Every year, ACEP’s Federal Government Affairs Committee and the ACEP federal advocacy team work together to establish an expansive list of goals and priorities that guide ACEP’s work on Capitol Hill for the upcoming legislative session. When a new Congress convenes every two years, we reach out to every Member of Congress to share our top legislative priorities, which also form the basis for our in-person advocacy during the upcoming Leadership & Advocacy Conference.

For the 118th Congress, ACEP shared five key priorities with legislators:

ED Boarding Crisis

We’ve heard from emergency physicians across the country about the emergency department (ED) boarding crisis. To illustrate the stark reality of this problem, we asked members to share examples of the life-threatening impacts of ED boarding. Your stories paint a picture of an emergency care system already near collapse, gridlocked, and overwhelmed with patients waiting to be seen. Those testimonials formed the basis of the advocacy campaign ACEP launched in December 2022, and helped inform a letter ACEP and 34 other organizations sent to President Biden in November 2022 urging the Administration to convene a summit of stakeholders from across the health care system to address this crisis.

There are many factors that contribute to ED boarding, but unprecedented and rising staffing shortages throughout the health care system have recently brought this issue to a crisis point, further spiraling the stress and burnout driving the current exodus of excellent physicians, nurses, and other health care professionals. We need a health care system that can accurately track available beds and other relevant data in real time, appropriate metrics to measure ED throughput and boarding, contingency plans and “load balancing” plans for boarding/crowding scenarios, fewer regulatory or other “red tape” burdens that delay necessary care, and more options for patients to receive the care they need and deserve in their communities.

ACEP’s advocacy team knows all EDs are different, and there is no one-size-fits-all solution to this multifactorial problem. The College is developing a broad range of potential legislative and regulatory solutions to alleviate the burdens and overall strain on EDs caused by patient boarding. ACEP strongly urges Congress to facilitate urgent collaboration by bringing together key stakeholders through roundtables, committee hearings, and legislation to provide both short- and long-term solutions to this public health crisis.

Workplace Violence

An August 2022 ACEP survey shows that ED violence is on the rise, and in addition to the physical, mental, and emotional toll of violence, contributes to growing job dissatisfaction and burnout and harms patient care. Unfortunately, public awareness of this problem remains a challenge. Videos of violent or unruly airline passengers often make their way across social media before the plane even takes off or lands, and authorities at all levels have stepped up enforcement of these crimes as a result, yet violence against emergency physicians and other health care workers remains essentially invisible to the public. But we cannot accept ED violence as “just part of the job”—violence in any other workplace is not tolerated, and it should not be tolerated in health care settings.

During the 117th Congress, ACEP supported two bipartisan bills to address workplace violence: the Workplace Violence Prevention for Health Care and Social Service Workers Act (H.R. 1195/S. 4182) as well as the Safety From Violence for Healthcare Employees (SAVE) Act (H.R. 7961). The Workplace Violence Prevention for Health Care and Social Service Workers Act would ensure that health care workplaces implement violence prevention plans and techniques and are prepared to respond to acts of violence, while the SAVE Act would establish federal legal penalties for individuals who knowingly and intentionally assault or intimidate health care workers and provide grants to help hospitals and medical facilities establish and improve workplace safety, security, and violence prevention efforts. ACEP is hopeful these bills will be reintroduced soon, and continues working to identify other possible policy solutions to address this growing problem.

Mental Health Care Access

At the end of the 117th Congress in December 2022, Congress took some important steps to improve access to mental health and substance use disorder services and care. Unfortunately, far too many Americans still have limited options for the longer-term followup mental health treatment they need and deserve, leaving many individuals with nowhere else to turn but the ED. Recognizing these challenges, many communities have adopted alternative models to improve emergency psychiatric care and reduce psychiatric patient boarding.

To ensure that communities can implement models that best fit their needs, ACEP helped develop and supports the bipartisan Improving Mental Health Access from the Emergency Department Act. This legislation would provide funding to help communities implement and expand programs to expedite transition to post-emergency care through expanded coordination with regional service providers, increase the supply of inpatient psychiatric beds and alternative care settings, and expand approaches to psychiatric care in the ED to include telepsychiatry, peak period crisis clinics, or dedicated psychiatric emergency service units. This legislation was passed by the House of Representatives during the 117th Congress, but was not considered by the Senate. ACEP is working with the sponsors of this bill and are hopeful it will be reintroduced in the very near future.

ACEP is also strongly urging Congress to continue working to address physician mental health as part of larger policy efforts. Thanks to your advocacy, in 2022, the Dr. Lorna Breen Health Care Provider Protection Act (P.L. 117-105) was signed into law, establishing new programs and providing critical resources to address physician and health care worker mental health and burnout. ACEP continues working with legislators to keep up this critical effort, and is urging Congress to ensure this law honoring the life and legacy of Dr. Breen receives the funding it needs.

Reauthorizing the Pandemic and All-Hazards Preparedness Act

If there is one thing the experience of the COVID-19 response has shown, it’s that more steps are needed to improve our emergency preparedness infrastructure on all fronts. Congress addressed many pandemic-related needs in the recent year-end package, but the upcoming reauthorization of the Pandemic and All-Hazards Preparedness Act (PAHPA) provides another opportunity to improve our nation’s disaster preparedness plans and infrastructure. As Congress begins the reauthorization effort (its current authorization expires Sept. 30), we are asking them to consider:

• Developing a robust, coordinated national trauma and emergency preparedness system that can provide awareness of resources and surge capacity throughout the health care system;
• Additional efforts to incentivize and operationalize domestic production of essential emergency medications, equipment, and PPE and ensure that distribution of these resources is prioritized for frontline clinicians and first responders;
• Reauthorization of the successful MISSION ZERO program that awards grants to enable military trauma care teams to provide care at civilian trauma centers;
• Protecting our emergency response systems and infrastructure from cyberattacks and other potential vulnerabilities; and
• Promoting research through the NIH’s Office of Emergency Care Research (OECR) to foster basic, translational, and clinical research and research training for the emergency setting.

Medicare’s Promise to Seniors

The annual issue of steep cuts to Medicare physician payments cuts threatens the viability of the health care safety net and puts patient access at risk. We support efforts to provide greater stability and certainty in this system instead of the current perennial task of finding costly, short-term fixes for long-term problems.

ACEP believes the physician community can help deliver on the promise of the Medicare Access and CHIP Reauthorization Act (MACRA) that repealed the flawed Sustainable Growth Rate (SGR) formula, and that with improvements, MACRA can be significantly more effective in facilitating the transition to value-based care delivery. It does not necessitate the wholesale dismantling of the current system, it but does require more regular oversight and iteration to attain a sustainable payment system that truly incentivizes high-quality, cost-effective care—and importantly, it must ensure that emergency physicians and other physician specialties are meaningfully integrated as collaborators.

ACEP shared our recommendations for improving the Medicare physician payment system and MACRA in a response to a congressional request for information (RFI) in October 2022. We will continue to work with Congress to identify long-term, substantive reforms and have urged Congress to hold hearings and roundtables to explore potential solutions that will guarantee the stability and security of the Medicare program for future generations.

Ryan McBride is Director of ACEP’s Congressional Affairs.