ACEP MEMBER AMISH SHAH, MD, FACEP (D-AZ-1) is running against incumbent David Schweikert (R-AZ-1) for a House seat in Maricopa County. Dr. Shah trained at Lincoln Medical and Mental Health in New York.
ACEP Now: What obstacles exist in Congress to address hospital boarding? What would be your recommendations on how to address them?
Dr. Shah: Start to get your members of Congress to begin dialog with CMS because that’s where the rules are made that will affect this issue and solve this problem for us. We’ve got to be able to build relationships, to get the right people at the right time in the right room – at the right table – to be able to create incentives so that this doesn’t happen, and patients have better outcomes.
ACEP Now: The FTC is looking into consolidation: What are your thoughts on consolidation among insurers and providers of health care?
Dr. Shah: We have always regulated monopolies in the U.S., and FTC has always been a group that has protected people from monopoly for the benefit of the consumer and for society at large. And we’ve seen in other industries like big tech, they’ve been very hesitant to go after monopolies. Now, I think there is a place for them to carefully examine the market power in any one given industry in a given location and ask whether that meets the definition of monopoly power. I certainly hope they would do that. I was an economics major, you know, and I’d be concerned if somebody were exerting monopoly power at the expense of the consumer.
ACEP Now: How would you encourage other physicians to follow in your footsteps away from the bedside to tackle issues in Congress or a state legislature?
Dr. Shah: I’ve been saying for many years that physicians need to get involved because people who are making these decisions are not necessarily from the health care world and wouldn’t understand it the way you would. And you’re smart, kind, compassionate people who care a lot and do this for the sake of patients. It’s great to do this one patient at a time of the bedside, but also some of us need to go and be involved at the system level because the system under which we all work, you know, will be a big determinant as well, right? You can be the world’s greatest doc, right, working at the bedside over and over again, toiling away. But if you’re working in a system that doesn’t work for the patients, then you’re not having nearly the impact you would like to have.
ACEP Now: Should ER docs unionize to get better working conditions?
Dr. Shah: That’s a complicated question. I attended the ACEP panel on this last year, and they talked about the pros and the cons. It may not be for everybody. Some groups and practices have explored the option, understand what they’re getting into and have concluded that that they’re going to work together to get better outcomes under a unionized model. It has clearly made sense for those groups. It’s not a decision to be taken lightly.
ACEP Now: What are you hoping to accomplish at the federal level that you couldn’t at the state level?
Dr. Shah: The big thing at the federal level is that Medicare and Medicaid are controlled up there at the federal level, right? And a lot of health care financing is done at the federal level that isn’t done at the state level. That’s really it. We did have some control over the state Medicaid system at the state legislature level, which was good. But you’re trying to get everybody covered and lower the costs. I mean that’s really it, and it’s a much bigger problem. CMS controls a lot of the rules for how things are financed, and therefore that’s where you have to go if you want to make changes.
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