Each October at ACEP’s annual Council meeting, the ACEP Council elects new leaders for the College. The Council represents all 53 chapters, 35 sections of membership, the Association of Academic Chairs in Emergency Medicine, the Council of Emergency Medicine Residency Directors, the Emergency Medicine Residents’ Association, and the Society for Academic Emergency Medicine. On Oct. 15, Council members will elect the College’s president-elect and four members to the ACEP Board of Directors. This month, we’ll meet the president-elect candidates. In September, we’ll introduce the Board of Directors candidates.

Platform-Statements

The following Board members are candidates for the office of president-elect. They responded to this question:

What major challenge does the College face that you would like to make your signature issue for the next three years?

Hans House, MD, FACEP (Iowa)

Current Professional Positions: professor, emergency medicine, University of Iowa; vice chair for education, Department of Emergency Medicine, University of Iowa

Internships and Residency: combined internal medicine–emergency medicine residency, Olive View-UCLA Medical Center Medical Degree: MD, University of Southern California (1997)

Candidate Question Response:

Physician wellness is the most concerning challenge that faces not just the College but all of medicine. Our health care system cannot afford the loss of talent and productivity that comes with today’s frightening rate of burnout. Improving physician wellness isn’t just about making work-life balance changes to what we do outside the hospital, such as exercise, diet, sleep, and family time.

Curing the epidemic of burnout requires us to change the system and put physicians back in control of their environment. In a 2014 article in The Atlantic, Richard Gunderman wrote, “Professional burnout is the sum total of hundreds and thousands of tiny betrayals of purpose, each one so minute that it hardly attracts notice.”¹

Each time emergency physicians feel bogged down by the detailed legal paperwork for admitting psychiatric patients, they suffer one of those hundred-thousand betrayals. Every time physicians scream at multiple hard stops in their electronic health record (EHR) that were placed there only to satisfy inspectors with clipboards and checklists, they suffer one of those betrayals. Every time physicians are denied compensation because their value is judged by an invalid quarterly Press Ganey survey, they suffer one of those betrayals.

Our members want to have sufficient resources to care for their patients and carry out the mission of emergency medicine: the calling to care for anyone, anytime, for anything.

How do we take back control of our profession? By empowering physicians as leaders from the hospital boardroom to the statehouse. By taking every possible opportunity to tell our story to the public to build up the trust our patients place in emergency providers. By encouraging physician ownership of groups and emergency departments so that emergency physicians define the practice and processes as patient-centered and true to the core mission of emergency medicine.

ACEP’s staff in Washington, D.C., is adept and influential, but we can do more to support the efforts of state chapters in shaping local legislation. ACEP can leverage our investment in the Clinical Emergency Data Registry (CEDR) to encourage provider-friendly improvements to the EHR, such as pushing prescription and laboratory data to the user without enduring further mouse clicks. By speaking with one voice and taking collective action for the well-being of our members and patients, ACEP can once again allow physicians to be healers and focus on practicing the art of medicine.

“Each time emergency physicians feel bogged down by the detailed legal paperwork for admitting psychiatric patients, they suffer one of those hundred-thousand betrayals.” —Hans House, MD, FACEP

Paul Kivela, MD, MBA, FACEP (California)

Current Professional Positions: managing partner, Napa Valley Emergency Medical Group; medical director, Medic Ambulance; chief medical officer, Newsura Insurance Services; business consultant, numerous medical businesses

Internships and Residency: emergency medicine internship and residency, LA County–Harbor–UCLA Medical Center

Medical Degree: MD, University of Illinois College of Medicine (1990)

Candidate Question Response:

Our specialty is under a public relations attack. Insurance companies have accused us of “balance billing” and sending “surprise medical bills.” Legislators have accused us of being a cause of the opioid epidemic and portrayed many emergency visits as expensive and unnecessary. So often over the last several years, whether it’s price or care issues, emergency medicine has been viewed as the “problem.” Hospitals have forced inefficient EHRs on us, boarded patients in the emergency department, and then complained to us about throughput times. Our approach to many of these important issues has been largely defensive of our practices. Consolidation of payers, health systems, and medical groups will add additional pressures in the very near future.

However, medicine is changing, and we must change our strategies.

ACEP needs to embrace the future and be recognized as the organization that the government, insurance companies, consumer groups, patients, and every emergency physician goes to for solutions to their problems.

In order to answer the challenge:

1. We need to provide solutions that show that emergency medicine residency training is cost-effective and improves medical outcomes.
2. We need to advocate for payment models that reward emergency physicians for their value through gainsharing models that reward physicians for providing cost-effective quality care. This must be a win-win-win for payers, physicians, and patients.
3. We need to advocate for further physician autonomy and resources, including interoperable EHRs that allow physicians to determine the best product for the job.
4. We need to further vet and develop medical-legal solutions that safeguard evidence-based practices and minimize defensive ordering.
5. We need to make sure, as health systems consolidate, that physicians, not administrators, are determining appropriate care.

The president of ACEP serves two crucial roles for the College. He or she is a spokesperson for the College and determines the direction by establishing objectives and assigning them to committees.

I have the proven spokesperson experience and skills to effectively communicate the message, whether that’s with policymakers, the public, our colleagues in the House of Medicine, or other emergency physicians. I have the background and vision to unify the specialty and fortify the College.

