emergency department crowding and the use of nontraditional beds. Am J Emerg Med. 2012;30(8):1474–1480.
  19. Rooney KD, Schilling UM. Point-of-care testing in the overcrowded emergency department – can it make a difference? Crit Care. 2014;18(6):692.
  20. Lamb L, Kashani P, Ryan J, et al. Impact of an in-house emergency radiologist on report turnaround time. CJEM. 2015;17(1):21-26.
  21. Arya R, Salovich DM, Ohman-Strickland P, et al. Impact of scribes on performance indicators in the emergency department. Acad Emerg Med. 2010;17(5):490-494.
  22. Marshall JS, Verdick CM, Tanaka MS, et al. Implementation of medical scribes in an academic emergency department: effect on emergency department throughput, clinical productivity, and emergency physician professional fees. Acad Emerg Med. 2012;60(4S):S105.
  23. Ward MJ, Landman AB, Case K, et al. The effect of electronic health record implementation on community emergency department operational measures of performance. Ann Emerg Med. 2014;63(6):723-730.
  24. Bristow DP, Herrick CA. Emergency department case management: the dyad team of nurse case manager and social worker improve discharge planning and patient and staff satisfaction while decreasing inappropriate admissions and costs: a literature review. Lippincott Case Manag. 2002;7(6):243-251.
  25. 25. Turner SB, Stanton MP. Psychiatric case management in the emergency department. Prof Case Manag. 2015;20(5):217-227.
  26. 26. New England Health Care Institute. Waste and Inefficiency in the Health Care System — Clinical Care: A Comprehensive Analysis in Support of System-wide Improvements.
  27. Pollaris G, Sabbe M. Reverse triage: more than just another method. Eur J Emerg Med. 2015;0(0):1-8.
  28. McClelland MS, Lazar D, Sears V, Wilson M, Siegel B, Pines JM. The past, present, and future of urgent matters: lessons learned from a decade of emergency department flow improvement. Acad Emerg Med.2011;18(12):1392-1399.
  29. Howell E, Bessman E, Kravet S, et al. Active bed management by hospitalists and emergency department throughput. Ann Int Med. 2008;149(11):804-810.
  30. Murphy SO, Barth B, Carlton EF, et al. Does an ED flow coordinator improve patient throughput? J Emerg Nurs. 2014;40(6):605-612.
  31. Barrett L, Ford S, Ward-Smith P, et al. A bed management strategy for overcrowding in the emergency department. Nurs Econ. 2012;30(2):82-85.
  32. Powell ES, Khare RK, Venkatesh AK, et al. The relationship between inpatient discharge timing and emergency department boarding. J Emerg Med. 2012;42(2):186-196.
  33. Khanna S, Boyle J, Good N, et al. Early discharge and its effect on ED length of stay and access block. Stud Health Technol Inform. 2012;178:92-98.

Chapter 6. Non-Emergent Visits and Challenges to the Prudent Layperson Standard

  1. Hsia RY, et al. Do mandates requiring insurers to pay for emergency care influence the use of the emergency department? Health Affairs. 2006;25(4):1086-1094.
  2. Hall MA. The impact and enforcement of prudent layperson laws. Ann Emerg Med. 2004:43(5):558-566.
  3. Westmoreland TM. SMD Letter: Managed Care Provisions Regarding Coverage of Emergency Services by MCOs. April 18, 2000.
  4. Balanced Budget Act of 1997, (PL 105-33, Aug. 5, 1997).
  5. Heimoff S. Will Prudent Layperson Please Report to the ER. Managed Care. May 1999.
  6. Blachly L. ACEP Initiative Supporting ‘Prudent Layperson’ Standard Becomes Law in Health Care Reform Act. ACEP News. May 2010.
  7. National Center for Health Statistics. Health, United States, 2016-With Chartbook on Trends in Health. May 2017. Hyattsville, MD. 2017
  8. Agency for Health care Research and Quality. Total Health Services-Mean and Median Expenses per Person with Expense and Distribution of Expenses by Source of Payment: United States, 2014. Medical Expenditure Panel Survey Household Component Data. Generated interactively.
  9. National Hospital Ambulatory Medical Care Survey. 2015 Emergency Department Summary Tables.
  10. McCaig LF, Nawar EW. National Hospital Ambulatory Medical Care Survey: 2004 emergency department summary. Adv Data 2006; undefined: pp. 1-29.
  11. Nourjah P. National Hospital Ambulatory Medical Care Survey: 1997 emergency department summary. Adv Data 1999; undefined: pp. 1-24.
  12. Young GP, Wagner MB, Kellermann AL, Ellis J, Bouley D. Ambulatory visits to hospital emergency departments. Patterns and reasons for use. 24 Hours in the ED study group. JAMA. 1996;276:460-465.
  13. Raven MC, Lowe RA, Maselli J, Hsia RY. Comparison of presenting complaint vs discharge diagnosis for identifying “nonemergency” emergency department visits. JAMA. 2013;309(11):1145-53.
  14. Chou SC, Gondi S, Baker O, et al. Analysis of a commercial insurance policy to deny coverage for emergency department visits with nonemergent diagnoses. JAMA Network Open. 2018;1(6):e183731.
  15. Pines JM, Schlicher N, Presser E, George M, McClellan M. Washington State Medicaid: Implementation and Impact of “ER is for Emergencies” Program. Center for Health Policy at Brookings; The Brookings Institution.
  16. Kentucky Spirit Health Plan. Letter to Kentucky Spirit Provider. May 31, 2012. MS. 201 East Main Street, Lexington, KY.
  17. Notice of Intent. Louisiana Register. March 20, 2014;40(3):652.
  18. Corbett T. Pennsylvania Department of Public Welfare. Healthy Pennsylvania Section 1115. Feb. 19, 2014.
  19. Murphy T. Is it an emergency? Insurer makes patients question ER visit. Associated Press News.
  20. Livingston S. Hospitals and patients feel the pain from Anthem’s ED policy. Modern Healthcare. December 2, 2017.
  21. Wooster L. ACEP battles Anthem BlueCross BlueShield policy that jeopardizes prudent layperson standard. ACEPNow. March 14, 2018.
  22. American College of Emergency Physicians. ACEP turns up criticism of Anthem’s emergency care policy with a new video campaign.
  23. American College of Emergency Physicians. Physician groups take legal action against Anthem’s Blue Cross Blue Shield of Georgia.

Chapter 7. Frequent Fliers: High Cost, High Need

  1. LaCalle E, Rabin E. Frequent users of emergency departments: the myths, the data, and the policy implications. Ann Emerg Med. 2010;56(1):42-48.
  2. LaCalle EJ, Rabin EJ, Genes NG. High-frequency users of emergency department care. J Emerg Med. 2013;44(6):1167-1173.
  3. Mann C. Reducing nonurgent use of emergency departments and improving appropriate care in appropriate settings. January 2014.
  4. Sommers AS, Boukus ER, Carrier E. Dispelling myths about emergency department use: majority of Medicaid visits are for urgent or more serious symptoms. Res Brief. 2012;(23):1-10, 1-3.
  5. Capp R, Rosenthal MS, Desai MM, et al. Characteristics of Medicaid enrollees with frequent ED use. Am J Emerg Med. 2013;31(9):1333-1337.
  6. Capp R, West DR, Doran K, et al. Characteristics of Medicaid-Covered Emergency Department Visits Made by Nonelderly Adults: A National Study. J Emerg Med. 2015;49(6):984-989.
  7. Heisler EJ, Tyler NL. Hospital-Based Emergency Departments: Background and Policy Considerations. December 2014.
  8. Moe J, Kirkland S, Ospina MB, et al. Mortality, admission rates and outpatient use among frequent users of emergency departments: a systematic review. Emerg Med J. 2016;33(3):230-236.
  9. Ruger JP, Richter CJ, Spitznagel EL, Lewis LM. Analysis of Costs, Length of Stay, and Utilization of Emergency Department Services by Frequent Users: Implications for Health Policy. Acad Emerg Med. 11(12):1311-1317.
  10. Zhou RA, Baicker K, Taubman S, Finkelstein AN. The Uninsured Do Not Use The Emergency Department More — They Use Other Care Less. Health Aff (Millwood). 2017;36(12):2115-2122.
  11. Vinton DT, Capp R, Rooks SP, Abbott JT, Ginde AA. Frequent users of US emergency departments: characteristics and opportunities for intervention. Emerg Med J. 2014;31(7):526-532.
  12. Billings J, Raven MC. Dispelling an urban legend: frequent emergency department users have substantial burden of disease. Health Aff Proj Hope. 2013;32(12):2099-2108.
  13. Mann C. Targeting Medicaid Super-Utilizers to Decrease Costs and Improve Quality. CMS. July 2013.
  14. Hunt KA, Weber EJ, Showstack JA, Colby DC, Callaham ML. Characteristics of frequent users of emergency departments. Ann Emerg Med. 2006;48(1):1-8.
  15. McDonnell WM, Gee CA, Mecham N, Dahl-Olsen J, Guenther E. Does the emergency medical treatment and labor act affect emergency department use? J Emerg Med. 2013;44(1):209-216.
  16. American College of Emergency Physicians. EMTALA Fact Sheet.
  17. Kane CK. Physician Marketplace Report: The Impact of EMTALA on Physician Practice. 2003.
  18. Lindrooth RC, Perraillon MC, Hardy RY, Tung GJ. Understanding the Relationship Between Medicaid Expansions And Hospital Closures. Health Aff Proj Hope. 2018;37(1):111-120.
  19. Haefner M. Moody’s: 2-year delay on Medicaid DSH cuts credit positive for safety-net hospitals. Becker’s Healthcare.
  20. Smulowitz PB, Friedman AB, Pines JM. Appropriations for “appropriate” visits: Payment denials for emergency department care. Am J Emerg Med. 2018;36(8):1511-1512.
  21. American College of Emergency Physicians. Insurers Denying Emergency Room Care.
  22. American College of Emergency Physicians. One in Four Americans, Fearing Insurance Gaps, Reported Medical Conditions Got Worse After They Delayed Emergency Care.
  23. Raven MC, Lowe RA, Maselli J, Hsia RY. Comparison of presenting complaint vs discharge diagnosis for identifying “nonemergency” emergency department visits. JAMA. 2013;309(11):1145-1153.
  24. Hsia RY, Friedman AB, Niedzwiecki M. Urgent Care Needs Among Nonurgent Visits to the Emergency Department. JAMA Intern Med. 2016;176(6):852-854.
  25. Pines J, Barrueto F, Presser E, George M, McClellan M. University of Maryland Upper Chesapeake Health: Increased Value Under a Fixed Hospital Budget. May 2015.
  26. Pines J, Schlicher N, Presser E, George M, McClellan M. Washington State Medicaid: Implementation and Impact of “ER is for Emergencies” Program. May 2015.
  27. Emanuel EJ. How to Solve the E.R. Problem. The New York Times.
  28. Pines J, Selevan J, McStay F, George M, McClellan M. Kaiser Permanente –California: A Model for Integrated Care for the Ill and Injured.
  29. Moe J, Kirkland SW, Rawe E, et al. Effectiveness of Interventions to Decrease Emergency Department Visits by Adult Frequent Users: A Systematic Review. Acad Emerg Med. 2017;24(1):40-52.
  30. Soril LJJ, Leggett LE, Lorenzetti DL, Noseworthy TW, Clement FM. Reducing Frequent Visits to the Emergency Department: A Systematic Review of Interventions. PLoS ONE. 2015;10(4).
  31. Kumar GS, Klein R. Effectiveness of case management strategies in reducing emergency department visits in frequent user patient populations: a systematic review. J Emerg Med. 2013;44(3):717-729.
  32. Fireman B, Bartlett J, Selby J. Can disease management reduce health care costs by improving quality? Health Aff Proj Hope. 2004;23(6):63-75.
  33. Schore JL, Brown RS, Cheh VA. Case management for high-cost Medicare beneficiaries. Health Care Financ Rev. 1999;20(4):87-101.

Chapter 8. Freestanding EDs, Satellite EDs, and Urgent Care Centers

  1. ACEP. Freestanding Emergency Departments. November 2018.
  2. Harish NJ, Wiler JL, Zane RD. How the Freestanding Emergency Department Boom Can Help Patients. NEJM Catalyst. October 2016.
  3. MedPAC. Chapter 8: Stand-alone emergency departments. In: Report to the Congress: Medicare and the Health Care Delivery System. June 2017:245-264.
  4. Dark C, Xu Y, Ho V. Freestanding Emergency Departments Preferentially Locate In Areas With Higher Household Income. Health Aff (Millwood). 2017;36(10):1712-1719.
  5. Schuur JD, Baker O, Freshman J, Wilson M, Cutler DM. Where Do Freestanding Emergency Departments Choose to Locate? A National Inventory and Geographic Analysis on Three States. Ann Emerg Med. 2017;69(4):383-392.
  6. Pines JM, Zocchi MS, Black BS. A Comparison of Care Delivered in Hospital-based and Freestanding Emergency Departments. Acad Emerg Med. 2018;25(5):538-550.
  7. MedPAC. Report to Congress. Chapter 2: Using Payment to Ensure Appropriate Access to and use of hospital emergency department services. June 2018.
  8. Pines JM, Ernst D. Solving The Rural Health Care Access Crisis With The Freestanding Emergency Center Care Model. Health Affairs. February 2017.
  9. Pearl RM. How Multi-Specialty Hubs Fill a Major Gap in the Care Continuum. NEJM Catalyst. March 2017.

