NATHANIEL SCHLICHER, MD, JD LEGISLATIVE ADVISOR EMERGENCY MEDICINE RESIDENTS’ ASSOCIATION EMERGENCY MEDICINE RESIDENT WRIGHT STATE UNIVERSITY ATTORNEY AT LAW JOHNSON, GRAFFE, KEAY, MONIZ & WICK, LLP Introduction to Health Policy

Why Are You Here? Maybe…  Cool Location  Meet and Greet  Program Paid For it Or Maybe…  Want to Make a Difference  Want to Guide Change  Care about an issue

History of this Program Where We Were Resident Focused Track Chair’s Challenge Social Reception to Meet the Leaders What We Have Added Added First-Timers from YPS Section of ACEP Integrated Media Training Roundtable discussions

Today’s Speakers 1:00 – 1:40 Introduction  Nathaniel Schlicher, MD, JD 1:40 – 2:20 Health Care Economics  James Eadie, MD, FACEP 2:20 – 3:00 Current Issues  Jennifer Wiler, MD, MBA

Afternoon Agenda 3:00 – 4:00 Roundtable Discussion  10 Hot Topics 4:00 – 6:00 Media Training  Speakers Bureau Pre-Requisite 6:15 – 7:15 Reception  Cocktails and Networking

Objectives What is Advocacy? Legislative Process Health Care Reform Medical Malpractice Reform Getting Involved

Advocacy Politics =

SPEAKING FOR A CAUSE, OFTEN FOR A VULNERABLE PERSON Advocacy is…

US!

What is Advocacy to You? Calling Consultants Getting that Test Free Care for All Hospital Boards Medical Staff Meetings Overcrowding Solutions State Laws Regulations Federal Policy Reimbursement

EMTALA Why should we care?

$138,300 / year per ER Physician $12, 300 / year Average Physician

On call Specialists Medical Home CLOSED

We Need a Seat at this Table! President Obama’s Health Reform Summit

Now Do you Care?

The Legislative Process

The Start Bill is Introduced Referred to Committee Referred to a Subcommittee Bart Gordon (HR 1188) Energy and Commerce Ways and Means Subcommittee On Health in both Committees

The Hearings Subcommittee Hearings  Report out or Table it Committee Hearings  Report out or Table it Full Chamber Considers  Approve, Defeat, Refer Back, or Table it Second House Consideration

The Home Stretch Compromise  Amendments referred back to original chamber  Conference committee Presidential Consideration  Sign  Veto  No Action Pass  Pocket Veto

Health Care Reform

The Rationale 46 million uninsured 1 in 3 Americans under 65 without health insurance in 2007/2008 Bankruptcy every 30 seconds from medical costs 72% of Americans favor increasing government control on costs

Obama Campaign Plan EHR 10 billion over 5 years Increased Prevention Align incentives for excellence – PQRI Malpractice insurer reform Competitive Insurance National Health Ins. Exch. SCHIP Expansion Eliminate Medicare Advantage Negotiate Drug Prices Tax Credits

Moments of Pause Expanded Pay for Performance SGR like cuts are likely More Medicaid or Medicare unclear Decrease specialist utilization via incentives

Funding the Plan Stimulus Bill  17 billion for EHR  60% subsidy for COBRA  87 billion for 2 years of Medicaid billion / year via  Tax cut rollbacks on >$250,000  Keep the Estate Tax 634 billion over 10 years  Reduced deductions  Medicare Advantage gone  Provider cuts

The Wrinkle Cost: $1.5 Trillion / 10 years Areas of Savings: Physicians Hospitals Insurers Drug Companies

Hope and Change Allocation for SGR Reversal in 10 year plan “Restructuring” of payments to physicians Can We Get a Bailout?

Tort Reform

Why? Insurance Premiums  $26 billion annually  12% / year growth rate Cases more expensive  52% exceed 1 million  Average verdict 4.7M Defensive Medicine??  $ billion estimates

What are the issues? Malpractice Caps Statute of Limitations Statute of Repose Attorney Fee Limits Expert Witness Qualifications

Where We Stand

Data from the CBO (2004) Caps improved costs  Decreased costs of health insurance  Decreased cost of malpractice coverage  Increased insurance premiums  Increased physicians Collateral Source Reform  Limited decline

Many Issues Remain State or Federal Issue? Clumping of tort reform Stigma of greed Powerful Plaintiff Bar

Getting Involved

EMRA 35 th year of existence  8457 Members  33% of all ACEP Health Policy Committee Legislative Advisor Advocacy Handbook

ACEP Projects 911 Network Speakers Bureau Access to Emergency Medical Services Act of 2009  S. 468 / H.R  Jen Wiler

ACEP Committees Federal Governmental Affairs Committee State Legislative / Regulatory Committee Medical-Legal Committee

NEMPAC Election Cycle 2 years  2 million dollar goal Ranking  1 – Anesthesiology (3.12M)  2 – Orthopaedics (2.37M)  3 – Radiology (1.70M)  4 – Ophthamology (1.69M)  5 – Emergency Med (1.68M) Give-a-shift Goal  $1000 / attending  $100 / resident

You May Be Involved But… Rally your group / residency / friends Give a Lecture / Journal Club on Advocacy Become a Spokesperson Give your Time and Money

2009 EMRA ADVOCACY HANDBOOK Want More Information?

Thank Yous Anthony Foianini, MD,  Maine Medical Center, Portland, ME Christopher S. Jones, MD  Eastern Virginia Medical School, Norfolk, VA Eric Goralnick, MD  Yale New Haven, New Haven, CT Daniel Freess, MD  University of Connecticut, Farmington, CT George Leach MD  Emory University, Atlanta, GA Edwin F. Lopez, MD  Sinai-Grace Hospital, Wayne State University, Detroit, MI Chet Schrader, MD  Washington University in St. Louis, St. Louis, MO Michael Dorrity, MD  MSU-Sparrow Hospital, Lansing, MI Erin E. Schneider, MD  Oregon Health and Science University, Portland, OR

Thank Yous Kaedrea Jackson, MD, MPH  SUNY Downstate Medical Center, Kings County Hospital Center, Brooklyn, NY Malika Fair MD, MPH  Carolinas Medical Center, Charlotte, NC Stephen Tantama, MD  Naval Medical Center San Diego, San Diego, CA Thomas Masters, MD  Wright State University, Kettering, OH Jamie “Akiva” Kahn, MA, MSIV  University of California at Irvine, Irvine, CA Marisa L Oishi, MD  Mount Sinai School of Medicine, New York, NY Jawad Kassem, MD  SUNY Upstate Medical University, Syracuse, NY Yogin Patel, MD, MBA  Apollo MD, Atlanta, GA

Upcoming Advocacy Events Advocacy Webinar – May 21 st at 2pm EST  Target Audience – Junior Faculty  Speakers – Nathan Schlicher and Gordon Wheeler ACEP Blog:  Thecentralline.org  Rotating Bloggers Twittering with LAC  Emresidents  LAC09

Take Away Points Advocacy is a core competency for us Get involved, we need you! Medical Malpractice Liability Reform may live Health Care Reform Details Coming Soon!  Stay involved

Thank you!