Leading ACEP is a team effort, with emergency physicians and staff working together to represent and advocate for the specialty. Last month, we interviewed ACEP President Michael J. Gerardi, MD, FAAP, FACEP, about the challenges and opportunities ahead for emergency medicine. This month, Jay A. Kaplan, MD, FACEP, who was named ACEP President-Elect in October 2014, shares his views on the key issues facing emergency medicine with ACEP Now Medical Editor-in-Chief Kevin Klauer, DO, EJD, FACEP.

Dr. Kevin Klauer: So, Jay, I want to make sure that people understand what your vision is for your presidential year. It starts way in advance and probably not even with your President-Elect year, but the ground is laid for many programs from one president to the next.

Dr. Jay Kaplan: The President, the President-Elect, and the Past President, along with our Executive Director Dean Wilkerson, have weekly leadership calls where we go over issues affecting the college on a month-to-month, week-to-week, and sometimes a day-to-day basis. We talk about leadership, and we talk about the issues that are important to emergency physicians. The Past President, the President, and the President-Elect along with our executive leadership work very closely together in order to keep the ship on course.

KK: On those weekly calls, can you give us a sense of what important issues you’ve dealt with recently?

JK: Recently, we’ve talked about quality issues, the value-based modifier, and the pay-for-performance issues that are affecting emergency physicians. We met recently in Washington, D.C., and one of the issues that came up was medical liability reform, in particular, safe harbors. We discussed how we can approach Congress with regard to that. We reviewed our Qualified Clinical Data Registry and getting that up and running so that emergency physicians do not take a hit in terms of their reimbursement as pay for performance becomes more challenging. We talked about fair payment because reimbursement is also a major issue for emergency physicians and the whole issue of the banning of balance billing and the “greatest of three” rule, which relates to how physicians are compensated by insurance companies.

“I have concerns about how we’re going to be paid for the increased number of patients we expect to see. Value always relates to what you get for the dollars that are spent. If we want more dollars in our own pockets, which is what I want for my colleagues…we’re going to have to show our value.”
—Jay A. Kaplan, MD, FACEP

KK: This sounds like a good segue into what you feel are the biggest challenges for emergency medicine now and in the future.

JK: Showing our value. Emergency medicine has been scapegoated. We are known as the most expensive place to receive care when that is not the case. We have tried to tell our legislators that we’re only 2 percent of the health care dollar, but they haven’t bought it. As we move into the era of Accountable Care Organizations and bundled payments and less reimbursement per patient, we’re going to have to show our value in terms of consistent practice, following practice guidelines, and decreasing cost. We can’t do anything about patients coming to us, but we can create programs for our ED super-users to improve appropriate utilization. As our population ages, I have concerns about how we’re going to be paid for the increased number of patients we expect to see. Value always relates to what you get for the dollars that are spent. If we want more dollars in our own pockets, which is what I want for my colleagues, we’re going to have to look at whether to admit patients or not and our choices regarding expensive advanced imaging. We need to show that by being more consistent in our utilization of admission and of imaging, we can save the “system” money, and therefore we deserve to be paid fairly.