President Letter: WA-ACEP’s Progress in 2017 and Beyond
Dear Colleagues –
I hope this letter finds you well in the New Year. I’m excited to report to you that your organization continues to grow and thrive, even in these challenging times. Already this year a number of important milestones have been reached:
Membership – Our count of Washington members now exceeds 700 for the first time in our history! This growth has earned our chapter an extra seat in the ACEP National Council where we will bring your voice to influence the policy decisions of the organization.
Largest Olympia Delegation – Washington ACEP had 16 members attend the WSMA Legislative Day in Olympia on January 25th. This stellar group of individuals helped advocate for a fair resolution to Balance Billing, addressing the opiate epidemic, and raising the tobacco age to 21. With the addition of the Washington State 911 Network, we are well on our way to making your voice heard locally.
No Divert Policy – With the extraordinary pressures on multiple facilities in the Puget Sound this winter, we advocated with our organizations for a return to a regional no divert. I’m excited to report that Pierce and King County have committed to a No Divert Policy and facilities in adjacent counties have committed to join as well. This will ensure that we don’t pass around the problem, but instead tackle it together.
Together we are making a difference in the lives of our patients and ensuring that Washington is the best place to practice for our people. Simply put, we are great when we have good people. I firmly believe that we have an incredible team in our departments and on your board of directors. We will continue to advocate for you and appreciate your participation and support whenever and wherever you can join us.
As always we stand ready to serve you where needed. Please do not hesitate to contact me if I can be of assistance.
Hon. Nathan Schlicher, MD, JD, FACEP
Balance Billing: Round and Round We Go
Last year, the Washington Insurance Commissioner, Mike Kriedler, declared an intent to eliminate out-of-network (OON) billing, also called balance billing. He is joined in this interest by Rep. Eileen Cody, chair of the House Health and Wellness committee, who has a long-time interest in this issue. Together, joined by Rep. Caldier, they convened a workgroup over the summer and fall to review the issue. This group included stakeholders such as your WA-ACEP and the Washington State Medical Association (WSMA), working closely together; multiple other specialty societies; the Washington State Hospital Association (WSHA) representing hospitals; and all of the state’s major insurance carriers. Overall the workgoup was ineffective and unfocused, with broad but poorly defined goals expanding to prohibit all that they term “surprise billing,” a poorly defined term, most of which occurring
outside the Emergency Department environment.
The Office of the Insurance Commissioner (OIC) drafted initial legislation, which was a highly disappointing effort modeled after laws enacted in Illinois and California. This would have banned OON billing while handing rate-setting authority to the insurers. This would have set into action a deflationary spiral to a minimum benefit standard (MBS) of 125% of Medicare rates, representing an existential threat to the integrity and solvency of the emergency care safety net. Fortunately, in no small part due to our representatives funded by WA-ACEP and the WSMA, this bill has yet to gain much support in Olympia.
Our chapter has been principled in pushing for a MBS based on providers’ reasonable charges and have rejected Medicare rates as a benchmark. WA-ACEP submitted a proposal drafted by Nathan Schlicher, MD, WA-ACEP President, modeled on successful legislation enacted in Connecticut. This would ban balance billing, fixing OON reimbursement at a more favorable MBS equal to the 80th percentile of a charge database called Fair Health. This would shield patients from excessive OON charges, ensure reasonable reimbursement for Emergency Physicians, and prevent a deflationary environment with regard to health insurance contracting. This has met with guarded interest, but prospects for acceptance are mixed at best.
The national ACEP Board and allied advocacy groups including “Physicians for Fair Coverage” have offered significant resources for us to fight this in the media and Olympia. However, Rep. Cody has long been an honest and open partner in these discussions and so we have deferred opening a media war. This would likely drive more support away from our position than it would gain.
The outcome of this legislative session is unclear. Huge uncertainty exists in healthcare and in the insurance market, with the potential for the repeal of the ACA and major restructuring of Medicaid and even Medicare possible. This, plus challenges to the state budget, may dim the enthusiasm for reform to OON billing in Olympia. The range of potential outcomes includes a good bill, a bad bill, a limited compromise on insurance network adequacy/transparency, or the status quo. Your WA-ACEP representatives will continue to negotiate in Olympia on your behalf. Should it become necessary, we may issue a call to action for members or initiate a media campaign. Thank you for your support and attention to this matter.