Chapter 9. Introduction to Payment

  1. American Medical Association. The CPT Code Process.
  2. American Medical Association. CPT Process — How a Code Become a Code.
  3. ACEP. What Every Graduating Resident Needs To Know About Reimbursement.
  4. ACEP. Evaluation and Management Documentation Requirements — CMS vs. CPT.
  5. CMS. Physician Fee Scheduled Search.
  6. CMS. Medicare Physician Fee Schedule.
  7. Edmunds M, Sloan FA. Geographic Adjustment in Medicare Payment: Phase 1: Improving Accuracy. 2nd ed. Washington, DC: National Academies Press; 2011.
  8. AMA. Medicare Physician Payment Schedule.
  9. EMDs. Understanding the 2018 Value Table.
  10. Medicare Access and CHIP Reauthorization ACT of 2015, 114th Congress (2015-2016).
  11. American College of Physicians. Medicare SGR formula/physician payment reform. Available at:
  12. Wikipedia. Medicare Sustainable Growth Rate.
  13. Clemens J, Gottlieb JD. In the Shadow of a Giant: Medicare’s Influence on Private Physician Payments. National Bureau of Economic Working Paper No. 19503. 2013.
  14. Reinhardt UE. The pricing of U.S. hospital services: chaos behind a veil of secrecy. Health Aff (Millwood). 2006;25(1):57-69.
  15. ACEP. Emergency Medicine and Payment Reform.
  16. Cutler DM, Ghosh K. The potential for cost savings through bundled episode payments. N Engl J Med. 2012;366(12):1075-1077.
  17. Paul III D, Graves H, Arroyo D, Neal K, Daniel B, Coustasse A. Managed care and accountable care organizations. Northeast Business & Economics Association 2014 Forty-First Annual Meeting, West Long Branch, NJ.
  18. SaIgnite. 10 FAQS About the Merit-based Incentive Payment System.
  19. Medicare Program; CY 2018 Updates to the Quality Payment Program; and Quality Payment Program: Extreme and Uncontrollable Circumstance Policy for the Transition Year. Fed Regist. Nov. 16, 2017.
  20. Quality Payment Program. 2018 Merit-based Incentive Payment System (MIPS) Participation and Overview.

Chapter 10. Reforming FFS/PFP

  1. Agency for Healthcare Research and Quality. Understanding Quality Measurement (US Department of Health and Human Services).
  2. Wennberg JE, Brownlee S, Fisher ES, Skinner JS, Weinstein JN. An Agenda for Change Improving Quality and Curbing Health Care Spending: Opportunities for the Congress and the Obama Administration. The Dartmouth Institute for Health Policy & Clinical Practice. 2008.
  3. CMS. Roadmap for Implementing Value Driven Healthcare in the Traditional Medicare Fee-for-Service Program.
  4. CMS. Hospital Value-Based Purchasing - Overview.
  5. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001.
  6. CMS. 2018 Merit-based Incentive Payment System Bonus Overview Fact Sheet.
  7. CMS. Quality Payment Program. 2018.
  8. CMS. 2018 Merit-based Incentive Payment System (MIPS) Cost Performance Category Fact Sheet.
  9. Partners L. Medicare Alternative Payment Models: Not Every Provider Has a Path Forward. 2017.
  10. ACEP. Acute Unscheduled Care Model (AUCM): Enhancing Appropriate Admissions.
  11. Griffey RT, Pines JM, Farley HL, Phelan MP, Beach C, Schuur JD, Venkatesh AK. Chief complaint based performance measures: a new focus for acute care quality measurement. Ann Emerg Med. 2015;65(4):387-395.
  12. Kamphuis CB, Turrell G, Giskes K, Mackenbach JP, van Lenthe FJ. Socioeconomic inequalities in cardiovascular mortality and the role of childhood socioeconomic conditions and adulthood risk factors: a prospective cohort study with 17-years of follow up. BMC Public Health. 2012;12:1045.
  13. Kauhanen L, Lakka HM, Lynch JW, Kauhanen J. Social disadvantages in childhood and risk of all-cause death and cardiovascular disease in later life: a comparison of historical and retrospective childhood information. Int J Epidemiol. 2006;35(4):962-968.
  14. Nordahl H. Social inequality in chronic disease outcomes. Dan Med J. 2014;61(11): B4943.
  15. Ullits LR, Ejlskov L, Mortensen RN, et al. Socioeconomic inequality and mortality--a regional Danish cohort study. BMC Public Health. 2015;15:490.
  16. Woolhandler S, Ariely D, Himmelstein DU. Pay-for-performance: toxic to quality? Insights from behavioral economics. Int J Health Serv. 2014;44(2):203-214.
  17. Cassel CK, Jain SH. Assessing individual physician performance: does measurement suppress motivation? JAMA. 2012;307(24):2595-2596.
  18. Berenson RA, Kaye DR. Grading a physician’s value--the misapplication of performance measurement. N Engl J Med. 2013;369(22):2079-2081.

Chapter 11. Delivery System Reform

  1. CMS. Accountable Care Organizations.
  2. ACEP Emergency Medicine Practice Committee. Accountable Care Organizations: What Do They Mean for Emergency Medicine?
  3. HRSA. What is a Medical Home? Why is it important?
  4. CMS. Bundled Payment Care Improvement Learning and Resources Area.
  5. CMS. Bundled Payments for Care Improvement (BPCI) Fact Sheet.
  6. The Lewis Group. CMS Bundled Payments for Care Improvement (BPCI) Initiative Models 2-4: Year 1 Evaluation and Monitoring Annual Report. February 2015.
  7. Sharp AL, Song Z, Safran DG, Chernew ME, Fendrick M. The effect of bundled payment on emergency department use: alternative quality contract effects after year one. Acad Emerg Med. 2013;20(9):961-964.
  8. Lineen J. Hospital Consolidation: “Safety in Numbers” Strategy Prevails in Preparation for a Value-Based Marketplace. J Healthc Manag. 2014;59(5):315-317.
  9. Plaster M. Consolidation: Are Two Heads Better Than One. EP Monthly. 2014.
  10. Byers J. Optum a Step Ahead in Vertical Integration Frenzy. Health Care Dive. April 12, 2018.
  11. Frankt AB. Hospital consolidation isn’t the key to lower costs and raising quality. JAMA. 2015;313(4):345.
  12. Hensley S. Atul Gawande Named CEO of Health Venture by Amazon, Berkshire Hathaway and JPMorgan. NPR Shots Health Inc. 2018;June 18.
  13. Silvers JB, Votruba M. Here’s how Atul Gawande and the Amazon-Berkshire-JPMorgan health-care venture could slash costs 15%-20%. MarketWatch The Conversation.
  14. Hunnicutt T, Humer C. Amazon, Berkshire, JPMorgan name Atul Gawande CEO of healthcare venture. Reuters.
  15. Abelson R, Hsu T. Amazon, Berkshire Hathaway and JPMorgan Name C.E.O. for Health Initiative. The New York Times.

Chapter 12. Data Registries: Impact on Quality and Reimbursement

  1. CMS. Merit-based Incentive Payment System (MIPS) Overview - QPP.
  2. CMS. Physician Quality Reporting System.
  3. CMS. 2018 Merit-Based Incentive Payment System (MIPS) Qualified Clinical Data Registry (QCDR) Self-Nomination Fact Sheet.
  4. ACEP. CEDR Home.
  5. Porter J, Love D, Peters A, Sachs J, Costello A. The basics of all-payer claims databases: a primer for states. APCD Council via Robert Wood Johnson Foundation.
  6. NCSL Briefs for State Legislators. Collecting Health Data: All-Payer Claims Databases. 2010.
  7. Ario J, McAvey K. Transparency In Health Care: Where We Stand And What Policy Makers Can Do Now. Health Aff (Millwood).
  8. The Commonwealth Fund. Love D, Custer W, Miller P. All-Payer Claims Databases: State Initiatives to Improve Health Care Transparency.
  9. CMS. Transforming Clinical Practice Initiative.
  10. ACEP. Emergency Quality Network (E-QUAL).

Chapter 13. Balance Billing and Fair Coverage

  1. 42 U.S.C. § 1395dd
  2. Kyanko KA, Curry LA, Busch SH. Out-of-Network Physicians: How Prevalent Are Involuntary Use and Cost Transparency? Health Serv Res. 2013;48(3):1154-1172.
  3. Berry KB. Reference-Based Pricing is Being Redefined. Benefits Magazine. 2015;52(10):26-31.
  4. Radnofsky L, Armour S. States Start to Approve Steep Increases in Health Premiums. The Wall Street Journal. 24 Aug 2016.
  5. Consumer Reports. Insurance Loopholes & Master Pricing: How Surprise Medical Bills Knock Consumers Down.
  6. Kane C. The Impact of EMTALA on Physician Practices. AMA Physician Marketplace Report. 2003.
  7. The Patient Protection and Affordable Care Act (PPACA), Pub. L. No. 111-148, 124. Stat. 119. 23 Mar 2010.
  8. See Federal Register, June 28, 2010, pp. 31788-37421.
  9. Carroll J. The Ingenix Aftermath. Manag Care. 2009;18(5):6-8.
  10. Stempel J. Aetna reaches $120 million settlement over reimbursements. Reuters. 2012.
  11. FAIR Health. About FAIR Health.
  12. Bishop H. HHS clarifies reasonableness of GOT regulation for out-of-network ER services. Health Reform WK-EDGE. 2018.
  13. Duane Morris. Departments Reaffirm “Greatest of Three” Rule and Clarify Outstanding Questions.
  14. Physicians for Fair Coverage. Meet Physicians for Fair Coverage.
  15. Murphy B. 20 things to know about balance billing. Becker’s Hospital Review. 27 Jan 2017.
  16. Crain’s New York Business via Modern Healthcare. New York law to curb surprise billing shows promising results.
  17. Texas Department of Insurance. Surprise medical bills.
  18. DSR Health Law. What you Need to Know about Assembly Bill 72: Independent Dispute Resolution Process.
  19. An Act Concerning Hospitals, Insurers and Health Care Consumers, CT Public Act No. 15-146 (2015).
  20. Hoadley J, Ahn S, Lucia K. Balance Billing: How Are States Protecting Consumers from Unexpected Charges? Georgetown University Health Policy Institute. 2015.
  21. AAEM. A Resource for Emergency Physicians on Balance Billing, Out-of-Network Fees, and Surprise Bills.
  22. Texas Department of Insurance. TDI fines Humana over network adequacy.
  23. Shortridge EF, Moore JR, Whitmore H, O’Grady MJ, Shen AK. Policy Implications of First-Dollar Coverage: A Qualitative Examination from the Payer Perspective. Public Health Rep. 2011;126(3):394–399.
  24. Lerner Financial Group. Health Insurance 101: First Dollar Coverage.
  25. End the Surprise Insurance Gap. Legislative Guidelines.

Chapter 14. Regulatory Environment Evolution and Dangers

  1. ACEP. Fact Sheet: ACEP Responses to Major Medicare Payment Rule for CY 2019. /siteassets/new-pdfs/advocacy/cy-2019-pfs-and-qpp-proposed-rule-acep-responses-summary.pdf.
  2. Wagner R, via ACEP Observation Medicine Section. Update on the 2 MN Rule: RACs, BFCC QIO’s, the OIG and the MOON.
  3. Cassidy A. Health Policy Brief: The Two Midnight Rule. Health Aff. 2015.
  4. Wright B, Zhang X, Rahman M, Kocher K. Informing Medicare’s Two Midnight Rule Policy With an Analysis of Hospital-Based Long Observation Stays. Ann Emerg Med. 2018;72(2):166-170.
  5. Dickson V. CMS will modify — not scrap — ‘two-midnight’ rule. Modern Healthcare. 2015.
  6. CMS. Hospital Outpatient Prospective Payment – Final Rule with Comment Period and Final CY2016 Payment Rates, Regulation No. CMS-1633-FC; CMS-1607-F2. CMS-1633-FC.html.
  7. MedPAC. Report to the Congress: Medicare and the Health Care Delivery System.
  8. Notice of Observation Treatment and Implication for Care Eligibility Act or the NOTICE Act, HR 876, 114th Cong (2015).
  9. ACEP. Modify Medicare Three-Day Hospital Inpatient Requirement to Ensure Seniors Have Appropriate Access to Post-Acute Services.
  10. Congressional Budget Office. The 2015 Long-Term Budget Outlook. June 2015.
  11. CMS. Hospital Readmissions Reduction Program (HRRP).
  12. Boccuti C, Casillas G. Aiming for Fewer Hospital U-turns: The Medicare Hospital Readmission Reduction Program. Kaiser Family Foundation. 2015.
  13. Zoler M. While U.S. heart failure readmissions fall, deaths rise. Cardiology News. 2017.
  14. Gupta A, Allen LA, Bhatt DL, et al. Association of the Hospital Readmissions Reduction Program Implementation With Readmission and Mortality Outcomes in Heart Failure. JAMA Cardiol. 2018;3(1):44-53.

