Dr. Goyal is associate executive director of quality for ACEP.

Emergency Medicine Health Care Reform Principles

As Congress takes up the future of the Patient Protection and Affordable Care Act, or Obamacare, ACEP issued an outline of emergency medicine health care reform principles it considers indispensable to any replacement legislation. The principles aim to maximize access to medical care while improving its quality and lowering its costs.

“Although the nation’s emergency departments continue to focus on our traditional mission of providing urgent and lifesaving care, our role has expanded over the last several decades to encompass safety-net care for uninsured and underinsured patients, public health surveillance, disaster preparedness, and filling gaps in care caused by physician shortages,” said ACEP President Rebecca Parker, MD, FACEP.

“Reimbursement reductions from public and private payers have substantially curtailed hospital capacity, which is extremely concerning for any community which might be faced with a severe disease outbreak or mass casualty event,” she said.

ACEP believes all Americans must have health care coverage, and it urges lawmakers to consider the following principles as they develop new health care policies:

• Maintain emergency services as a covered benefit for any insurance plan.
• Ensure the federal prudent layperson standard extends to Medicaid fee-for-service and that compliance measures are in place for all other health plans.
• Require health insurance transparency of data used to determine in- and out-of-network reimbursement rates for their patients’ medical care.
• Ensure appropriate reimbursement rates for emergency services.
• Eliminate need for prior authorization for emergency services and guarantee parity in coverage and patient co-payments for in- and out-of-network emergency care services.
• Retain protections for preexisting conditions, no lifetime limits, and allowing children to remain on their parents’ insurance plan until age 26.
• Enact meaningful medical liability reforms, including protections for physicians who provide federally mandated EMTALA-related services, who provide care for patients in a federally declared disaster area, and who follow clinical guidelines established by national medical specialty societies.
• Ensure any continuation or expansion of health savings accounts, health reimbursement accounts, association health plans, and individual health pools provide meaningful health insurance benefits and coverage for individuals and families, including access to emergency care services.
• Repeal the Independent Payment Advisory Board and the excise tax on high-cost employer health benefit plans. Delay repeal of the Center for Medicare & Medicaid Innovation until at least 2020 or amend it to eliminate mandatory provider participation in Medicare models. This will allow an adequate transition period for the Transforming Clinical Practice Initiative grants aimed at lowering costs, improving health outcomes, and delivering more effective care.
• Acknowledge the role of freestanding emergency centers and other health care delivery models as crucial to encouraging coverage innovation.
• Protect the most vulnerable populations in this country by making sure Medicare, Medicaid, and CHIP remain available and solvent for current and future generations.

“ACEP looks forward to working with the new Congress and the Trump administration to cultivate a health care system that expands access for all patients, encourages innovation, and ensures the continued availability of health care providers,” said Dr. Parker. “No one in this country should ever be without necessary care because of an inability to afford it.”