Liam Yore, MD, FACEP
WA-ACEP Balance Billing Workgroup Co-Chair
Stretch Your CME Dollar at the WA-ACEP 2017 Summit to Sound April 26-28 in Seattle
Our agenda blends both national speakers with local experts to tackle tough issues such as pulmonary management, violence in medical settings, infections in the returning traveler, human trafficking and pediatric emergencies. Register for the 2017 WA-ACEP Summit to Sound for three days of clinical updates, hands-on workshops and networking opportunities.
Back by Popular Demand: Tales from the Pit at Summit to Sound
Physicians, PAs, RNs and EMTs are invited to bring their entertaining and educational cases to the session and provide a brief presentation. The audience will vote and cash prize will be awarded for the following categories: Craziest Case, Most Heartwarming, Saved by my Nurse, as well as others. All participants will be awarded a “Tales from the Pit” t-shirt. Interested? Submit a brief description of your case to email@example.com by March 24, 2017. Submissions should follow HIPAA guidelines. Cases chosen for presentation during the April 28 session will be notified by April 7, 2017.
Congratulations New ACEP Fellows
WA-ACEP Members, Drs. Melody Denson of Fox Island; Jason Hanley of Portland, OR; Jesse Hostetter Kropf of Portland, OR; Thomas Robey of Seattle; and Danielle Schindler of Bainbridge Island earned the FACEP designation and will be recognized at ACEP17 in Washington, DC.
WA-ACEP Supported Legal Brief Prevails
In a case that could have had profound consequences for physicians and other health care providers, the Washington Supreme Court handed down a most welcome 9-0 decision in Dunnington v. VMMC, protecting the established burden of proof in medical malpractice cases rather than lowering that burden, as a victory for the plaintiffs would have done.
At issue in the case was a legal question concerning the burden of proof of causation in medical malpractice cases when a plaintiff alleges loss of chance of a better outcome. While the defendant in the case was a podiatrist, a decision against the defendant would likely have changed how causation is litigated against all health care providers—lowering the burden of proof for loss of a chance of a better outcome and resulting in even more defensive medicine.
The court also considered whether, if the defendant physician relies on a "contributory negligence" legal defense, a jury should be allowed to hear evidence related to a patient's failure to follow his or her physician’s instructions. Fortunately, the court also agreed with our position on this issue by determining that evidence related to how a patient complied with a physician’s instructions (or in this case, failed to comply) could be presented to the jury when relevant to the defendant’s contributory negligence defense.
WA-ACEP joined the Washington State Medical Association, the Washington State Hospital Association, and the Washington State Radiological Society in the filing of the amicus brief. Physicians Insurance A Mutual Company also provided support.
ACEP Board of Directors Action
Read a summary of the January 2017 ACEP Board of Directors meeting.
Mark Your Calendar
ACEP Leadership and Advocacy Conference
March 12-15, 2017
2017 WA-ACEP Summit to Sound
April 26-28, 2017
Bell Harbor Conference Center
Oct. 29-Nov. 1, 2017
EM Leadership Summit
Nov. 10, 2017
The Conference Center at the Seattle Tacoma International Airport
Like WA-ACEP on Facebook and follow us on Twitter @WashingtonACEP
Washington ACEP Board
Nathan Schlicher, MD, JD FACEP
John Matheson, MD, FACEP
Patrick Solari, MD, FACEP
Liam Yore, MD, FACEP
Cameron Buck, MD, FACEP
Russ Carlisle, MD, FACEP
Jaime Delcampo, MD, FACEP
Raul Garcia, DO, FACOEP
Jamie Jenkins, MD, FACEP
Catharine Ryan Keay, MD, FACEP
Brian Livingston, MD, FACEP
Gregg Miller, MD, FACEP
Susan Stern, MD
Jennifer L’Hommedieu Stankus, MD, JD, FACEP
Julianna Yu, MD
Stephen Anderson MD FACEP
Past President (Non voting)
Enrique Enguidanos, MD, FACEP
Past President (Non voting)
Christopher Kang MD FACEP
Past President (Non Voting)
Justin Bacon, DO
Sabiha Barot, MD
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