Chapter 15. Graduate Medical Education Funding

  1. Gudbranson E, Glickman A, Emanuel E. Reassessing the Data on Whether a Physician Shortage Exists. JAMA. 2017;317(19): 1945-1946.
  2. Eden J, Berwick D, Wilensky G. Graduate Medical Education That Meets the Nation’s Health Needs. Washington, D.C.: National Academies Press; 2014.
  3. Congressional Research Service. Federal Support for Graduate Medical Education: An Overview (Updated December 2018).
  4. Fryer GE Jr, Green LA, Dovey S, Phillips RL Jr. Direct graduate medical education payments to teaching hospitals by Medicare: unexplained variation and public policy contradictions. Acad Med. 2001;76(5):439-445.
  5. MedPAC. Report to Congress: Medicare Payment Policy, March 2010.
  6. Centers for Medicare & Medicaid Services. Indirect Medical Education (IME).
  7. CMS. Indirect medical education (IME).
  8. National Press Club. Governance and finance of graduate medical education. Health Aff. 2014.
  9. AAMC. Medicaid Graduate Medical Education Payments: A 50-State Survey.
  10. La Couture B. Primer: The Disproportionate Care Hospital (DSH) Program. American Action Forum.
  11. AAFP. Medicare GME Payments – background and basics.
  12. Nelb R. DSH Payments: Policy Changes and Policy Options. MacPAC. Sept. 13, 2018.
  13. AAMC. Medicare Payments for Graduate Medical Education: What Every Medical Student, Resident, and Advisor Needs to Know.
  14. Salsberg E, Rockey PH, Rivers KL, Brotherton SE, Jackson GR. US residency training before and after the 1997 Balanced Budget Act. JAMA. 2008 Sep 10;300(10):1174-80.
  15. AAMC. Table B3: Number of Active Residents, by Type of Medical School, GME Specialty, and Sex. 2016-2017
  16. AAMC. Graduate Medical Education Primers – Part 4.
  17. Wynn BO, Smalley R, Cordasco KM. Does it cost more to train residents or to replace them?: a look at the costs and benefits of operating graduate medical education programs. Rand Health Quarterly. 2013;3(3).
  18. Rosenthal E. An American Sickness: How Health Care Became Big Business and How You Can Take It Back. Missouri Medicine. 2018 Mar;115(2):128.
  19. Wynn BO, Smalley R, Cordasco KM. Does it cost more to train residents or to replace them?: a look at the costs and benefits of operating graduate medical education programs. Rand Health Quarterly. 2013;3(3).
  20. Stoller J, et al. Financial Contribution of Residents When Billing as “Junior Associates” in the “Surgical Firm”. J Surg Educ. 2016;73(1):85-94.
  21. Madan AK, Fabian TC, Tichansky DS. Potential financial impact of first assistant billing by surgical residents. Am Surg. 2007;73(7):652-657.
  22. Ben-Ari R, Robbins RJ, Pindiprolu S, Goldman A, Parsons PE. The costs of training internal medicine residents in the United States. Am J Med. 2014 Oct 1;127(10):1017-23.
  23. Hayek S, Lane S, Fluck M, Hunsinger M, Blansfield J, Shabahang M. Ten Year Projections for US Residency Positions: Will There be Enough Positions to Accommodate the Growing Number of US Medical School Graduates?. J Surg Educ. 2018;75(3):546-51.
  24. Gregory J. HealthExec. Med School Enrollment up 28% since 2002, but residency slots may not be keeping pace. May 26, 2017.
  25. NRMP. Press Release: NRMP Releases Results and Data: 2018 Residency Match — Record Number of Positions Filled.
  26. CMS. Direct Graduate Medical Education.
  27. AAMC. The Resident Physician Shortage Reduction Act of 2015 (H.R. 2124).
  28. AHA. Fact Sheet: Resident Physician Shortage Reduction Act of 2017.
  29. U.S. Congress, 115th Session. House Bill 6056.
  30. U.S. Congress, 115th Session. House Bill 7233.
  31. ACEP. Securing Medicare GME Funding for Outside Rotations.
  32. EveryCRSReport. The Teaching Health Center Graduate Medical Education (THCGME) Program: Increased Funding and Policy Changes in BBA2018
  33. Chen C, Chen F, Mullan F. Teaching Health Centers: A New Paradigm in Graduate Medical Education. Acad Med. 2012;87(12):1752-1756.
  34. MiDocs Consortium. Report for Governor Rick Snyder and the Michigan Legislature.
  35. Iglehart JK. Institute of Medicine report on GME — a call for reform. N Engl J Med. 2015;372(4):376-381.
  36. Hoven AD for the American Medical Association. AMA Urges Continued Support for Adequate Graduate Medical Education Funding to Meet Future Physician Workforce Needs.
  37. ALiEM. How Competitive Was Emergency Medicine in the 2018 Match? The Answer Might Surprise You.
  38. AAEMRSA. Lay Corporations Running Residency Programs.
  39. Aboraya A. UCF, HCA Partner For 550 New Residency Slots. Health News Florida. 2015.
  40. Cook T. After the Match: Corporations Rush In to Fill MD Shortage. Emerg Med News. 2017;39(1):32.
  41. AAMC. Preserve Medicare Support for Physician Training.
  42. AAFP. VA Offers Funding for Residency Program Expansion. April 12, 2017.
  43. Spillance LL, Jagoda A, Hare MA, et al. Graduate medical education downsizing: perceived effects of participating in the HCFA demonstration project in New York State. Acad Emerg Med. 2001;8(2):145-150.

Chapter 16. Physician Shortage and Physician Workforce Challenge

  1. 1. AAMC. The Complexities of Physician Supply and Demand: Projections from 2016 to 2030.
  2. Lin MP, Baker O, Richardson LD, Schuur JD. Trends in Emergency Department Visits and Admission Rates Among US Acute Care Hospitals. JAMA Int Med. 2018;178(12):1708-1710.
  3. Pitts SR, Carrier ER, Rich EC, Kellermann AL. Where Americans get acute care: increasingly, it’s not at their doctor’s office. Health Aff (Millwood). 2010;29(9):1620-1629.
  4. Hsia RY, Kellermann AL, Shen YC. Factors associated with closures of emergency departments in the United States. JAMA. 2011;305(19):1978-1985.
  5. AAMC. 2012 Physician Specialty Data Book.
  6. Ginde AA, Sullivan AF, Camargo Jr CA. National Study of the Emergency Physician Workforce, 2008. Ann Emerg Med. 2009;54(3):349-359.
  7. Hall MK, Burns K, Carius M, Erickson M, Hall J, Venkatesh A. State of the National Emergency Department Workforce: Who Provides Care Where? Ann Emerg Med. 2018;72(3):302-307.
  8. Reiter M, Wen LS, Allen BW. The Emergency Medicine Workforce: Profile and Projections. J Emerg Med. 2016;50(4):690-693.
  9. NRMP. Results and Data 2018 Main Residency Match.
  10. Perina DG, Collier RE, Thomas HA, et al. Report of the task force on residency training information (2007-2008), American Board of Emergency Medicine. Ann Emerg Med. 2008;51:671-679.
  11. McDonald E. Updates from the ACGME Review Committee for Emergency Medicine 2018. EM Resident. 2018;45(3):6.
  12. MACPAC. Revisiting Emergency Department Use in Medicaid, July 2014.
  13. Tang N. Stein J, Hsia RY, et al. Trends and Characteristics of US Emergency Department Visits, 1997-2007. JAMA. 2010;304(6):664-670.
  14. Lin MP, Baker O, Richardson LD, et al. Trends in Emergency Department Visits and Admission Rates Among US Acute Care Hospitals. JAMA Intern Med. 2018;178(12):1708-1710.
  15. Pitts SR. Higher-Complexity ED Billing Codes – Sicker Patients, More Intensive Practice, or Improper Payments? N Engl J Med. 2012;367:2465-2467.
  16. Pitts SR, Pines JM, Handrigan MT, Kellermann AL. National Trends in Emergency Department Occupancy, 2001 to 2008: Effect of Inpatient Admissions versus Emergency Department Practice Intensity. Ann Emerg Med. 2012;60(6):679-686.
  17. AAMC. Active Physicians by Sex and Specialty, 2015.
  18. AAMC. Table A-1: U.S. Medical School Applications and Matriculants by School, State of Legal Residence, and Sex, 2018-2019.
  19. Medscape. Physician Compensation Report 2018.
  20. Madsen TE, Linden JA, Rounds K, et al. Current Status of Gender and Racial/Ethnic Disparities Among Academic Emergency Physicians. Acad Emerg Med. 2017;24(10):1182-1192.
  21. Choo EK, Kass D, Westergaard M, et al. The Development of Best Practice Recommendations to Support the Hiring, Recruitment, and Advancement of Women Physicians in Emergency Medicine. Acad Emerg Med. 2016;23(11):1203-1209.
  22. MACPAC. Revisiting Emergency Department Use in Medicaid.
  23. Kaiser Family Foundation. Distribution of Medicare Beneficiaries by Race/Ethnicity.
  24. The National Bureau of Economic Research. Reimbursement Rates for Primary Care Services. NBER Working Paper No. 24805.
  25. ACEP. Workforce Diversity in Health Care Settings: Policy Statement. /siteassets/new-pdfs/policy-statements/workforce-diversity-in-health-care-settings.pdf.
  26. EMRA. Diversity Oriented Away/Scholarship Programs.
  27. Goodman DC. Twenty-year trends in regional variations in the U.S. physician work- force. Health Aff (Millwood). 2004;Suppl Web Exclusives:VAR90-VAR97.
  28. Health Resources & Services Administration. National Health Service Corps Loan Repayment Information.
  29. Parker RB, Stack SJ, Schneider SM, ACEP Diversity Summit 2016 Attendees. Why Diversity and Inclusion Are Critical to the American College of Emergency Physicians’ Future Success. 2017;69(6):714-717.

