Arvind Venkat, MD, FACEP (Pennsylvania)

Current Professional Positions: vice chair for research and faculty academic affairs, department of emergency medicine, Allegheny Health Network, Pittsburgh, Pennsylvania; ethics committee chair and ethics consultant, Allegheny General Hospital, Pittsburgh; national director of research, US Acute Care Solutions, Canton, Ohio

Internships and Residency: emergency medicine residency, University of Cincinnati College of Medicine/University Hospital

Medical Degree: MD, Yale University School of Medicine, New Haven, Connecticut (2000)

Response

ACEP and our members are at a crossroads. The COVID-19 pandemic accelerated our challenges but also provided ACEP with a window to ensure emergency physicians and our patients have a better future, one where the emergency care system is properly resourced for all who need it.

Our greatest opportunity as a College and as emergency physicians is to capitalize on the public stature earned through the current crisis in order to advocate for a reimbursement system that recognizes our frontline public health role. This is a role we have always fulfilled but now is the focus of public, governmental, and media admiration. We must seize this opportunity to push for direct funding of capacity and readiness at the emergency physician level. We deserve reimbursement for the expertise and preparation we deliver to our patients and our communities when crisis strikes. Having worked in reimbursement advocacy throughout my career and having witnessed how we are often placed on the defensive in debates over balance billing and insurance downcoding, our opportunity is to take our enhanced reputation from the current crisis to advocate proactively for reimbursement for our public health role. To prepare for the next crisis, whether it is the next wave of COVID-19, mass casualty events, or other societal ills that inevitably will present to the ED, we need all payers to compensate us for the patients we are rightly expected to be prepared to care for, not just those who seek our care. The specific ask may take the form of pushing for enhanced RVU attribution for our CPT codes to spread increased reimbursement across all payers or direct federal funding of emergency physicians and their practices, among other strategies. The opportunity to make the ask successfully will never be higher or more appropriate.

Our greatest threat as a College and as emergency physicians is that we will simply return to a reimbursement system nearly entirely based on volume of patients seen. It is unconscionable that, as we are called heroes by the public, our compensation is threatened. This results from a volume-based reimbursement system adversely driving the levels of emergency physician staffing, the role of mid-level providers in our practice, the divisions in our specialty on the scale and types of our practice organizations and their relationship with their constituent emergency physicians, and the personal well-being of our members when forced to work clinically on the thinnest of margins. We must use our enhanced stature from the current crisis to advocate successfully that emergency physicians, as the front line against this pandemic and future public health crises, must be compensated as highly skilled and essential public health professionals. The current reimbursement system based on volume alone divides us, leads to burnout, and jeopardizes the future of our profession and ACEP. This must change.