ACEP Now: Boarding What obstacles exist in Congress to address hospital boarding? What would be your recommendations on how to address them?

ACEP MEMBER TIMOTHY C. PECK, MD (D-IN-9) is running against incumbent Erin Houchin (R-IN-9) and Libertarian Russell Brooksbank (L-IN-9) in southeastern Indiana, a district that includes Bloomington and Indiana’s Louisville suburbs. Dr. Peck went to medical school at NYU Grossman and trained at the Harvard Affiliated Emergency Medicine Residency Program at Beth Israel Deaconess. He founded multiple novel medical practices and technology companies, including Call9, Curve Health, and CareScout. He also has worked as an advocate in D.C, testifying before Congress to advocate for telemedicine and value based care.

Dr. Peck: All my recommendations on health and health care here point back to the problems we have about experience. We don’t incentivize experience in our systems and our laws – both the provider’s experience as well as the patient’s experience, so when it comes to hospital boarding, it falls right in line with that. There’s no hard line for how many hours you should be measured on in terms of boarding or in terms of how long you’re in the emergency department. I think it’s a very easy fix on the Congressional side, to have more physicians in Congress and more people who understand what it is to be on the ground there to just logically put in experience measures –time of boarding being one of them. 

ACEP Now: What are your thoughts on consolidation among insurers and providers of health care?

Dr. Peck: Right here in Indiana and District 9, I have several critical access hospitals that are part of the consolidation effort of other systems. One of the pieces of reform that needs to happen is how we reward and incentivize not-for-profit systems – to continue to give them the tax breaks that they need and deserve to be a not-for-profit. But we also need much more scrutiny over their reserves. Where are the profits going and how are they using them? Those reserves are used much more for pavilions and surgery centers in wealthy suburbs and urban areas and less so in rural areas and critical access hospitals. When you have billions of dollars in reserves, and I see that critical access hospitals in my district literally don’t even have security, that’s a problem. I was dumbfounded to see how much more equitable distribution should be required if you’re going to be in a system that’s consolidating under tax breaks. This question also addresses private equity (PE). There’s an incongruency between private equity and the mission of medicine. One is a cost reduction function which is very useful in that industry. Another is to deliver the best patient care you possibly can, and those things don’t work very well together. As an emergency physician who has founded a telemedicine practice, treating patients in nursing homes, and worked to reduce unnecessary hospitalizations, I’ve seen what PE has done to the nursing home industry. The function of PE, which is cost cutting, creates horrible patient experiences for the families, patients and providers. I don’t think, in its current form, that private equity should be part of the health care system. 

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. Peck: My path may be a little bit different. I became an entrepreneur first, then gained some valuable experience while living in a nursing home for three months. One thing about emergency doctors is that we’re problem solvers, right? That’s our job. We’re just really good at figuring things out. Those skills we learn in emergency medicine translate to entrepreneurship for sure, making something from nothing. But they’re also useful in policy and politics, especially the ability to be calm when things are hectic, or somebody you disagree with is yelling at you. As emergency physicians, we’re still trying to find solutions. Having the confidence to know that those skills are so transferable will take a little bit of the fear out of making the jump and putting their hat into the ring. I think we need to highlight that at ACEP a little bit more, letting people know that the skills and knowledge emergency physicians have are extremely valuable and something the country needs. When you can change the very way Medicare works or work to preserve physician payment vs. hospital payment with inflation, you have the capability to help literally every physician in the country. 

ACEP Now: What are you hoping to accomplish in Congress?

Dr. Peck: Making sure physician payments keep up with inflation. There’s a chart I’ve seen that shows physician payment on one line, and it’s just flat while hospital payments are skyrocketing up the chart. That can only be fixed through Medicare reform. At the federal level, we also can work on legislation that considers incentives and value, and by value, I mean not only quality but patient experience. There’s a lack of understanding by politicians about what patient experience really is – what an end user experience is. Right now, there’s no incentive to get people out of the emergency department by hospital administrators. Congress doesn’t write laws that requires CMS to consider patient experience in the way we should. We don’t have a 4-hour rule anymore, and it’s why there’s no incentive to get people out of the emergency department by administrators. circle-plus