Chapter 17. Advanced Practice Providers in the ED

  1. Hall M, Burns K, Carius M, Erickson M, Hall J, Venkatesh A. State of the National Emergency DepartmentWorkforce: Who Provides Care Where? Ann Emerg Med. 2018;72(3):302-307.
  2. Nurse Journal. Nurse Practitioner vs Physician Assistant.
  3. American Association of Nurse Practitioners. NP Fact Sheet.
  4. National Commission on Certification of Physician Assistants. NCCPA Annual Report. 2017 Statistical Profile of Certified Physician Assistants.
  5. Brown DFM, Sullivan AF, Espinola JA, Camargo CA. Continued rise in the use of mid-level providers in US emergency departments, 1993–2009. Int J Emerg Med. 2012;5:21.
  6. Augustine JJ. More Advanced Practice Providers Working in Emergency Departments. ACEP Now. 2017.
  7. Menchine MD, Wiechmann W, Rudkin S. Trends in Midlevel Provider Utilization in Emergency Departments from 1997 to 2006. Acad Emerg Med. 2009;16:963-969.
  8. Graduate Nursing EDU. Nurse Practitioner Fellowship and Residency Programs.
  9. PA School Finder. Postgraduate PA Residency and Fellowship Programs.
  10. SEMPA. SEMPA Emergency Medicine Physician Assistant Postgraduate Training Program Standards 2019.
  11. Krauss C. EM Physician Assistant Terry Carlisle Recalls Long Career, Discusses Future of Specialty. ACEP Now. 2018.
  12. National Resident Matching Program. Results and Data. 2018 Main Residency Match.
  13. Centers for Disease Control and Prevention, National Center for Health Statistics. National Hospital Ambulatory Medical Care Survey: 2015 Emergency Department Summary Tables.
  14. Menchine MD, Wiechmann W, Rudkin S. Trends in midlevel provider utilization in emergency departments from 1997 to 2006. Acad Emerg Med. 2009;16(10):963-969.
  15. U.S. Department of Health and Human Services Health Resources and Services Administration, Bureau of Health Workforce, National Center for Health Workforce Analysis. National and Regional Projections of Supply and Demand for Primary Care Practitioners: 2013–2025.
  16. Phillips AW. Emergency physician evaluation of PA and NP practice patterns. JAAPA. 2018;31(5):38-43.
  17. Harper G. Trust Me I’m a Doctor: The Struggle over Scope of Practice and Its Effect on Health Care Fraud and Abuse. DePaul Journal of Health Care Law. 2013;15(2):237-253.
  18. Morgan PA, Abbott DH, McNeil RB, Fisher DA. Characteristics of primary care office visits to nurse practitioners, physician assistants and physicians in United States Veterans Health Administration facilities, 2005 to 2010: a retrospective cross-sectional analysis. Hum Resour Health. 2012;10:42.
  19. Poonam A. VHA Directive 1350 Advanced Practice Registered Nurse Full Practice Authority. Department of Veterans Affairs. VHA Publications Distributions List. 2017.
  20. U.S. Department of Veterans Affairs. Office of Public and Intergovernmental Affairs VA Grants Full Practice Authority to Advanced Practice Registered Nurses.
  21. Poghosyan L. Federal, state, and organizational barriers affecting nurse practitioner workforce and practice. Nursing Economics. 2018;36(1):43-45.
  22. Sofar D. AMA Resolution Opposes Independent Practice by APRNs. Am J Nurs. 2018;118 (3):12.
  23. Oliver GM, Pennington L, Revelle S, Rantz M. Impact of nurse practitioners on health outcomes of Medicare and Medicaid patients. Nurs Outlook. 2014.62(6):440-447.
  24. Traczynski J, Udalova V. Nurse practitioner independence, health care utilization, and health outcomes. Paper presented at the Fourth Annual Midwest Health Economics Conference, Madison, WI. 2013.
  25. Weinberg M, Kallerman P. Full Practice Authority for Nurse Practitioners Increases Access and Controls Cost, Technical Appendix. Bay Area Council Economic Institute. 2014.
  26. Newhouse RP et al. CNE Series. Advanced Practice Nurse Outcomes 1990-2008: A Systematic Review. Nurs Econ. 2011;29(5):230-250.
  27. Doan Q, Sabhaney V, Kissoon N, Sheps S, Singer J. A systematic review: The role and impact of the physician assistant in the emergency department. Emerg Med Australas. 2011;23(1):7-15.
  28. Virginia’s Legislative Information System. HB793 Nurse practitioners; practice agreements.
  29. American Medical Association. Scope of Practice.
  30. National Conference of State Legislatures. Two dozen scope of practice laws enacted in 2017.
  31. Robbins D, Howard R, Grembowski M. Chapter 24: Washington State Fraud and Abuse Prohibitions. Washington Health Law Manual — 3rd Edition.
  32. American Medical Association. “Truth in Advertising” campaign.
  33. American Medical Association. Physician-led Team-based Care.
  34. ACEP. Guidelines Regarding the Role of Physician Assistants and Advanced Practice Registered Nurses in the Emergency Department.
  35. Barton Associates. Nurse Practitioner Scope of Practice Laws.
  36. American Medical Association. State law chart: Nurse Practitioner Practice Authority.
  37. American Association of Nurse Practitioners. State Practice Environment.
  38. Wiler JL, Ginde AA. State Laws Governing Physician Assistant Practice in the United States and the Impact on Emergency Medicine. J Emerg Med. 2015;28(2):e49-e58.
  39. American Academy of PAs. PA Scope of Practice.
  40. Bureau of Labor Statistics, U.S. Department of Labor, Occupational Outlook Handbook, Physicians and Surgeons.
  41. CNA Health Pro. Understanding Nurse Practitioner Liability: CNA HealthPro Nurse Practitioner Claims Analysis 1998-2008, Risk Management Strategies and Highlights of the 2009 NSO Survey.
  42. Brook C, Chomut A, Jeanmonod RK. Physician assistants contribution to emergency department productivity. West J Emerg Med. 2012;13(2):181-185.
  43. CMS. National Health Expenditure Projections 2017-2026 Forecast Summary.
  44. Carter A, Chochinov A. A systematic review of the impact of nurse practitioners on cost, quality of care, satisfaction and wait times in the emergency department. CJEM. 2007;9(4): 286-295.
  45. Eibner C, Hussey P, Ridgely S, McGlynn E. Controlling Health Care Spending in Massachusetts: An Analysis of Options. RAND Corporation. 2009.
  46. Nurse Practitioners’ Association of Ontario. Fact Sheet on the Value of Nurse Practitioners.
  47. Perloff J, DesRoches CM, Buerhaus P. Comparing the Cost of Care Provided to Medicare Beneficiaries Assigned to Primary Care Nurse Practitioners and Physicians. Health Serv Res. 2015;51(4):1407-23.
  48. Perryman Group. The economic benefits of more fully utilizing advanced practice registered nurses in the provision of care in Texas. 2012.

Chapter 18. Controversies in Board Certification

  1. American Medical Association. AMA FREIDA Specialty Training Data.
  2. American Board of Emergency Medicine.
  3. Buie LA. Specialty Certifying Boards in American Medicine. Br Med J. 1965;1:543-547.
  4. American Board of Medical Specialties. ABMS History.
  5. American Board of Emergency Medicine. History.
  6. Teirstein PS, Topol EJ. The Role of Maintenance of Certification Programs in Governance and Professionalism. JAMA. 2015;313(18):1809-1810.
  7. ACEP Now. ABEM’s New President Discusses Continuing Certification.
  8. Kelly M, Milling Jr TJ. The New Alternatives to the ConCert Examination: Will the Shorter Tests Make Emergency Physicians Less Miserable? Ann Emerg Med. 2018;72(1):A15-A17.
  9. Kowalenko T. ABEM Is Working on Alternative to ConCert Examination. June 2018.
  10. Harris County Medical Society. Maintenance of Certification Requirements.
  11. Texas Medical Association. Maintenance of Certification.
  12. Johnson DH. Maintenance of Certification and Texas SB 1148: A Threat to Professional Self-Regulation. JAMA. 2017;318(8):697-698.
  13. ACEP Now. New ABEM President Dr. Terry Kowalenko Discusses Certification, Issues Facing Emergency Medicine. September 2017.
  14. ACEP. Letter from The Coalition to Oppose Medical Merit Badges. /siteassets/uploads/uploaded-files/acep/continuing-education/coalition-to-oppose-medical-merit-badges-letter_acep-v2.pdf.
  15. Daniel v. American Board of Emergency Medicine, 428 F.3d 408, 436 (2d Cir. 2005).
  16. ABPS. About the American Board of Physician Specialties.
  17. American Association of Physician Specialists, Inc. v. New York State Department of Health, 09-4325-cv.(2d Cir. 2010).
  18. Texas Medical Board. Certifying Boards Recognized for Purposes of Advertisement. and
  19. American Osteopathic Association. The Single GME Accreditation System.
  20. Accreditation Council for Graduate Medical Education. Memo of Understanding.

Chapter 19. Medical Liability Reform

  1. Jena AB, Seabury S, Lakdawalla D, Chandra A. Malpractice risk according to physician specialty. N Engl J Med. 2011;365:629-636.
  2. AMA. AMA studies show continued cost burden of medical liability system.
  3. Singh R, Solanki J. Has tort reform been effective in abating the medical malpractice crisis? An empirical analysis from 1991-2012. 2014.
  4. Hubbard FP. The Nature and Impact of the “Tort Reform” Movement. Hofstra Law Review. 2006;35(2):4.
  5. Bal BS. An Introduction to Medical Malpractice in the United States. Clin Orthop Relat Res. 2009;467(2):339-347.
  6. OLR Research Report. Coppolo G. Damages - Medical malpractice. 2004.
  7. Waxman DA, Greenberg MD, Ridgely S, Kellermann AL, Heaton P. The effect of malpractice reform on emergency department care. N Engl J Med. 2014;371(16):1518-1525.
  8. Seabury SA, Helland E, Jena AB. Medical Malpractice Reform: Noneconomic Damages Caps Reduced Payments 15 Percent, With Varied Effects By Specialty. Health Affairs (Millwood). 2014;33(11):2048–2056.
  9. Fisher TL. Medical malpractice in the United States: a review. Can Med Assoc J. 1974;110(1):102-103.
  10. Committee on Medical Liability, American Academy of Pediatrics. Guidelines for expert witness testimony in medical malpractice litigation. Pediatrics. 2002;109(5):974-979.
  11. ACEP. Expert witness guidelines for the specialty of Emergency Medicine. 2015.
  12. Roslund G. Medical liability and the Emergency physician: A State by State comparison. CommonSense. 2014;March/April:15-23.
  13. American College of Surgeons. Safe harbors: Liability reform for patients and physicians. 2013.
  14. Californians Allied for Patient Protection. MICRA and Access to Health Care: January 2014.
  15. Consumer Watchdog. Five Dangerous Myths About California’s Medical Malpractice Restrictions.
  16. Texas Medical Association. Summary of Texas medical professional liability law.
  17. CRST. The Effects of Tort Reform in Texas.
  18. AMA. Senators may stall medical liability-reform legislation.
  19. NPR. This GOP health bill proposes new limits to medical malpractice awards. 2017.
  20. CBO. Congressional Budget Office Cost Estimate: H.R. 1215 Protecting Access to Care Act of 2017.

Chapter 20. Corporate Practice of [Emergency] Medicine

  1. Silverman SI. In an Era of Healthcare Delivery Reforms, The Corporate Practice of Medicine Is A Matter That Requires Vigilance. Health Law & Policy. 2015;9(1):1-23.
  2. AMA. Issue Brief: Corporate Practice of Medicine.
  3. 42 U.S.C. Section 300e-10(a).
  4. Schaff MF, Leone AM, Mack GD. How State Law Issues May Affect ACOs. In: Pavarini P, ed. The ACO Handbook: A Guide to Accountable Care Organizations. 2nd Ed. Washington, D.C.: American Health Lawyers Association; 2015.
  5. AMA. Fee Splitting: Code of Medical Ethics Opinion 11.3.4.
  6. AMA. Policy Research Perspectives: Updated Data on Physician Practice Arrangements: Physician Ownership Drops Below 50 Percent.
  7. The Physicians Foundation. 2018 Survey of America’s Physicians.
  8. Joseph JW, Davis S, Wilker EH, et al. Modelling attending physician productivity in the emergency department: a multicentre study. Emerg Med J. 2018;35:317-322.
  9. Best Practices Leaders in Emergency Medicine. White Paper: Staffing Your Emergency Department.
  10. AHRQ. Improving Patient Flow and Reducing Emergency Department Crowding: A Guide for Hospitals.
  11. ACEP. Guidelines Regarding the Role of Physician Assistants and Advanced Practice Registered Nurses in the Emergency Department.
  12. AAEM. Policy on Open Books.
  13. Sullivan W. Is Due Process Good for Emergency Physicians? Emergency Physicians Monthly. 2018.
  14. ACEP. ACEP Applauds Bill to Protect Due Process for Emergency Physicians.
  15. H.R.6372 - To require the Secretary of Health and Human Services issue regulations to ensure due process rights for physicians furnishing emergency medical services.
  16. AMA. For first time, physician practice owners are not the majority.
  17. AAEM. Emergency Medicine and the Physician Practice Management Industry: History, Overview, and Current Problems.

Chapter 21. EHRs and HIEs: Technology in Patient Care

  1. Settles C. Meaningful Use 2015: The History of Meaningful Use. TechnologyAdvice. Published 2018.
  2. Perry W, Venkatesh A. IT in the Emergency Environment: Emergency Health Care Goes HITECH. EM Resident. 2015;42(6):16-17.
  3. SVMIC. Meaningful Use: Avoiding the 3% Penalty in 2018.
  4. AMA. AMA Proposes Reforms to Meaningful Use to Benefit Patients, Physicians. American Medical Association.
  5. CMS. 2018 MIPS Advancing Care Information Performance Category Fact Sheet.
  6. The Office of the National Coordinator for Health Information Technology. Meaningful Use and MACRA.
  7. Shapiro JS, Crowley D, Hoxhaj S, et al. Health information exchange in emergency medicine. Ann Emerg Med. 2016;67(2):216-226.
  8. Gordon BD, Bernard K, Salzman J, Whitebird RR. Impact of Health Information Exchange on Emergency Medicine Clinical Decision Making. West J Emerg Med. 2015;16(7):1047-1051.
  9. Stokes-Buzzelli S, Peltzer-Jones JM, Martin GB, Ford MM, Weise A. Use of health information technology to manage frequently presenting emergency department patients. West J Emerg Med. 2010;11(4):348-53.
  10. Fertel BS, Hart KW, Lindsell CJ, Ryan, RJ, Lyons MS. Patients who use multiple EDs: quantifying the degree of overlap between ED patients. West J Emerg Med. 2016;16(2):229-233.
  11. Melendez-Rosado J, Thompson KM, Cowdell JC, Sanchez Alvarez C, Ung RL, et al. Reducing unnecessary testing: an intervention to improved resident ordering practices. Postgrad Med J. 2017;93(1102):476-479.
  12. Pines J, Schlicher N, Presser E, George M, McClellan M. Washington State Medicaid: Implementation and Impact of “ER is for Emergencies” Program. Richard Merkin Initiative on Payment Reform and Clinical Leadership. May 4, 2015.
  13. Whiteside LK, Darnell D, Jackson K, Wang J, Russo J, et al. Collaborative care from the emergency department for injured patients with prescription drug misuse: an open feasibility study. J Subst Abuse Treat. 2017;82:12-21.
  14. Collaborative effort in Washington state slashes non-essential use of the ED by Medicaid patients, delivering millions in projected savings. ED Manag. 2013;25(4):41-4.

