ACEP Now: Boarding has persisted as an issue for the past couple of years. In my career, it’s gotten worse and worse over time, especially after COVID. What obstacles do you find in Congress that exist right now when it comes to addressing hospital boarding, and what would be your recommendations on how we could address them from a society organizational perspective?

ACEP MEMBER AND U.S. REP.
RICH MCCORMICK, MD, is a veteran and emergency physician who serves Georgia’s 6th Congressional District in the United States House of Representatives.
Between deployments, Dr.
McCormick earned his Master
of Business Administration from National University and medical degree from Morehouse School of Medicine in Atlanta. He completed residency in emergency medicine through Emory while training at Grady Hospital in Atlanta. Most recently, Dr. McCormick served as an emergency physician at
Northside Hospital. Incumbent Rich McCormick, Bob Christian, and Charles King are running in the general election for newly drawn U.S. House Georgia District 7.

Rep. McCormick: First of all,  government is very bad at solving problems. Medicine is unique and very complex. We’ve seen it in the way we pay for medicine, it’s a $5 trillion industry in America. That’s the same as the third-largest GDP in the world. Between the PBMs, the pharmaceuticals, the hospital systems, the doctors, the mid-levels, the nurses, the techs… it is a complex system of payments. The boarding issue is not just one thing. Why would it be worse after COVID? Are there more people sick? You could say that the population is growing at a set rate, but more so in some areas than others. We have underserved communities in the rural areas, we have, let’s say, for example, in the Atlanta region, we had AMC, one of the largest hospitals in the region closed. What does that do? Overburden the other hospital systems.

Each hospital system has its own unique challenges. One thing I will say though is the free market is really good at sorting these out, but if you have a certificate of need (CON) for example, you have no way to compete, you have no way to expand, you have no way to reinvest in serving the public.

ACEP Now: The Federal Trade Commission has been looking into the consolidation aspect as it persists among insurers, as well as providers of health care, that means hospital systems as well as physician groups. The Senate started to look into that and investigate as well. And I was just curious what your thoughts are as it pertains to consolidation, but also the private equity side, in terms of how physician practices have been getting funding more and more recently.

Rep. McCormick: You go back to 74% of all physicians are now employed by hospital systems. Once you’re an employee, you are kind of cut out of the profit ideas, you don’t have a competition model anymore, you just have a survival. And maybe you get paid more because of RVUs, depends on what system you’re in. For an ER doctor, we’re paid entirely on RVUs. Most physicians now are paid on RVUs, which means that the more patients you see, the more money you make, but it also encourages you to hustle through patients as fast as possible.

I think AI is going to change some things, it’s going to make us more efficient. You’re not going to need scribes anymore, which means there’s another $20 per hour employee that goes away. Once we get good at [AI], your note will basically be written by the time you leave and you can modify it accordingly.

Now the problem is we have some insurance companies that literally have 40% denial from ER physicians.  We spend all that time with the patient, spend all that time with EMRs, we have a scribe, we have coders, and we stay up late trying to complete our notes after our shifts, and we’re still getting 40% denials. That’s almost half of our billing getting denied. Meanwhile, insurance companies are making record profits.

Why wouldn’t you invest in a company like that, where basically, you can deny people their reimbursements, you can deny people their pre-approvals, you can basically decide the fate of surprise billing, and have no accountability.

And look at what [Secretary Bacerra] has done in Texas. He’s been taken to court four times, and lost all four cases. That’s either a really bad lawyer or a guy who’s purposely doing the wrong thing to evade what Congress has outlined, taking it totally out of the purview of the intent of the legislation on surprise billing.

It shouldn’t be just PBMs and insurance companies making record profits, and hospitals trying to hang on for dear life, and physicians all becoming employees of hospitals, which, once again, increases the price. In the end, it should be about patients.

ACEP Now: Dr. Aisha Terry, has focused on the pipeline of leadership for the College this year. How would you encourage other physicians to follow in your footsteps, maybe if they’re feeling like they want to get away from the bedside and tackle issues, whether that’s in Congress, or a state legislature, or local level?

