Each year, ACEP’s Council elects new leaders for the College at its meeting. The Council, which represents all 53 chapters, 39 sections of membership, the Association of Academic Chairs of Emergency Medicine, the Council of Emergency Medicine Residency Directors, the Emergency Medicine Residents’ Association, and the Society for Academic Emergency Medicine, will elect the College’s President-Elect and four members to the ACEP Board of Directors when it meets in September. This month, we’ll meet the President-Elect candidates.

Jon Mark Hirshon, MD, PhD, MPH, FACEP

Current Professional Positions: professor, department of emergency medicine and department of epidemiology and public health, University of Maryland School of Medicine, Baltimore; senior vice-chair of the University of Maryland, Baltimore Institutional Review Board

Internships and Residency: emergency medicine residency, Johns Hopkins Hospital, Johns Hopkins University, Baltimore; preventive medicine residency, Johns Hopkins Bloomberg School of Public Health

Medical Degree: MD, University of Southern California School of Medicine, Los Angeles (1990)

Response

The other night, during a busy shift, a mid-60s woman came into my ED via ambulance with hypotension and inferior changes concerning for a ST-elevation MI on the EMS-transmitted ECG. Upon arrival, we confirmed the ECG changes and activated the catheter lab, and shortly thereafter, the patient went upstairs for catheterization and stenting. The system worked—a life was saved! Unfortunately, our dysfunctional, fragmented U.S. healthcare system is under siege and threatened from many directions, both internally and externally. While the system worked today for my patient, will it work tomorrow for your patient or family member with a life-threatening emergency?

Assuring appropriate financial and societal support remains a critical external threat to EM. Longtime emergency physician Paul Seward recently penned an article on Stat News describing EDs as “the ‘chewing gum and duct tape’ holding together U.S. healthcare.” As the cost of healthcare in the U.S. has skyrocketed, EDs are viewed as the healthcare safety net—or as stated by a previous U.S. president: “I mean, people have access to healthcare in America,” he said. “After all, you just go to an ER.” Out-of-pocket medical expenses are mounting astronomically while insurance companies are making record profits. Many Americans are only one medical emergency away from poverty or homelessness. We, as frontline providers, see this on a daily basis. Our EDs may be our neighbors’ front door to the hospital, but it is our window to the problems seen in our communities.

ACEP must, and I will, continue to fight to assure high-quality emergency care for all Americans. This is a multipronged approach, including legal, educational, and lobbying activities on both federal and state levels. Last summer, while having lunch with my senator, Ben Cardin, the federal champion of the prudent layperson standard, he was shocked to learn that prudent layperson was under siege again. ACEP and the Medical Association of Georgia are suing Anthem BlueCross BlueShield of Georgia for their policy allowing for retrospective denial for some care delivered in EDs. Previously, we sued the U.S. Department of Health and Human Services to require transparency of data and fair insurance coverage for emergency patients who are “out of network” because of a medical emergency. Our lobbying and educational efforts include almost daily interactions with policymakers and regulators, including high-quality, effective presentations at the RVS Update Committee, to assure that we are paid for the work that we do. We must, and I will, fight to make sure that we receive fair compensation for the care we deliver through supporting legal action, developing coalitions and partnerships, and testifying in front of politicians and the public.

“ACEP must, and I will, continue to fight to assure high-quality emergency care for all Americans. This is a multipronged approach, including legal, educational, and lobbying activities on both federal and state levels.” —Jon Mark Hirshon, MD, PhD, FACEP

However, assuring fair compensation is only one external threat we face. The ever-increasing regulatory burden remains a significant problem, negatively impacting our productivity and our well-being. We face this concretely on a daily basis with the growing burden of documentation as enforced by our electronic medical records. For every five minutes I spend with a patient, I spend 15 to 20 minutes documenting. This negatively impacts my rapport with patients, coworkers, and trainees. Reducing administrative burdens is critical and was a central theme of my testimony earlier this year before the House Committee on Ways and Means’ Health Subcommittee on reducing administrative burdens for physicians in the Medicare program. Decreasing regulatory burdens and improving our work environment are critical aspects of improved care delivery and emergency physician well-being. This will be a critical objective of my time as ACEP President.