Chapter 22. Telehealth

  1. What is TeleHealth? faqs-what-telehealthhow-telehealth-different-telemedicine.
  2. Flodgren G, Rachas A, Farmer AJ, Inzitari M, Shepperd S. Interactive telemedicine: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2015;9:CD002098.
  3. MedPAC Report to the Congress Mandated report: Telehealth services and the Medicare program. March 2018.
  4. Sikka N, Paradise S, Shu M. Telehealth in Emergency Medicine: A Primer. ACEP Emergency Telemedicine Section. 2014.
  5. Arora S, Peters A, Burner E, Nok Lam C, Menchine M. Trial to Examine Text Message-Based mHealth in Emergency Department Patients with Diabetes (TExT-MED): A Randomized Controlled Trial. Ann Emerg Med. 2014;63(6):745-754.
  6. New York Presbyterian. New York Presbyterian/Weill Cornell Medical Center’s Emergency Department Telehealth Express Care Service Wins 2017 Emergency Care Innovation of the Year Award.
  7. The Role of Telehealth in an Evolving Health Care Environment: Workshop Summary. The National Academies Press. Washington, D.C. 2012.
  8. Telligen and gpTRAC. Telehealth Start-Up and Resource Guide V1.1.
  9. RAND Corporation. Direct-to-Consumer Telehealth May Increase Access to Care But Does Not Decrease Spending.
  10. Gilman M, Stensland J. Telehealth and Medicare: payment policy, current use, and prospects for growth. Medicare Medicaid Res Rev. 2013;3(4):E1-E14.
  11. Medicare Rights Center. Analysis of the Bipartisan Budget Act of 2018.
  12. Kao DP, Lindenfeld J, Macaulay D, Birnbaum HG, Jarvis JL, Desai US, Page RL 2nd. Impact of a telehealth and care management program on all-cause mortality and healthcare utilization in patients with heart failure. Telemed J E Health. 2016;22(1):2-11.
  13. CMS Medicare Learning Network. Summary of Policies in the Calendar Year (CY) 2019 Medicare Physician Fee Schedule (MPFS) Final Rule, Telehealth Originating Site Facility Fee Payment Amount and Telehealth Services List, CT Modifier Reduction List, and Preventive Services List.
  14. AMA. Highlights of the 2018 Medicare Physician Fee Schedule (MPFS) Final Rule.
  15. Neufeld JD, Doarn CR, Aly R. State policies influence Medicare telemedicine utilization. Telemed J E Health. 2016;22(1):70-74.
  16. Texas Medical Association. Three Things You Need to Know About Texas’ Telemedicine Law.
  17. Center for Connected Health Policy. 50 State Scan of Telehealth Reimbursement Laws and Medicaid Policies – Factsheet.
  18. Rogove HJ, Amoateng B, Binner J, Demaerschalk BM, Sanders RB. A survey and review of telemedicine license portability. Telemed J E Health. 2015;21(5):374-381.
  19. Call9, Inc. The Evolution of Medical Care.
  20. DeGaspari J. Emergency Physicians Find their Telemedicine Niche. Healthcare Informatics. Oct. 4, 2014.
  21. Poon SJ, Schuur JD, Mehrotra A. Trends in Visits to Acute Care Venues for Treatment of Low-Acuity Conditions in the United States From 2008 to 2015. JAMA Intern Med. 2018;178(10):1342-1349.
  22. New England Healthcare Institute. Research Update: Remote Physiological Monitoring. 2015.
  23. Atrius Health. VNA Care Network Foundation Expands Home Telemonitoring Program. network-foundation-expands-home-telemonitoring-program/.
  24. Castellucci M. Telehealth drives up healthcare utilization and spending. Modern Healthcare. March 7, 2017.
  25. Papanagnou D, Stone D, Chandra S, Watts P, Chang AM, Hollander JE. Integrating Telehealth Emergency Department Follow-up Visits into Residency Training. Cureus. 2018;10(4):e2433.
  26. du Toit M, Malau-Aduli B, Vangaveti V, Sabesan S, Ray RA. Use of telehealth in the management of non-critical emergencies in rural or remote emergency departments: a systematic review. J Telemed Telecare. 2017;1357633X17734239.

Chapter 23. Palliative and End-of-Life Care in the ED

  1. World Health Organization. WHO Definition of Palliative Care.
  2. ACEP. Emergency Department Palliative Care: Information Paper. Developed by Members of the Emergency Medicine Practice Committee. June 2012. /siteassets/uploads/uploaded-files/acep/clinical-and-practice-management/resources/administration/palliative_care_ip_final_june2012_edited.pdf.
  3. Smith AK, McCarthy E, Weber E, et al. Half of older Americans Seen in Emergency Department in Last Month of Life; Most Admitted to Hospital, and Many Die There. Health Aff (Millwood). 2012;31:1277-1285.
  4. Brighton LJ, Bristowe K. Communication in palliative care: talking about the end of life, before the end of life. Postgraduate Med J. 2016;92(1090):466-470.
  5. Galushko M, Romotzky V, Voltz R. Challenges in end-of-life communication. Curr Opin Support Palliat Care. 2012;6(3):355.
  6. Morganti KG, Bauhoff S, Blanchard JC, et al. The Evolving Role of Emergency Departments in the United States. Santa Monica, CA: RAND Corporation, 2013.
  7. DeVader TE, Albrecht R, Reiter M. Initiating Palliative Care in the Emergency Department. J Emerg Med. 2012;43(5):803-10.
  8. Beynon T, Gomes B, Murtagh FE, et al. How common are palliative care needs among older people who die in the emergency department? Emerg Med J. 2011;28:491.
  9. Smith AK, Fisher J, Schonberg MA, et al. Am I doing the right thing? Provider perspectives on improving palliative care in the emergency department. Ann Emerg Med. 2009;54:86-93, e1.
  10. Grudzen CR, Stone SC, Mohanty SA, et al. “I want to be taking my own last breath:” Patients’ reflections on illness when presenting to the emergency department at the end of life. J Palliat Med. 2011;14:293-96.
  11. Quill TE, Abernethy AP. Generalist plus Specialist Palliative Care — Creating a More Sustainable Model. N Engl J Med. 2013;368:1173-75.
  12. Grudzen CR, Richardson LD, Morrison M, et al. Palliative care needs of seriously ill, older adults presenting to the emergency department. Acad Emerg Med. 2010;17:1253-57.
  13. Lamba S. Early goal-directed palliative therapy in the emergency department. J Palliat Med. 2009;12(9):767.
  14. Lamba S, Mosenthal AC. Hospice and Palliative Medicine: A Novel Subspecialty of Emergency Medicine. J Emerg Med. 2012;43(5):849-53.
  15. Lamba S, Nagurka R, Zielinski A, et al. Palliative care provision in the emergency department: barriers reported by emergency physicians. J Palliat Med. 2013;16(2):143-7.
  16. Rosenberg M, Rosenberg L. Integrated model of palliative care in the emergency department. West J Emerg Med. 2013;14(6):633-6.
  17. Quest TE, Marco CA, Derse AR. Hospice and palliative medicine: new subspecialty, new opportunities. Ann Emerg Med. 2009;54:94-102.
  18. Grudzen CR, Richardson LD, Hopper SS, et al. Does palliative care have a future in the emergency department? Discussions with attending emergency physicians. J Pain Symptom Manage. 2012;43(1):1-9.
  19. Beemath A, Zalenski RJ. Palliative emergency medicine: resuscitating comfort care? Ann Emerg Med. 2009;54(1):103-5.
  20. Chan GK. End-of-life models and emergency department care. Acad Emerg Med. 2004;11(1):79-86.
  21. Kraus CK, Greenberg MR, Ray DE, Dy SM. Palliative Care Education in Emergency Medicine Residency Training: A Survey of Program Directors, Associate Program Directors, and Assistant Program Directors. J Pain Symptom Manage. 2016;51(5):898-906.
  22. Center to Advance Palliative Care (CAPC). IPAL-EM “Improving Palliative Care in Emergency Medicine.”
  23. Lamba S, DeSandre PL, Todd KH, et, al. Integration of Palliative Care into Emergency Medicine: The Improving Palliative Care in Emergency Medicine (IPAL-EM) Collaboration. J Emerg Med. 2014;46(2):264-70.
  24. Ouchi K, Wu M, Medairos R, et al. Initiating palliative care consults for advanced dementia patients in the emergency department. J Palliat Med. 2014;17(3):346-50.
  25. Grudzen CR, Richardson LD, Johnson PN, et al. Emergency Department-Initiated Palliative Care in Advanced Cancer: A Randomized Clinical Trial. JAMA Oncol. 2016;2(5):591-98.
  26. Barbera L, Taylor C, Dudgeon D. Why do patients with cancer visit the emergency department near the end of life? CMAJ. 2010;182(6):563-8.
  27. Rosenberg M, Lamba S, Misra S. Palliative medicine and geriatric emergency care: challenges, opportunities, and basic principles. Clin Geriatr Med. 2013;29(1):1-29.
  28. Grudzen C, Richardson LD, Baumlin KM, et al. Redesigned geriatric emergency care may have helped reduce admissions of older adults to intensive care units. Health Aff (Millwood). 2015;34(5):788-95.
  29. Grudzen CR, Richardson LD, Morrison M, et al. Palliative care needs of seriously ill, older adults presenting to the emergency department. Acad Emerg Med. 2010;17:1253-57.
  30. Liberman T, Kozikowski A, Kwon N, et al. Identifying Advanced Illness Patients in the Emergency Department and Having Goals-of-Care Discussions to Assist with Early Hospice Referral. J Emerg Med. 2018;54(2):191-197.
  31. Ouchi K, Block SD, Schonberg MA, et al. Feasibility of Testing of an Emergency Department Screening Tool to Identify Older Adults Appropriate for Palliative Care Consultation. J Palliat Med. 2017;20(1):69-73.
  32. ACEP Geriatric Emergency Department Accreditation Program. (ACEP GEDA) Available online at:
  33. Grudzen CR, Hwang U, Cohen JA, et al. Characteristics of emergency department patients who receive a palliative care consultation. J Palliat Med. 2012;15(4):396-9.
  34. Wu FM, Newman JM, Lasher A, et al. Effects of initiating palliative care consultation in the emergency department on inpatient length of stay. J Palliat Med. 2013;16(11):1362-7.
  35. George N, Phillips E, Zaurova M, et al. Palliative Care Screening and Assessment in the Emergency Department: A Systematic Review. J Pain Symptom Manage. 2016;51(1):108-19.
  36. Grudzen CR, Stone SC, Morrison RS. The palliative care model for emergency department patients with advanced illness. J Palliat Med. 2011;14(8):945-50.
  37. Casarett D, Pickard A, Bailey FA, et al. Do Palliative Consultations Improve Patient Outcomes? J Amer Geriatric Soc. 2008;56(4):593-99.
  38. Choosing Wisely®, An Initiative of the ABIM Foundation. American College of Emergency Physicians: Five Things Physicians and Patients Should Question.
  39. Smith AK, Schonberg MA, Fisher J, et al. Emergency department experiences of acutely symptomatic patients with terminal illness and their family caregivers. J Pain Symptom Manage. 2010;39(6):972-81.
  40. da Silva Soares D, Nunes CM, Gomes B. Effectiveness of Emergency Department Based Palliative Care for Adults with Advanced Disease: A Systematic Review. J Palliat Med. 2016;19(6):601-09.
  41. National Academies of Science, Institute of Medicine (IOM). Dying in America: Improving Quality and Honoring Individual Preferences Near the End of Life.
  42. Zive DM, Fromme EK, Schmidt TA, et al. Timing of POLST Form Completion by Cause of Death. J Pain Symptom Manage. 2015;50(5):650-658.
  43. Bomba PA, Kemp M, Black JS. POLST: An Improvement over Traditional Advance Directives. Cleveland Clinic Journal of Medicine. 2012;79(7):457-464.
  44. National POLST Paradigm. National POLST Paradigm Program Designations.
  45. Schmidt TA, Zive D, Fromme EK, et al. Physician orders for life-sustaining treatment (POLST): lessons learned from analysis of the Oregon POLST Registry. Resuscitation. 2014;85(4):480-5.
  46. Schmidt TA, Olszewski EA, Zive D, et al. The Oregon physician orders for life-sustaining treatment registry: a preliminary study of emergency medical services utilization. J Emerg Med. 2013;44(4):796-805.
  47. Schmidt TA, Hickman SE, Tolle SW, et al. The Physician Orders for Life-Sustaining Treatment program: Oregon emergency medical technicians’ practical experiences and attitudes. J Am Geriatr Soc. 2004;52(9):1430-4.
  48. Richardson DK, Fromme E, Zive D, et al. Concordance of Out-of-Hospital and Emergency Department Cardiac Arrest Resuscitation with Documented End-of-Life Choices in Oregon. Ann Emerg Med. 2014;63(4):375-383.
  49. Mirarchi FL, Doshi AA, Zerkle SW. TRIAD VI — How Well do Emergency Physicians Understand Physicians Orders for Life-Sustaining Treatment (POLST) Forms? J Patient Safe. 2015;11(1):1-8.
  50. Mirarchi FL, Cammarata C, Zerkle SW, et al. TRIAD VII — Do Prehospital Providers Understand Physicians Orders for Life-Sustaining Treatment Documents? J Patient Safe. 2015;11(1):9-17.
  51. Jesus JE, Geiderman JM, Venkat A, et al. Physician orders for life-sustaining treatment and emergency medicine: ethical considerations, legal issues, and emerging trends. Ann Emerg Med. 2014;64(2):140-4.
  52. Jesus JE, Marshall KD, Kraus CK, et al. Should Emergency Department Patients with End-of-Life Directives be Admitted to the ICU? J Emerg Med. 2018;55(3):435-440.
  53. Limehouse WE, Feeser VR, Bookman KJ, Derse A. A model for emergency department end-of-life communications after acute devastating events. Part I: decision-making capacity, surrogates, and advance directives. Acad Emerg Med. 2012;19(9):E1068-72.
  54. Zeitoun NK. New Medicare Rule Will Reimburse Physicians for Advance Care Planning. The Hospitalist. 2015(11).
  55. Yadav KN, Gabler NB, Cooney E, et al. Approximately one in three US adults completes any type of advance directive for end-of-life care. Health Aff (Millwood). 2017;36(7):1244-1251.
  56. Physician Assisted Suicide Fast Facts. CNN.
  57. U.S. Department of Health and Human Services. What is the U.S. Opioid Epidemic? March 3, 2018.
  58. Reyes-Gibyy CC, Anderson KO, Todd KH. Risk for Opioid Misuse Among Emergency Department Cancer Patients. Acad Emerg Med. 2016;23(2):151-8.
  59. Hochman MJ, Wolf S, Zafar SY, et al. Comparing unmet needs to optimize quality: Characterizing inpatient and outpatient palliative care populations. J Pain Symptom Manage. 2018;51(6):1033-1039.
  60. Kanzaria HK, Probst MA, Hsia RY. Emergency Department Death Rates Dropped By Nearly Fifty Percent, 1997-2011. Health Aff (Millwood). 2016;35(7):1303-08.

