Posts Tagged Congress

Access Act Provisions Considered for Senate Bill

Sen. Debbie Stabenow at the introduction of Access to Emergency Medical Services Act

Sen. Debbie Stabenow at the introduction of Access to Emergency Medical Services Act

The U.S. Senate Finance Committee is finalizing its health care reform proposal. ACEP has been working with Sen. Debbie Stabenow (D-MI), the sponsor of the “Access to Emergency Medical Services Act” (S. 468), to include the provisions of the bill in the Senate Finance Committee package.

Sen. Stabenow and ACEP need your help. Sen. Stabenow’s office has notified ACEP staff that the Finance Committee is reluctant to include these provisions unless they hear from other Senators on the Finance Committee about the importance of this legislation.

You can help. Take immediate action on behalf of all emergency physicians and your patients.

Please check the following list and if your Senator is on the Finance Committee, please call the number listed, ask to speak to the health policy staff person also on the list and urge them to weigh in with Finance Committee staff about the importance of including the emergency medicine provisions of S. 468 in their draft legislation. Please do not call all the Senators in the list.  Only call your Senator’s office.

Briefly, the “Access to Emergency Medical Services Act” (S. 468) would:

  1. Create a national commission to examine all the issues affecting access to emergency care and provide recommendations to Congress on how to address these problems
  2. Provide additional resources (10% add-on payment) to physicians who provide EMTALA-related services to Medicare beneficiaries
  3. Create a CMS working group to develop boarding and ambulance diversion standards, guidelines, measures and incentives.

Questions? Contact Brad Gruehn or Jeanne Slade in ACEP’s Washington, DC office at 202-728-0610. Please call your Senator’s office before the close of business, Tuesday, June 23.
U.S. Senate Finance Committee   

Senate Member                         Staff Member                Contact Number


Max Baucus (D-MT)                    Liz Fowler                       (202) 224-4515

Jay Rockefeller (D-WV)               Jocelyn Moore                 (202) 224-6472

Kent Conrad (D-ND)                    Kate Spaziani                  (202) 224-2043

Jeff Bingaman (D-NM)                 Fred Isasi                        (202) 224-5521

John Kerry (D-MA)                      Alison Bonebrak              (202) 224-2742

Blanche Lincoln (D-AR)               Ashley Ridlon                 (202) 224-4843

Ron Wyden (D-OR)                     Eva Dugoff                      (202) 224-5244

Chuck Schumer (D-NY)               Meghan Taira                  (202) 224-6542

Maria Cantwell (D-WA)                Mark Iozzi                      (202) 224-3441

Bill Nelson (D-FL)                       Madeline Otto                 (202) 224-5274

Bob Menendez (D-NJ)                 Emma Palmer                (202) 224-4744

Tom Carper (D-DE)                      Racquel Russell            (202) 224-2441

Chuck Grassley (R-IA)                 Mark Hayes                  (202) 224-4515

Orrin Hatch (R-UT)                       Pattie DeLoatche          (202) 224-5251

Olympia Snowe (R-ME)               Bill Pewen                     (202) 224-5344

Jon Kyl (R-AZ)                            Jennifer Romans            (202) 224-4521

Jim Bunning (R-KY)                     Holly Santry                   (202) 224-4343

Mike Crapo (R-ID)                        Katie Oppenheim           (202) 224-6142

Pat Roberts (R-KS)                      Alison Anway                 (202) 224-4774

John Ensign (R-NV)                      Michelle Spence             (202) 224-6244

Mike Enzi (R-WY)                        Chuck Clapton                (202) 224-3424

John Cornyn (R-TX)                      Stephanie Carlton            (202) 224-2934





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A Review of Obama’s Speech to the AMA

The AMA Section Council on Emergency Medicine

The AMA Section Council on Emergency Medicine

ACEP President Nick Jouriles shares his thoughts on President Obama’s speech to the AMA House of Delegates yesterday

President Obama was warmly received by the physicians at the AMA Annual Meeting earlier today. Like many in the crowd, I went with mixed feelings. Our current system is not sustainable, we all know that. But would he actually speak specifically to some- even one – of the critical issues in emergency medicine today? What are his plans, how will our issues be addressed, and where do we go from here?

For starters, the President told us that he is not trying to create a state run plan. “When you hear the naysayers claim that I’m trying to bring about government-run health care, know this–they are not telling the truth,” Mr. Obama emphasized.

But his plan does have a public component and includes: an emphasis on preventative care, widespread use of electronic health records, and changes in the health insurance industry including a new “exchange” where individuals and businesses can purchase a health plan. That “exchange” includes a government option.

Like many in the audience I was wondering about President Obama’s emphasis on wasteful spending in health care. He does not lay the blame at the foot of physicians, but the constant drumbeat coming from his administration on this issue is unsettling. Can inefficiencies be wrung from the system? Can we streamline some of our processes? Can things be done differently? Yes, yes and yes. But to the tune of hundreds of billions of dollars? I don’t see it. Most emergency physicians don’t see it, and neither will most Americans.

But then, he brought up an issue we can all agree on. I am encouraged that he is open to changes in the medical liability system. That was a position I had not expected from this Administration, and although he does not take a strong position, it is a start. President Obama said, “[W]hile I’m not advocating caps on malpractice awards which I believe can be unfair to people who’ve been wrongfully harmed, I do think we need to explore a range of ideas about how to put patient safety first, let doctors focus on practicing medicine, and encourage broader use of evidence-based guidelines. That’s how we can scale back the excessive defensive medicine reinforcing our current system of more treatment rather than better care.”

