What do you think that emergency physicians should be paying attention to in Congress right now that we aren’t focused on?

Dr. Green: Saving rural hospitals and then allowing rural freestanding emergency departments. That bill will continue to come up until we’re [Republicans] in charge. Nancy Pelosi’s just not been allowed to solve that problem, if you’re more than 35 miles from another ER a freestanding ER can’t bill CMS for Medicare and Medicaid. So, I’m trying to get that removed because when a rural hospital closes, we’ll get at least keep the ER as a freestanding ER.

Maybe a business model would be that the rural hospital becomes a freestanding ER and a nursing home or something like that. That way you keep the jobs in the rural community and you keep some emergency medicine coverage in that rural community. I’ve run this bill every year that I’ve been in Congress and I can’t get with a Democrat co-sponsor. I can’t get Nancy [Pelosi] to let the bill be heard.

You founded a hospital ED physician group in Tennessee. Can you tell me more about that? The trend right now is of independent physician groups apparently being swallowed up by either hospitals or by investor groups. And I was wondering what your thoughts are about that.

Dr. Green: I founded [the company] and we grew the company up to 52 contracts in 11 states when I left. We had about 1,000 clinicians when I sold the company. The way I did it was the physicians owned the net revenue from their local facility. It was almost like a franchise and I believe the company that took it over from me continued to do that. The company that took it over from me was American Physician Partners. I like the idea of the doctor owning the upside of their business at their local place now. The advantage of having larger groups is you can negotiate better rates with the payers. You know, a small ER group of eight guys and gals working in their own ER goes to Blue Cross Blue Shield (BCBS). BCBS says you’re going to get 85 percent of Medicare on your reimbursement rates, whereas if you’ve got 75 ER docs then you might get 150 percent of Medicare from Blue Cross Blue Shield. If I was to do it again, I would probably try to find some way where there could be a coop or an association of independent groups so that they can negotiate together, but the laws are a little bit restrictive on how you can negotiate because antitrust. The turnover in the company was less than 2 percent. In fact, the only people that left the company for the first three years were asked to leave because they had customer service, patient satisfaction issues, or competency issues.