Chapter 24. Mental Health in the ED

  1. Sisti DA, Segal AG, Emanuel EJ. Improving Long-term Psychiatric Care. JAMA. 2015;313(3):243.
  2. Tuttle GA. Report of the Council on Medical Service, American Medical Association: Access to Psychiatric Beds and Impact on Emergency Medicine. Reports/council-on-medical-service/a08-cms-psychiatric-bedsemergency-medicine.pdf.
  3. Sharfstein SS, Dickerson FB. Hospital Psychiatry For The Twenty-First Century. Health Aff (Millwood). 2009;28(3):685-688.
  4. Organisation Development for Co-operation and Economic. Hospital beds (Indicator). 2018. doi:10.1787/0191328e-en.
  5. Zeller SL. Treatment of Psychiatric Patients in Emergency Settings. Prim Psychiatry. 2010;17(6):35-41.
  6. Weiss AJ, Barrett ML, Heslin KC, Stocks C. Trends in Emergency Department Visits Involving Mental and Substance Use Disorders, 2006-2013: Statistical Brief #216.
  7. Bronson J, Berzofsky M. Indicators of Mental Health Problems Reported by Prisoners and Jail Inmates, 2011-12.
  8. Prins SJ, Draper L. Improving Outcomes for People with Mental Illnesses under Community Corrections Supervision: A Guide to Research-Informed Policy and Practice. New York; 2009.
  9. Petrila J, Redlich A. Mental Illness and the Courts: Some Reflections on Judges as Innovators. Court Rev J Am Judges. 2007;43(4):164-176.
  10. Van Dorn RA, Desmarais SL, Petrila J, Haynes D, Singh JP. Effects of Outpatient Treatment on Risk of Arrest of Adults With Serious Mental Illness and Associated Costs. Psychiatr Serv. 2013;64(9):856-862.
  11. James DJ, Glaze LE. Special Report Highlights: Mental Health Problems of Prison and Jail Inmates. Washington; 2006.
  12. Cunningham P, McKenzie K, Taylor EF. The struggle to provide community-based care to low-income people with serious mental illness. Health Aff (Millwood). 2006;25(3):694-705.
  13. Congressional Research Service; Heisler EJ, Tyler NL. Hospital-Based Emergency Departments: Background and Policy Considerations. 2014.
  14. Minnesota Psychiatric Society. Task Force Report: The Shortage of Psychiatrists and of Inpatient Psychiatry Bed Capacity. 2002.
  15. Martinez ME, Cohen RA. Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, January-June 2014.
  16. Cohen RA, Zammitti EP, Martinez ME. Health Insurance Coverage: Early Release of Estimates From the National Health Interview Survey, 2017 What’s New? Atlanta; 2017.
  17. Office of Applied Studies SA and MHSA. Results from the 2009 National Survey on Drug Use and Health: Volume I. Summary of National Findings. Washington; 2009.
  18. Kaiser Family Foundation. Mental Health Financing in the United States, A Primer. Washington; 2011.
  19. Coffey R, Houchens R, Chul Chu B, et al. Emergency Department Use for Mental and Substance Use Disorders. Washington; 2010.
  20. Bose J, Hedden SL, Lipari RN, Park-Lee E. Key Substance Use and Mental Health Indicators in the United States: Results from the 2017 National Survey on Drug Use and Health. Rockville; 2017.
  21. Hedden SL, Kennet J, Lipari R, et al. Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health.
  22. Huang T-Y, Yang J, Moyo P, Simoni-Wastila L. Co-occurring mental illness in emergency department and hospital inpatient encounters related to substance abuse in Maryland. Addict Sci Clin Pract. 2015;10(Suppl 1):A22.
  23. ACEP. Definition of Boarded Patient. Policy Statements. 2018.
  24. Broida RI, Desai SA, Easter BD, et al. Emergency Department Crowding: Emergency Medicine Practice Committee High Impact Solutions Subcommittee Members. 2016. /siteassets/sites/acep/media/crowding/empc_crowding-ip_092016.pdf.
  25. Sun BC, Hsia RY, Weiss RE, et al. Effect of emergency department crowding on outcomes of admitted patients. Ann Emerg Med. 2013;61(6):605-611.e6.
  26. ACEP Emergency Medicine Practice Committee. Practical Solutions to Boarding of Psychiatric Patients in the Emergency Department Does Your Emergency Department Have a Psychiatric Boarding Problem? Washington; 2015. Health Boarding/Practical Solutions to Boarding of Psych Patients in EDs.pdf.
  27. McCullumsmith C, Clark B, Blair C, Cropsey K, Shelton R. Rapid Follow-Up for Patients After Psychiatric Crisis. Community Ment Health J. 2015;51(2):139-144.
  28. Chang G, Weiss A, Kosowsky JM, Orav EJ, Smallwood JA, Rauch SL. Characteristics of Adult Psychiatric Patients With Stays of 24 Hours or More in the Emergency Department. Psychiatr Serv. 2012;63(3):283-286.
  29. Kutscher B. Washington state bans boarding psych patients in EDs. Modern Healthcare. 2014.
  30. Brooks D. States leverage telepsychiatry solutions to ease ED crowding, accelerate care. ED Manag. 2015.
  31. Roberts N, Hu T, Axas N, Repetti L. Child and Adolescent Emergency and Urgent Mental Health Delivery Through Telepsychiatry: 12-Month Prospective Study. Telemed e-Health. 2017;23(10):842-846.
  32. ACEP. Psychiatric “Boarding” in Emergency Departments Ruled Unconstitutional in Washington State. Press Release. 2014.
  33. Zun LS. Pitfalls in the care of the psychiatric patient in the emergency department. J Emerg Med. 2012;43(5):829-835.
  34. McClure JA. Psychiatric Boarding in New Hampshire: Violation of a Statutory Right to Treatment. 2016.
  35. Cline BL. HB 2118 Acute Psychiatric Bed Registry; Frequency of Updating. Alexandria: Virginia House of Delegates; 2015.
  36. Deeds RC. SB 1265 Acute Psychiatric Bed Registry; Frequency of Updating. Alexandria: Senate of Virginia; 2015.
  37. National Alliance on Mental Illness. State Mental Health Legislation, 2015: Trends, Themes and Effective Practices. Arlington; 2015.
  38. Clarke D, Usick R, Sanderson A, Giles-Smith L, Baker J. Emergency department staff attitudes towards mental health consumers: A literature review and thematic content analysis. Int J Ment Health Nurs. 2014;23(3):273-284.
  39. Zun L. Care of Psychiatric Patients: The Challenge to Emergency Physicians. West J Emerg Med. 2016;17(2):173-176.
  40. Alakeson V, Pande N, Ludwig M. A Plan To Reduce Emergency Room ‘Boarding’ Of Psychiatric Patients. Health Aff (Millwood). 2010;29(9):1637-1642.
  41. Richmond JS, Berlin JS, Fishkind AB, et al. Verbal De-escalation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup. West J Emerg Med. 2012;13(1):17-25.
  42. GovTrack. 14th Congress H.R. 34 21st Century Cures Act. 2018.
  43. GovTrack. H.R. 2646 114th Congress Helping Families in Mental Health Crisis Act of 2016. 2018.
  44. GovTrack. S. 2680 114th Congress Mental Health Reform Act of 2016. 2018.
  45. Parker RB. ACEP Letter of Support — “Excellence in Mental Health & Addiction Treatment Expansion Act” HR 3931. 2017. /siteassets/sites/acep/media/advocacy/acepletterofsupporthr3931-10192017.pdf.
  46. Parker RB. ACEP Letter of Support — “Excellence in Mental Health & Addiction Treatment Expansion Act” S. 1905. 2017. /siteassets/sites/acep/media/advocacy/acepletterofsupport-s1905--10192017.pdf.
  47. Library of Congress. H.R.3931 - 115th Congress (2017-2018): Excellence in Mental Health and Addiction Treatment Expansion Act. 2017.
  48. Library of Congress. S.1905 - 115th Congress (2017-2018): Excellence in Mental Health and AddictionTreatment Expansion Act. 2017.
  49. National Council for Behavioral Health. Excellence in Mental Health and Addiction Treatment Expansion Act (S. 1905/H.R. 3931). Washington; 2018.

Chapter 25. Community Paramedicine and EMS Policy Issues

  1. Beck E, Craig A, Beeson J, et al. Mobile Integrated Healthcare Practice: A Healthcare Delivery Strategy to Improve Access, Outcomes, and Value. AMR Foundation for Research and Education, with support from an unrestricted educational grant from the Medtronic Foundation. 2012.
  2. National Center for Health Statistics. Emergency Department Visits: 2015.
  3. National Center for Health Statistics. Health, United States, 2017 – Data Finder.
  4. Weinick RM, Burns RM, Mehrotra A. Many emergency department visits could be managed at urgent care centers and retail clinics. Health Aff (Millwood). 2010;29(9):1630-1636.
  5. Hsia RY, Niedzwiecki M. Avoidable emergency department visits: a starting point. Int J Qual Health Care. 2017;29(5):642-645.
  6. CMS. Emergency Room Diversion Grant Program. 2012. Available at
  7. CMS. Reducing Nonurgent Use of Emergency Departments and Improving Appropriate Care in Appropriate Settings. 2014. Available at
  8. Weiss AJ (Truven Health Analytics), Barrett ML (M.L. Barrett, Inc.), Heslin KC (AHRQ), Stocks C (AHRQ). Trends in Emergency Department Visits Involving Mental and Substance Use Disorders, 2006–2013. HCUP Statistical Brief #216. December 2016. Agency for Healthcare Research and Quality, Rockville, MD.
  9. Non-Emergency Hospital Diversion Program. State of Rhode Island and Providence Plantations. Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals. 2010.
  10. Munjal K, Carr B. Realigning reimbursement policy and financial incentives to support patient-centered out-of-hospital care. JAMA. 2013;309(7):667-668.
  11. Morganti KG, Alpert A, Margolis G, Wasserman J, Kellermann AL. Should payment policy be changed to allow a wider range of EMS transport options? Ann Emerg Med. 2014;63(5):615-626.e5.
  12. Alpert A, Morganti KG, Margolis GS, Wasserman J, Kellermann AL. Giving EMS flexibility in transporting low-acuity patients could generate substantial medicare savings. Health Aff (Millwood). 2013;32(12):2142-2148.
  13. Emergency Medical Services Agenda for the Future. NHTSA. 1996.
  14. ACEP. Policy Statement: Boarding of Admitted and Intensive Care Patients in the Emergency Department. 2017.
  15. Feibel C. Houston fire department using doctor video chats for minor 911 calls.
  16. Langabeer 2nd JR, Gonzalez M, Alqusairi D, et al. Telehealth-enabled emergency medical services program reduces ambulance transport to urban emergency departments. West J Emerg Med. 2016;17(6):713-720.
  17. Emergency medical services agenda for the future. NHTSA. 1996.
  18. Bronsky J, Giordano K, Johnson R. Mobile integrated healthcare program changing how EMS responds to behavioral health crises. Journal of EMS. October 2016.
  19. McCrae J. Efforts to divert non-urgent ER use to alternate providers, focusing on providing better care and lower costs. Committee on health education, labors and pensions subcommittee on primary health and aging. United States Senate, 2011.
  20. Pennsylvania health care cost containment council, (2013, 3 25). Retrieved from Annual report 2012:
  21. Philyaw J, Bachman M, Currie B, Reed R, Tilson E. Community health programs for complex patients. 2015.
  22. Association for Community Affiliated Plans. (2014, 3 26). Safety Net Health Plan Efforts to Reduce Avoidable Emergency Department Utilization.
  23. National Center for Health Statistics. Health, United States, 2012: With special feature on emergency care. 2013.

