On the Health Policy Horizon
The first day of spring has passed, and that means the 2015 ACEP Legislative Advocacy Conference and Leadership Summit (previously known as LAC) is just around the corner. This year's revamped Conference will be held in Washington, DC from May 3-6 and will be jam-packed with informative lectures, skills sessions, networking events, Capitol Hill visits, and a new one-day leadership summit. Whether you've previously attended or are new to the meeting, this year's conference will be high-yield and well worth your time. The conference kicks off at noon on Sunday, May 3 with Leadership and Advocacy Essentials (formerly the Residents and First Timers Track). This half-day of programming hosted by EMRA and the ACEP Young Physicians Section will feature a veritable who's who of leaders in health policy, and will provide essential information on regulatory and legislative topics. Monday will feature more expert lectures as well as small group networking events, while Tuesday will be the day for hill visits and in-person advocacy with legislators. The final day of the conference (Wednesday) will mark the first annual LAC Leadership Summit featuring interactive sessions on leadership development. All in all, the conference will no doubt build your policy knowledge base and inspire you to get involved in advocacy.
So what are some of the hot topics that will be discussed at the Essentials sessions on May 3rd? A quick introduction to the topics and information about the corresponding conference session.
Session: Stop the Madness! Treating Patients with Mental Illness in the ED
Presenter: Dr. Aimee Moulin, MD, FACEP
The combination of EMTALA and the movement in the 1980s and 1990s to deinstitutionalize patients with severe mental illness has had some unintended consequences. Inpatient psychiatric facilities have shuttered their doors over the last three decades, and as a result, emergency departments have seen an increasing number of patients presenting with acute psychiatric needs. Left with fewer and fewer appropriate venues for acute psychiatric care, emergency departments have resorted to the “boarding” of psychiatric patients who are unsafe for discharge, but cannot be adequately treated in the emergency department. Boarding of psychiatric patients has become such a large problem in some areas of the country that the courts have intervened. In August of 2014, the Washington state Supreme Court ruled that boarding of psychiatric patients was unconstitutional as it violated the state's Involuntary Treatment Act. The ruling has forced the state to quickly expand psychiatric resources in order to abide by the court's ruling, improve psychiatric care, and maintain public safety. States across the country will be grappling with the same issue in years to come. What are some solutions to the problem? How do we fulfill our mandate under EMTALA, provide high quality emergency psychiatric care, and protect patients' civil rights?
Health Insurance Reform
Session: Health Policy Journal Club — How Health Insurance Policy Changes Affect Emergency Department Utilization
Presenter: Jeremiah Schuur, MD, MHS, FACEP
One of the principal mechanisms by which the Affordable Care Act (ACA) increased access to healthcare was the expansion of Medicaid eligibility. Though a Supreme Court decision in 2012 allowed states to opt out of Medicaid expansion, enrollment in the program has increased by about 7 million. The economic argument for Medicaid expansion is that if more low-income individuals are insured, they will be more likely to obtain preventive and primary care. By doing so, they will be less likely to utilize the emergency department unnecessarily, thereby saving money for the health care system. In order to further reduce unnecessary health care utilization among the poor, some states have incorporated cost-sharing mechanisms such as small co-pays into the Medicaid program. The idea here is that if patients have some skin in the game they will seek medical attention only when they actually need it. So does expanding Medicaid actually reduce ED utilization and cost? Do cost-sharing programs for the poor further reduce utilization and cost?
Health Care Spending for the Elderly
Session: Health Care Spending in our “Senior Years”
Presenter: Dr. Tony Cirillo, MD, FACEP
Between 2010 and 2050, the population of Americans over the age of 65 years will double, while the population over 80 and 90 will triple and quadruple, respectively.1 Recent data indicates that national per capita expenditures on health care are 3 to 5 times greater for those over 65 years than for children and younger adults.2 Put those two pieces of data together and it's easy to see why many in the health policy world are examining how to make health care for the elderly less costly. What are the best strategies for reducing these costs while providing high quality care? What role will emergency physicians have as care coordination and end-of-life care are prioritized within the health care system?
Payment Reform and Care Coordination
Session: Who has Time to Coordinate?: Sensible Strategies for Reforming our Delivery System and Ending Fragmented Care
Presenter: Aisha Liferidge, MD FACEP
In late January, Health and Human Services (HHS) Secretary Sylvia Burwell announced an aggressive timeline for the replacement of Medicare's traditional fee-for-service payment model with one that incorporates quality and value metrics.3 HHS has stated it aims to tie (1) 50% of its payments to alternative payment models (e.g., accountable care organizations, primary care medical homes, and bundled payments), and (2) 90% of its payments to quality or value metrics by 2018. Moreover, HHS plans to work with Medicaid programs and private insurers to expand the reach of alternative payment models far beyond Medicare. Accountable care organizations (ACOs) have already popped up around the country as part of demonstration projects, and though they have not consistently demonstrated cost-savings, they are here to stay. Similarly, prospective, bundled payments for episodes of care are also being integrated into Medicare reimbursement. Both ACOs and bundled payments are meant to increase care coordination among primary care and specialty providers, thereby reducing redundancy and inefficiency (e.g., duplicative tests, poor follow-up, unplanned return visits). What will be the role of emergency medicine providers within a healthcare system that increasingly emphasizes care coordination? What should care coordination from the ED look like?
These are just a few of the lectures and topics the will be addressed at this year's Legislative Advocacy Conference and Leadership Summit. We hope to see as many EMRA members there as possible. Your EMRA Board will be there advocating, and we hope that you join us.
- Kaiser Family Foundation. The Rising Cost of Living Longer: Analysis of Medicare Spending by Age for Beneficiaries in Traditional Medicare. January 2015. Available at http://kff.org/medicare/report/the-rising-cost-of-living-longer-analysis-of-medicare-spending-by-age-for-beneficiaries-in-traditional-medicare.
- Centers for Medicare and Medicaid Services. National Health Expenditure Date Fact Sheet. Available at http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet.html.
- HHS Press Office. Better, Smarter, Healthier: In historic announcement, HHS sets clear goals and timeline for shifting Medicare reimbursements from volume to value. January 26, 2015. Available at http://www.hhs.gov/news/press/2015pres/01/20150126a.html.