“Hospitals have forced inefficient EHRs on us, boarded patients in the emergency department, and then complained to us about throughput times.” —Paul Kivela, MD, MBA, FACEP

Robert E. O’Connor, MD, MPH, FACEP (Virginia)

Current Professional Positions: professor and chair, physician-in-chief, Department of Emergency Medicine, University of Virginia Health System; emergency physician, Culpeper Regional Hospital

Internships and Residency: emergency medicine residency, Medical Center of Delaware

Medical Degree: MD, Medical College of Pennsylvania (1982)

Candidate Question Response:

I have been asked to define my “signature issue” for the next three years. I have served on the ACEP Board for six years, including this past year as chair of the Board. I have worked to formulate solutions to many of the problems that we all face every day. Fair payment, tort reform, practice management, and physician wellness are but a few of these issues. Two of our newest initiatives, the CEDR and the Emergency Department Information Exchange (EDIE), represent a significant way to improve emergency care.

Would you rather work harder or work smarter? Documentation requirements, clinical decision making, reimbursement, and quality reporting are converging on emergency medicine and will force us to choose—do we work harder or smarter?

During my time as chair of the Board, we have made major commitments to launching CEDR and EDIE. Implementation is only the first step, and the use of technology to enable greater efficiency will be my signature issue during the next three years. These systems will require a sustained commitment to reach as many ED patients as possible while undergoing continual refinement. Imagine working a shift where you have access to information from every ED visit in the country for every patient you see. No more faxing medical releases to outside hospitals for old records. Imagine having access to national-level practice-improvement data that can be used to satisfy pay-for-performance requirements for reimbursement but also can be used to improve quality of care and outcomes. Imagine an EHR that provides work-saving decision support, documentation assistance, and integration with clinical data from all sources. This is how we work smarter.

In July, I attended a corporate advisory council meeting hosted by ACEP. I have participated in these meetings in the past, but this one was different. The overriding theme from companies providing goods and services to emergency physicians was a desire to make products that will improve care and allow us to work smarter. I will enable industry to work with emergency physicians to develop these strategies so that we stop wasting our time performing pointless, repetitive actions in order to do our job.

These initiatives are only just the beginning. For us to successfully incorporate CEDR, EDIE, and IT solutions into our practice at the national level, ACEP will need unwavering presidential support.

Implementation of CEDR, EDIE, and IT support will be my signature issue.

“Imagine having access to national-level practice- improvement data that can be used to satisfy pay-for- performance requirements for reimbursement but also can be used to improve quality of care and outcomes.” —Robert E. O’Connor, MD, MPH, FACEP

John J. Rogers, MD, CPE, FACEP (Georgia)

Current Professional Positions: co-emergency department medical director, Coliseum Northside Hospital; staff ED physician, multiple locations throughout Georgia

Internships and Residency: internship, Department of Surgery, University of Iowa; residency, Department of Surgery, Medical Center of Central Georgia (now Mercer University)

Medical Degree: MD, University of Iowa (1978)

Candidate Question Response:

Our major challenge is also our major opportunity: to ensure that the health care reforms embedded in the Affordable Care Act are implemented in a manner that supports our ability to deliver emergency care while at the same time improves rather than impedes our work life. As MACRA (the Medicare Access and CHIP Reauthorization Act of 2015) matures, we must provide the strategies that tie quality and payment in a rational manner. Quality measures must be meaningful, improve outcomes, be aligned with facility measures, and must not be implemented prematurely nor in a fashion that’s so complex or costly that it punishes small groups. MIPS (the Merit-Based Incentive Payment System) requires streamlining; we must understand how we can function in an alternative payment model and ensure the financial risks are appropriate.

Another challenge is President Obama’s budget proposal that requires all hospital-based physicians to accept in-network payment and prohibits balance billing. We must not passively acquiesce to becoming indentured servants who serve at the whims of the insurance industry. We must also be prepared to intelligently discuss the idea of offering a public option that many see as a precursor to a single-payer system.

Each ACEP president builds upon what others have begun. We have been enlightened about our diversity deficit, and a task force will develop a white paper to serve as our road map to close this diversity gap. Diversity is neither a cause de jour nor what is trendy or fashionable, but it is how organizations become stronger. Anything that makes us stronger must be embraced. We must not be satisfied with the mere appearance of diversity but insist on something more substantial and meaningful: diversity of thought and perspective.

Our attention has been turned to wellness, yet wellness is only the first part of a twofold approach to burnout. Wellness is about coping with the significant stresses of our practice; however, we must also remove the cause of our burnout. The cause is not the usual stress of practicing our craft; it’s the abuse heaped upon us by bad policy and its implementation. These are born from well-meaning but poorly informed and educated legislators, regulators, and administrators. Advocacy is important, but to be truly effective, we need the data and the evidence to be truly persuasive and effective, and this comes from health policy research. We also need more of us as the decision makers, as I mentioned in my address to the Council two years ago.

“We must not be satisfied with the mere appearance of diversity but insist on something more substantial and meaningful: diversity of thought and perspective.” —John J. Rogers, MD, CPE, FACEP

Reference

1. Gunderman R. For the Young Doctor About to Burn Out. The Atlantic. February 21, 2014.