Chapter 26. Opioids

  1. Poon S, Greenwood-Ericksen M. (2014). The Opioid Prescription Epidemic and the Role of Emergency Medicine. Ann Emerg Med. 2014;63(5):490-495.
  2. Lanser P, Gesell S. Pain management: the fifth vital sign. Healthc Benchmarks. 2001;8(62):68-70.
  3. Rudd RA, Seth P, David F, Scholl L. Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015. MMWR Morb Mortal Wkly Rep. ePub: 16 December 2016.
  4. Centers for Disease Control and Prevention. Opioid Overdoses Treated in Emergency Departments: Identify Opportunities for Action. March 2018.
  5. National Center on Health Statistics, CDC Wonder. National Overdose Deaths from Select Prescription and Illicit Drugs. December 2016.
  6. Opioid Overdose. Centers for Disease Control and Prevention. Published February 9, 2017.
  7. Paulozzi LJ, Mack KA, Hockenberry JM. Vital signs: variation among states in prescribing of opioid pain relievers and benzodiazepines — United States, 2012. MMWR Morb Mortal Wkly Rep. 2014;63:563–8.
  8. Changes in Opioid Prescribing Practices. Centers for Disease Control and Prevention. Published August 30, 2017.
  9. Weiss A, Molly B, Lauren OM, Marguerite B, Anne E, Claudia S. Inpatient Stays and Emergency Department Visits Nationally and by State, 2014. Healthcare Cost and Utilization Project Agency for Healthcare Research and Quality. June 2017.
  10. Chanell Baylor. Medication-Assisted Treatment (MAT). Veterans and Military Families SAMHSA - Substance Abuse and Mental Health Services Administration. Published July 21, 2015.
  11. SAMHSA - Substance Abuse and Mental Health Services Administration. Published July 21, 2015.
  12. Volkow ND, Frieden TR, Hyde PS, Cha SS. Medication-Assisted Therapies — Tackling the Opioid - Overdose Epidemic. New Engl J Med. 2014;370(22):2063-2066.
  13. Nagel LM. Emergency Narcotic Addiction Treatment. US Department of Justice Drug Enforcement Administration. October 2002.
  14. Kite A. Every state but Missouri has opioid drug tracking. Why are senators against it? The Kansas City Star. Published April 29, 2018.
  15. D’Onofrio G, O’Connor PG, Pantalon MV, et al. Emergency Department — Initiated Buprenorphine/Naloxone Treatment for Opioid Dependence. JAMA. 2015;313(16): 1636-1644.
  16. Prescription Drug Monitoring Programs Linked to Reductions in Opioid Overdose Deaths. June 2016.
  17. Patrick SW, Fry CE, Jones TF, Buntin MB. Implementation Of Prescription Drug Monitoring Programs Associated With Reductions In Opioid-Related Death Rates. Health Aff (Millwood). 2016;35(7):1324-32.
  18. Center for Drug Evaluation and Research. Postmarket Drug Safety Information for Patients and Providers - Information about Naloxone.
  19. Office of National Drug Control Policy. Model Naloxone Access Act. August 2016.
  20. HHS Acting Secretary Declares Public Health Emergency to Address National Opioid Crisis.
  21. Vital Signs: Trends in Emergency Department Visits for Suspected Opioid Overdoses — United States. MMWR Morbidity and Mortality Weekly Rep. March 2018;67(9):279–285.
  22. ACEP. Emergency Physicians Vital to Opioid Overdose Treatment and Prevention ACEP Supports Two New Bills to Improve Emergency Overdose Care Coordination, Pain Management.
  23. H.R.5176 - Preventing Overdoses While in Emergency Rooms Act of 2018.
  24. Department of Drug and Alcohol Programs. Department Focus on Addressing Overdose. Focus on Addressing Overdose.aspx.
  25. Department of Drug and Alcohol Programs. Warm Hand-Off.
  26. H.R.5197 - ALTO Act.
  27. ACEP. ACEP Leader Testifies Before Congress on Combating the National Opioid Crisis.
  28. ACEP-Developed Opioid Bills Pass the House, Move to Senate. ACEP Now. July 18, 2018;37(7):3.
  29. ACEP. ACEP Applauds Passage of Opioid Crisis Response Act.
  30. Cantrill SV, Brown MD, Carlisle RJ, et al. Clinical Policy: Critical Issues in the Prescribing of Opioids for Adult Patients in the Emergency Department. Ann Emerg Med. 2012;60(4):499-525.
  31. Colorado ACEP 2017 Opioid Prescribing & Treatment Guidelines: Confronting the Opioid Epidemic in Colorado’s Emergency Departments. 2017.
  32. ACEP. E-QUAL Opioid Toolkit: Pain Management and Safe Opioid Use.
  33. ACEP Policy Statement. Naloxone Access and Utilization for Suspected Opioid Overdoses. June 2016.
  34. ACEP Policy Statement. Naloxone Prescriptions by Emergency Physicians. October 2015.
  35. Bedard L, Haney S, Morhaim D. 2017 Annual Council Meeting. Resolution 37(17) Medically Supervised Injection Facilities. /siteassets/uploads/uploaded-files/acep/about-us/leadership/council/2017-resolutions-compendium.pdf.
  36. Ng J, Sutherland C, Kolber MR. Does Evidence Support Supervised Injection Site? Can Fam Physician. 2017;63(11):866.
  37. Gaeta JM, Racine M. New Strategies Are Needed to Stop Overdose Fatalities: The Case for Supervised Injection Facilities. Ann Intern Med. 2018;168(9):664-665.

Chapter 27. Drug Shortages and Prescription Drug Costs

  1. American Medical Association. New AMA Policy Reflects Frustration over ongoing Drug Shortages.
  2. Mazer-Amirshahi M, Pourmand A, Singer S, Pines JM, Anker JV. Critical Drug Shortages: Implications for Emergency Medicine. Acad Emerg Med. 2014; 21(6):704-711.
  3. Chen SI, Fox ER, Hall MK, Ross JS, Bucholz EM, Krumholz HM, Venkatesh AK. Despite Federal Legislation, Shortages of Drugs Used in Acute Care Settings Remain Persistent and Prolonged. Health Aff (Millwood). 2016;35(5):798-804.
  4. American Society of Health-System Pharmacists. ASHP Drug Shortages Roundtable: Minimizing Impact on Patient Care.
  5. American Society of Health-System Pharmacists. Drug Shortages List.
  6. The Conversation. Drug shortages pose a public health crisis in the US.
  7. Fry E. Critical Condition: Inside Pfizer’s Drug Supply Problem. Fortune.
  8. Government Accountability Office. Drug Shortages: Public Health Threat Continues, Despite Efforts to help Ensure Product Availability.
  9. Mangione A. The Multi-Billion Dollar Solution — Repeal Safe Harbor.
  10. MarketWatch. Why did these generic drugs’ prices jump as much as 85%?
  11. TruthinRx.
  12. AMA. AMA Responds to administration blueprint to tackle rising drug prices.
  13. Howard J. EpiPen cost soars, but it’s not the only drug to. CNN.
  14. Team T. Why Are Generic Drug Prices Shooting Up? Forbes.
  15. Luhby T. Just who gets those big drug rebates? CNNMoney.
  16. Konrad W. Feeling the pain of rising drug prices? Blame the middle man. CBS News.
  17. Appleby J. Tracking Who Makes Money On A Brand-Name Drug. Kaiser Health News.
  18. Baghdadi R. Health Policy Brief: Prescription Drug Pricing #7 Medicaid Best Price. Health Affairs.
  19. Lee T, Gluck A, Curfman G. The Politics of Medicare and Drug-Price Negotiation. Health Affairs.
  20. Sachs R, Bagley N, Lakdawalla D. Value-Based Pricing For Pharmaceuticals In The Trump Administration. Health Affairs.
  21. AMA. AMA Expands Advocacy Efforts Supporting Drug Price Transparency. November 2017.
  22. ACEP. ACEP Applauds FDA Launch of Drug Shortage Task Force. July 2018.
  23. Nedelman M. Drug shortages prompt FDA to form task force. CNN.
  24. Identifying the Root Causes of Drug Shortages and Finding Enduring Solutions; Public Meeting; Request for Comments. Federal Register Number 2018;19612.

Chapter 28. Social Determinants of Health

  1. Wilkinson R, Marmot M. Social Determinants of Health: The Solid Facts. 2nd ed. Denmark: WHO; 2003.
  2. County Health Rankings & Roadmaps. Rankings Reports 2018.
  3. Bachrach D, Pfister H, Wallis K, Lipson M. Addressing Patients’ Social Needs: An Emerging Business Case for Provider Investment. The Commonwealth Fund, Skoll Foundation and Pershing Square Foundation. 2014.
  4. VHA Office of Homeless Programs, VHA Office of Primary Care Operations & Primary Care Services, VA National Center on Homelessness Among Veterans. National H-PACT Update. Winter 2015.
  5. Krieger JW, Takaro TK, Song L, Weaver M. The Seattle-King County Healthy Homes Project: A Randomized, Controlled Trial of a Community Health Worker Intervention to Decrease Exposure to Indoor Asthma Triggers. Am J Public Health. 2005;95(4):652-659.
  6. Housing Resources Leveraged by the Special Homeless Initiative of the Massachusetts Department of Mental Health, 1992–2006 Evaluation of the Special Homeless Initiative, Massachusetts Department of Mental Health Tatjana Meschede and Helen Levine Center for Social Policy, McCormack Graduate School of Policy Studies, University of Massachusetts, Boston. Martha R. Burt Urban Institute. June 1, 2007.
  7. Axelson DJ, Still MJ, Coates WC. Social Determinants of Health: A Missing Link in Emergency Medicine Training. AEM Education and Training Early View. aet2.10056/abstract.
  8. AAMC. Diversity of US Medical Students by Parental Education.
  9. AAMC. Diversity of US Medical Students by Parental Income.
  10. Gottlieb L, Hessler D, Long D, Amaya A, Adler N. A Randomized Trial on Screening for Social Determinants of Health: the iScreen Study. Pediatrics. 2014;134(6).
  11. Elliott L, Nerney M, Jones T, Friedmann P. Barriers to Screening for Domestic Violence. J Gen Intern Med. 2002;17(2):112–116.
  12. D’Onofrio G, Degutis L. Screening and brief intervention in the Emergency Department. Alcohol Research & Health. 2004-2005;28(2):63-72.
  13. International and Domestic Health Equity and Leadership, UCLA. Suggested Reading List. 2017.
  14. Social Intervention Research and Evaluation Network. Evidence Library. 2018.
  15. Elrich M. Health Disparity Curriculum at The Warren Alpert Medical School of Brown University. Rhode Island Medical Journal. 2014.
  16. University of Chicago Pritzker School of Medicine. Health Disparities Curriculum. 2018.
  17. Wagner R, Koh N, Bagian JP, Weiss KB, for the CLER Program. CLER 2016 National Report of Findings. Issue Brief #4: Health Care Disparities. Accreditation Council for Graduate Medical Education, Chicago, Illinois USA. February, 2017.
  18. Anderson ES, Lippert S, Newberry J, Bernstein E, Alter HJ, Wang NE. Addressing Social Determinants of Health from the Emergency Department through Social Emergency Medicine. West J Emerg Med. 2016;17(4):487-489.
  19. UCLA International and Domestic Health Equity and Leadership. Social Emergency Medicine Teaching Modules. 2017.
  20. Rippe E, Ledesma K. Population Health and Social Emergency Medicine. In: Shafer K, ed. EMRA Fellowship Guide. 2nd ed. Dallas, Texas: Emergency Medicine Residents’ Association.
  21. FitzGerald C, Hurst S. Implicit bias in healthcare professionals: a systematic review. BMC Medical Ethics. 2017;18(19):1-18.
  22. Dehon E, Weiss N, Jones J, Faulconer W, Hinton E, Sterling S. A systematic review of the impact of physician implicit racial bias on clinical decision making. Acad Emerg Med. 2017;24(8):895-904.
  23. Project Implicit. Education. 2011.
  24. Project Implicit. Take a Test. 2011.
  25. UCLA Equity, Diversity and Inclusion. Implicit Bias.
  26. Andrew Levitt Center for Social Emergency Medicine. SEM Resources. 2009.
  27. Hsieh D, Wang M, Losonczy L, Alter H. Thinking outside of the box: How well do emergency department providers understand their patients? SAEM Western Regional Meeting, 2014; New England SAEM Regional Meeting, 2014; SAEM National Meeting, 2014; CIR-SEIU Quality Improvement and Patient Safety Summit, 2014.
  28. Losonczy L, Hsieh D, Hahn C, Fahimi J, Alter H. More than just meds: National survey of providers’ perceptions of patients’ social, economic, environmental, and legal needs and the effect on emergency department utilization. Social Medicine. 2015;1:1-8.
  29. Ontario Ministry of Health and Long-Term Care. Population Health Assessment and Surveillance Protocol, 2008.
  30. HealthBegins. Upstream Risk Screening Tool.
  31. Sturmberg JP. Health System Redesign: How to Make Health Care Person-Centered, Equitable, and Sustainable. Springer; 2017.
  32. Malecha PW, Williams JH, Kunzler NM, Goldfrank LR, Alter HJ, Doran KM. Material Needs of Emergency Department Patients: A Systematic Review. Acad Emerg Med. 2018;25(3):330-359.
  33. Doran KM, Greysen SR, Cunningham A, Tynan-McKiernan K, Lucas GI, Rosenthal MS. Improving Post-Hospital Care for People Who Are Homeless: Community-Based Participatory Research to Community-Based Action. Healthcare. 2015;3(4):238-244.