Like I said, a start.

We will also have to look long and hard at proposals affecting the physician payment system. In addressing the issue, Mr. Obama said, “We need to bundle payments so you aren’t paid for every single treatment you offer a patient with a chronic condition like diabetes, but instead are paid for how you treat the overall disease.”

How that plays out for emergency medicine will be key, but given our 25 year history with EMTALA, where many hospitals receive extra funds for indigent care while we do not , his emphasis on this is not a good sign.

Finally, it was disappointing not to hear emergency medicine mentioned specifically. We saw how our emergency departments were affected with the “worried well” of H1N1. And the New York Times published my letter to the editor addressing that point. But the White House has hit the mute button for now- or until the next epidemic or natural disaster occurs- regarding the crisis in emergency medicine.

It was a good speech and a good start. It was great to be in the audience. Now it’s time for Congress to get down to business and find solutions that we can all believe in. And time for the nation’s emergency physicians to stand up and make our voice heard. Our patients need us.

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Encouraging Signs for Emergency Medicine

ACEP's Washington, DC Staff

ACEP's Washington, DC Staff

It is 2009 and we have a new administration, new impetus for health care reform and new hope for meaningful change. It seems everyone agrees that the current system is not sustainable, but that seems to be all anyone agrees on. Everything else is anybody’s guess.

ACEP has worked hard to include emergency medicine in the current debate. It has been a struggle, but fortunately, the ACEP-supported “Access to Emergency Medical Services Act of 2009” enjoys bipartisan support in the House and Senate. More than 120 legislators are now co-sponsors and ACEP continues to working closely with key legislators and their staffs to promote the legislation.

One very positive note was passed on by ACEP’s Washington, DC office yesterday. Legislative staff in the House and Senate have said that various provisions of the bill have been submitted to the committees writing the health care reform bills. That is very good news and it looks like the work of the thousands of ACEP members who have called, written and visited their members of Congress is starting to pay off.

Their efforts are part of a comprehensive three-pronged approach. First, there is a strong direct lobbying campaign on Capitol Hill by ACEP staff members, including Brad Gruehn, Jeanne Slade and Gordon Wheeler. This dovetails with a grass roots lobbying campaign supported by the 1350 members of the 911 Legislative Network. These ACEP and EMRA members have developed relationships with their Senators and House members and contact them regularly to relate ACEP’s positions on legislation and regulatory initiatives. In addition, hundreds of other ACEP and EMRA members have participated in ACEP’s “Contact Congress Campaign” and are demanding that emergency medicine’s issues be addressed in upcoming reform legislation.

The third part of this approach, and a key piece of ACEP’s ability to influence the debate, is the National Emergency Medical Political Action Committee, better known as NEMPAC. This ACEP-supported organization is now one of the top-five medical specialty PACs in the country, and contributes more than $2 million per election cycle to federal legislators who support emergency physicians.

Change comes slowly in Washington, DC. But ACEP will continue its decades long work to make sure that when a bill is put on the President’s desk for his signature, the concerns of emergency physicians will be included.

CMS establishes new Toolkit, PQRI helpline

On the regulatory front, CMS recently posted 2009 implementation advice for the 2009 Physician Quality Reporting Initiative (PQRI).

Tools include a downloadable numerical listing of all codes included in the 2009 PQRI for incorporation into billing software, and a link to measure-specific worksheets for reporting each measure. CMS has also established a new help line for PQRI participants with questions regarding participation procedures, feedback reports, and bonus payments. The telephone number is 866-288-8912, and will be in operation between 7:00am and 7:00pm Central time.

CMS plans to create a new email address for inquiries as well. Additional information about these tools and the PQRI program may be found at the CMS PQRI Web site.

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Why Go Inside the Beltway?

Are you a political animal?  If not, you may wonder why anyone would want to go inside the beltway.  You may not even have any idea what the beltway is.  It’s a piece of interstate highway – I-495, known as the Capital Beltway – that loops around DC and provides a metaphorical dividing line between the thinking of those inside and outside.  If you live, work, eat, sleep and breathe the Federal Government, you are a Washington Insider, an inside-the-beltway type.  If not, well then, you’re normal, like everyone else.


I’ve been coming here every spring since 1994, trying to get my elected representatives – and, sometimes even more important, their senior staff who are health policy wonks – to understand that emergency medicine isn’t just the center of my universe, but the center of THE universe – and that what matters most in life is that everyone in these United States has access to an adequately (dare I say generously?) funded, high quality system of emergency medical care.


If you do what I do for a living, and especially if you see it (as I do) as not so much a living but a calling, then you understand what I mean.  But people inside the beltway often don’t.  They require much education – and re-education, which means not sending them off to a camp in the Chinese countryside but coming back here every year to reinforce the old messages and add important new ones.  Once you get used to this ongoing need they have to be indoctrinated … I mean informed … then you realize that trips to DC at other times of the year and the occasional visit to the office in the home district can also be useful.  After a while they recognize you and know your name, and you’re on your way to building relationships with your elected representatives.  In politics, as in so many other facets of life, getting what you want is all about building relationships.


The immutable foundation of our message is that what we want is what is best for our patients and the nation’s healthcare system.  We’re the guys and gals with the white hats, the ones who take care of the least fortunate among us – and the most fortunate in their worst moments.  We’re there 24/7/365, and all we ask is that we be provided adequate resources to enable us to do our job the way it should be done.


Think you might be interested?  Call the Washington office (202-728-0610) and ask how you can get involved.  And then put on your white hat and saddle up!

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