Rep. McCormick: Don’t lose your way. Realize that it’s a massive pay cut. Even if you’re not in Congress, you can be involved in this process. The reason I think orthopedists have done so well because they’ve been involved, they’ve been politically engaged, they’ve used their assets to preserve their assets. When you’re disengaged, guess what? You’re in the trough, you’re getting fed on. And if you look at ER physicians for example, we have taken essentially a 25% pay cut in the last couple of years.

We need to be involved, whether it be in the lobbying effort, or in the political effort. Realize it is truly a sacrifice, it is not something you’re going to go up here, and say, “Wow, I’m treated so well. Oh, wow, I’m so respected.” You lose respect instantly. Politicians are at the bottom for respect. I went from being a Marine and a doctor, highly respected, to being a politician. I think we’re about equal with telemarketers.

ACEP Now: You went to Morehouse School of Medicine, which is one of the four historically Black medical schools, which includes Howard, Meharry, and King Drew at UCLA. Morehouse School of Medicine talks about being successful at shifting the curve by accepting matriculants with MCAT scores that are maybe on par for minority applicants, but then they outperform other tests like USMLE, relative to peer institutions. And I was wondering about Morehouse, and what allows them to see that success. One of the reasons I wanted to bring that up is because there’s this bill called the EDUCATE Act, which you’re a co-sponsor of, and which ACEP stands in opposition to. Do you feel like the EDUCATE Act might risk the future success that has been experienced at places like Morehouse School of Medicine?

Rep. McCormick: First of all, I’m very proud of my Morehouse heritage. I was actually student body president, elected the same year that Obama was elected President of the United States in a school that’s 60% female, 8% Black, and about 95% liberal, a white male conservative was elected student body president. That’s based on relationships, it’s not based on politics or identity.

But I will say this, the reason I’m against DEI, and the reason I co-sponsored this bill is because [DEI] has gone way overboard. It’s going to create more racism.

Now, if you’re a historically Black school, that’s a totally different thing, and I actually have an amendment to this that excludes traditionally Black schools. I think that’s very important, to realize there’s a tradition, and there’s a reason for having Howard, Morehouse, and Meharry. I think there’s a reason for those schools, and I’m very, very proud of those schools and what they do. I agree, I watched firsthand, people that probably wouldn’t have gotten into most schools and did just fine on the USMLE. I think they had individual attention, because they were given a belief system, they had a work ethic, and they just continued to plod and improve, and I loved it.

But I will say that if you’re looking at schools that are judging people based on the color of their skin rather than the content of their character, and they’re not a traditionally minority school, I think we get into some really scary ground. You’re going to have people saying, “Well, the only reason you got in the school is because you’re Black.” Well, that’s considered racism. But when you start saying, “You’re going to get into school because you’re Black.” Well, if you’re a traditionally Black school, I get it. But if you’re not, why does that not alarm people that that’s going to create racism, that people are going to say, “Oh, you have a double standard”?

Take a look at UCLA and their admissions, tell me that it’s equal, that it’s based on the 9% of the population that’s Black.  I’m going to tell you as a guy who came from abject poverty, I grew up with nothing. Should I be punished because I’m white, even though I had nothing growing up? I had a single mom who had no money, should I be excluded from a school because I just happen to be white? Does that give me privilege to get into that school? Of course not. It is based on hard work. Should I be excluded because I work really hard, but I have the wrong color of skin? That is racism by definition. Why would we support that?

I’ll tell you, a lot of kids in my Morehouse school came from physician families. Did they have a disadvantage over this poor white kid who came from a single parent secretary? Who’s got the advantage here? You tell me.

ACEP Now: What do you think about unionization in emergency medicine in order to try to get better working conditions when we’re being employees of hospitals or employees of big corporate groups?

Rep. McCormick: Unfortunately this is a byproduct of the environment we created. We’ve done a poor job of controlling residencies. When you flood the market with people, then you’re going to end up having horrible hours, working on weekends, working overnights, and working on holidays, and getting paid a pittance, because you have flooded the market. So that’s really the only way to fight back.