Chapter 29. Women’s Health

  1. Gulati M, Shaw LJ, Merz CNB. Myocardial Ischemia in Women: Lessons from the NHLBI WISE Study. Clin Cardiol. 2012;35(3):141-148.
  2. Vaccarino V, Parsons L, Every NR, Barron HV, Krumholz HM. Sex-based differences in early mortality after myocardial infarction. National Registry of Myocardial Infarction 2 Participants. N Engl J Med. 1999; 341:217–25.
  3. Greenwood BN, Carnahan S, Huang L. Patient-physician gender concordance and increased mortality among female heart attack patients. Proc Natl Acad Sci U S A. 2018;115(34):8569-8574.
  4. McGregor A, Safdar B, Seigel T, Miner J, Davenport M. Gender-Specific Emergency Care Part I. 2013.
  5. Chapman KR, Tashkin DP, Pye DJ. Gender bias in the diagnosis of COPD. Chest. 2001; 119:1691-1695.
  6. Wizemann T, Pardue M. Exploring the Biological Contributions to Human Health: Does Sex Matter? Washington, DC: The National Academies Press; 2001.
  7. Lui KA, Dipietro Mager NA. Women’s involvement in clinical trials: historical perspective and future implications. Pharm Pract (Granada). 2016;14(1):708.
  8. Ramasubbu K, Gurm H, Liaker D. Gender bias in clinical trials: do double standards still apply? J Womens Health Gend Based Med. 2001;10(8):757-764.
  9. Centers for Disease Control and Prevention. Leading Causes of Death (LCOD) in Females United States, 2015.
  10. American Heart Association. Fact Sheet: Cardiovascular Disease: Women’s No. 1 Health Threat. public/@wcm/@adv/documents/downloadable/ucm_483545.pdf.
  11. United Nations Education, Science, and Cultural Organization. Fact Sheet 51: Women in Science. women-in-science-2018-en.pdf.
  12. Filardo G, da Graca B, Sass D, Pollock B, Smith E, Martinez M. Trends and comparison of female first authorship in high impact medical journals: observational study (1994-2014). BMJ. 2016;352:i847.
  13. Moss-Racusin C, Dovidio J, Brescoll V, Graham M, Handelsman J. Science faculty’s subtle gender biases favor male students. Proceedings of the National Academy of Sciences. 2012;109(41):16474-16479.
  14. HealthCare.Gov. Washington, District of Columbia: U.S. Dept. of Health & Human Services. Print.
  15. Frost JJ, Frohwirth L, Zolna MR. Contraceptive Needs and Services, 2014 Update, New York: Guttmacher Institute; 2016.
  16. Finer LB, Zolna MR. Declines in Unintended Pregnancy in the United States, 2008–2011. N Engl J Med. 2016;374:843-852.
  17. Winner B, Peipert JF, Zhao Q, et al. Effectiveness of long-acting reversible contraception. N Engl J Med. 2012;366:1998-2007.
  18. MacDorman MF, Mathews TJ, Mohangoo AD, Zeitlin J. International comparisons of infant mortality and related factors: United States and Europe. National Vital Statistics Reports. 2010;63(5).
  19. CDC. Infant Mortality.
  20. Stevenson AJ, Flores-Vazquez IM, Allgeyer RL, Schenkkan P, Potter JE. Effect of removal of planned parenthood from the Texas Women’s Health Program. N Engl J Med. 2016;374(9):853-860.
  21. Grossman D. The Use of Public Health Evidence in Whole Woman’s Health v Hellerstedt. JAMA Intern Med. 2016;177(2):155.
  22. CDC. National Intimate Partner and Sexual Violence Survey.
  23. The Susan G. Komen Breast Cancer Foundation Inc. Understanding Risk.
  24. Daugherty JD, Houry DE. Intimate partner violence screening in the emergency department. J Postgrad Med. 2008;54(4):301-305.
  25. Choo E, Houry DE. Managing Intimate Partner Violence in the Emergency Department. Ann Emerg Med. 2015;65(4):447-451.e1.
  26. Plichta SB, Clements PT, Houseman C. Why SANEs matter: Models of Care for Sexual Violence Victims in the Emergency Department. J Forensic Nurs. 2007;3(1):15-23.
  27. International Association of Forensic Nurses and Emergency Nurses Association Joint Position Statement. Adult and Adolescent Sexual Assault Patients in the Emergency Care Setting.

Chapter 30. How a Bill Becomes a Law

  1. Drutman L, Teles S. Why Congress Relies on Lobbyists Instead of Thinking for Itself. The Atlantic. March 10, 2015.
  2. United States Congress. The Legislative Process.
  3. Center on Budget and Policy Priorities. Introduction to Budget Reconciliation.
  4. GovTrack. Statistics and Historical Comparison.
  5. Frumin A. Obamacare was not Passed using Budget Reconciliation. The Washington Post.
  6. Parlapiano A, Andrews W, Lee JC, Shorey R. How Each Senator Voted on Obamacare Repeal Proposals. The New York Times. July 28, 2017.
  7. Center on Budget and Policy Priorities. Policy Basics: The “Pay-As-You-Go” Budget Rule.
  8. Congressional Budget Office. How CBO Produces Fair-Value Estimates of the Cost of Federal Credit Programs: A Primer.
  9. U.S. House of Representatives Committee on the Budget. Praise for House Adherence to Pay-As-You-Go Principle.
  10. The National Law Review. Dewonkify — Offset: A Funding Source Used to Pay for Government Spending.

Chapter 31. Legislative Advocacy

  1. Chamberlain LJ, Sanders LM, Takayama JI. Child advocacy training: curriculum outcomes and resident satisfaction. Arch Pediatr Adolesc Med. 2005;159(9):842-847.
  2. Accreditation Council for Graduate Medical Education. Pediatrics program requirements.
  3. Earnest MA, Wong SL, Federico SG. Perspective: Physician advocacy: what is it and how do we do it? Acad Med. 2010;85(1):63-67.
  4. Code of ethics for emergency physicians. Ann Emerg Med. 2017;70(1):e7-e15.
  5. Ptakowski KK. Advocating for children and adolescents with mental illnesses. Child Adolesc Psychiatr Clin N Am. 2010;19(1):131-138.
  6. Congressional Management Foundation. Frustrated with Congress? Write better emails.
  7. ACEP. Federal Advisory Committee Recommends ACEP-Proposed Alternative Payment Model to HHS.
  8. U.S. Food & Drug Administration. Statement from FDA Commissioner Scott Gottlieb, MD, on FDA’s work to mitigate shortages of intravenous drugs, shorten supply disruptions, and better predict vulnerabilities.
  9. University of Washington. Arthur Kellermann: I’ve saved more lives with public health work than in the emergency room.
  10. ERIC. Equal Access to Care: Patient Dumping, Record of Testimony.
  11. Landers SH, Sehgal AR. How do physicians lobby their members of Congress? Arch Intern Med. 2000;160(21):3248-51.
  12. Hsuan C, Horwitz JR, Ponce NA, Hsia RY, Needleman J. Complying with the Emergency Medical Treatment and Labor Act (EMTALA): Challenges and solutions. J Healthc Risk Manag. 2017;37(3):31-41.
  13. Hemphill RR, Sklar DP, Christopher T, Kellermann AL, Tarrant JR. Emergency medicine and political influence. Acad Emerg Med. 2009;16(10):1019-1024.
  14. Christoffel KK. Public health advocacy: Process and product. Am J Public Health. 2000;90(5):722-726.
  15. Kraus JF, Fife D, Conroy C. Incidence, severity, and outcomes of brain injuries involving bicycles. Am J Public Health. 1987;77(1):76-8.
  16. Thompson RA, Et al. A case-control study of the effectiveness of bicycle safety helmets. N Engl J Med. 1989;320:1361-1367.
  17. CQ. Just a Handful of Social Media Comments Can Grab the Attention of Congress, Study Shows.
  18. Kush C. The One-Hour Activist: The 15 Most Powerful Actions You Can Take to Fight for the Issues and Candidates You Care About. San Francisco: Jossey-Bass; 2004.
  19. Community Associations Institute. Interacting with legislators on social networking.
  20. Associated Press. Political parties use social media to open up convention process.
  21. ACEP. ACEP Leader Testifies Before Congress on Combating the National Opioid Crisis.

Chapter 32. Getting Involved in the House of Medicine

  1. EMRA. Join the Health Policy Committee.
  2. ACEP. Health Care Reform.

Chapter 33. Health Services Research

  1. Kocher KE, Haggins AN, Sabbatini AK, Sauser K, Sharp AL. Emergency department hospitalization volume and mortality in the United States. Ann Emerg Med. 2014;64(5):446-457.e6.
  2. Lin MP, Nguyen T, Probst MA, Richardson LD, Schuur JD. Emergency Physician Knowledge, Attitudes, and Behavior Regarding ACEP’s Choosing Wisely Recommendations: A Survey Study. Acad Emerg Med. 2017;24(6):668-675.
  3. Rhodes KV, Kenney GM, Friedman AB, Saloner B, Lawson CC, Chearo D, Wissoker D, Polsky D. Primary care access for new patients on the eve of health care reform. JAMA Intern Med. 2014;174(6):861-9.
  4. Suzuki K, Inoue S, Morita S, Watanabe N, Shintani A, Inokuchi S, Ogura S. Comparative Effectiveness of Emergency Resuscitative Thoracotomy versus Closed Chest Compressions among Patients with Critical Blunt Trauma: A Nationwide Cohort Study in Japan. PLoS One. 2016;11(1):e0145963.
  5. Ward MJ, Self WH, Singer A, Lazar D, Pines JM. Cost-effectiveness analysis of early point-of-care lactate testing in the emergency department. J Crit Care. 2016;36:69-75.
  6. Hirshon JM, Warner M, Irvin CB, et al. Research Using Emergency Department-related Data Sets: Current Status and Future Directions. Acad Emerg Med. 2009;16(11):1103-1109.
  7. Hansoti B, Levine A, Ganti L, et al. Funding global emergency medicine research — from seed grants to NIH support. Int J Emerg Med. 2016;9:27.
  8. Davis SD, Ruiz S, Glynn P, Picariello G, Walley AY. Expanded Access to Naloxone Among Firefighters, Police Officers, and Emergency Medical Technicians in Massachusetts. Am J Public Health. 2014;104(8):e7-9.
  9. Gertner AK, Domino ME, Davis, CS. Do naloxone access laws increase outpatient naloxone prescriptions? Evidence from Medicaid. 2018;190:37-41.
  10. Patrick SW, Buntin MB, Martin PR, Scott TA, Dupont W, et al. Barriers to Accessing Treatment for Pregnant Women with Opioid Use Disorder in Appalachian States. Subst Abuse. 2018:1-18.

Further Reading

  • Gold MR. Critical Challenges in Making Health Services Research Relevant to Decision Makers. Health Serv Res. 2016;51(1):9-15.
  • Nellans K, Waljee JF. Health services research: evolution and applications. Hand Clin. 2014;30(3):259-68.
  • Phillips CD. What do you do for a living? Toward a more succinct definition of health services research. BMC Health Serv Res. 2006;6:117.
  • Rich E, Collins A. Current and Future Demand for Health Services Researchers: Perspectives from Diverse Research Organizations. Health Serv Res. 2018;53 Suppl 2:3927-3944.
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