Introduction to Advocacy Emergency Medicine Residents Association Advocacy Week 2011 Created by Alison Haddock, EMRA Legislative Advisor

Objectives Defining Advocacy Healthcare Crises Health Care Reform Getting Involved

Advocacy Politics =

Advocacy noun. the act of supporting an idea or cause.

US!

Advocacy = Every Day Negotiating with consultants Aligning resources for our patients Patient education Public health efforts Hospital boards and medical staff meetings Solutions for crowding and boarding State Laws Federal Laws Reimbursement Regulatory Issues

Advocacy Physician’s public role: advocacy for and participation in improving the aspects of communities that affect the health of individuals. Gruen RL, Pearson SD, Brennan TA. Physician-Citizens – Public Roles and Professional Obligations. JAMA. 291:

We are the safety net. Average physician = $12,300 in bad debt Emergency physicians = $138,300

How much does the US spend on health care each year?

$2.5 trillion

From 2000 OECD data

Basis for Health Care Reform Solutions to our crises ▫Coverage ▫Cost ▫Quality Popular support for concept of reform

Patient Protection and Affordable Care Act (ACA): The Past Kids on parents’ policies until 26yo No preexisting conditions for kids State-based high-risk pools Small business tax-credits Covering the Medicare “donut hole” No lifetime benefit limits or recissions Expanded quality reporting

Patient Protection and Affordable Care Act (ACA): The Future “Individual Mandate” in 2014 Preexisting conditions eliminated for all 2019 Projections ▫Cover 60% of the uninsured ▫Cost ~4% of health expenditures ▫Cut the deficit by <1%

From “What Will Happen Under Health Reform— and What’s Next?” by the Commonwealth Fund, published in May/June 2010 Columbia Journalism Review.

Patient Protection and Affordable Care Act (ACA): The Future State insurance exchanges ▫For individuals and small businesses ▫Premium subsidies ▫Regulated benefits Cost offsets ▫Cutting Medicare Advantage ▫Decreased Medicare provider payments ▫Taxes (tanning salons, high-income Medicare beneficiaries, penalties)

Emergency Medicine and the ACA Essential Health Benefits Package Prudent Layperson EM Research Regionalization

(Un)Sustainable Growth Rate -29.5% Medicare’s flawed formula for physician reimbursement Patched 5 times in 2010 Now stable until… January 1 st, 2012

SGR Solutions? Too expensive to fix! More than $369.8 billion

And there’s more! Access to care Overcrowding and boarding Workforce shortages On-call coverage Accountable Care Organizations (ACOs) The IPAB

Get Involved!

EMRA 36 years representing residents ▫9,000+ members ▫33% of ACEP Health Policy Committee EMRA-ACEP Health Policy Mini-Fellowship

ACEP Legislative Network Leadership and Advocacy Conference Ongoing advocacy efforts from the Washington DC Office ACEP Committees ▫Federal Governmental Affairs ▫State Legislative and Regulatory ▫Medical-Legal

NEMPAC 2 year election cycle fundraising Raised $1,090,166 in 2010 Physician PAC Rankings: Orthopedics (2.6M) Anesthesia (2.3M) **AMA (2.0M) Radiologists (1.8M) Emergency Medicine (1.5M) Give-A-Shift!

Get involved! Give a lecture or journal club on advocacy Donate some of your time or $$ Speak out!

Take-Home Points Advocacy is a core competency… ▫Bring it home to your fellow residents! The healthcare reform process has only just begun… And we need YOU to reach our goals!!!

Thank you!