In looking at the issues ACEP has been working on recently, I was struck by how many of them are unique to our specialty. Issues such as health care reform affect all physicians, but how many specialties have to deal with federal laws or state Supreme Court decisions that deal specifically with their practice environment? I can only think of one.

Let’s start with something as fundamental as getting paid for what we do. When the various committees that determine reimbursement rates start calculating, the discussion always centers on the office-based specialties. As a hospital-based specialty, emergency medicine is like Avis—we have to try harder. It is a constant struggle, but one that we successfully negotiated last year when our specialty received a 2% increase in payments, spread over 4 years, in the AMA practice expense survey. It may not seem like much, but others received cuts of up to 8%. We tried harder and succeeded.

Another EM-specific reimbursement battle started when Anthem/Wellpoint and Humana began bundling separately billable services into the emergency department evaluation and management codes. We filed compliance disputes with both insurers and are considering future actions later this year.

It seems that insurers are always looking for ways to game the system, especially when it comes to paying for emergency department services. And now, even the states have gotten into the act. When the California Supreme Court banned balance billing, emergency medicine was the one specialty mentioned in the ruling. CAL/ACEP picked up that gauntlet and has been fighting the good fight ever since. ACEP also got involved and created model legislation and support documents so other states could hopefully get ahead of the curve.

Then there’s EMTALA, the federal law written specifically for emergency medicine. No other specialty must see every patient who comes through the door. In fact, we are the only physicians who cannot mitigate our losses by choosing the proportion of Medicare or Medicaid patients we treat. Not that we would anyway, but we have to deal with this onerous and ever-expanding, unfunded federal mandate every day.

Our unique position also has many positive aspects. Emergency physicians have the rare ability to provide life-saving care in any situation, especially when the need is great. Right now, a large contingent of emergency physicians is providing care in unbelievably difficult circumstances in Haiti. Emergency physicians also have a disproportionate presence on DMAT and other disaster response teams. And many bravely serve our country in Iraq, Afghanistan, and throughout the world, putting their lives at risk every day. We can ask for no greater commitment than that.