In early 2007, Gwen Harry, executive director of the Virginia College of Emergency Physicians, filled out an application for ACEP’s State Public Policy Grant Program. The goal was simple: to obtain funding to assist the chapter in its efforts to enforce insurer compliance with current Virginia code protecting patient access to emergency services.
Explore This IssueACEP News: Vol 28 – No 11 – November 2009
The chapter’s reward? Funding in the amount of $12,500 to further the chapter’s extraordinary efforts.
The key word in that sentence, said Craig Price, ACEP’s director of chapter and state relations, is “extraordinary.”
“This grant program is for extraordinary state advocacy efforts that go above and beyond what a chapter would normally be engaged in and that are tied to a national priority objective,” he said. “ACEP wants to help chapters with major concerns that they’re trying to address.”
ACEP has budgeted $50,000 for the grant program each of the past several years, and the maximum amount of grant funds available for any single state public policy initiative cannot exceed one-fourth of that amount. To qualify for the program, chapters must also commit their own funds, totaling at least a dollar-for-dollar match of the funds requested from ACEP.
The grant money has made all the difference for VACEP, which, along with other emergency medicine groups and key stakeholders, challenged a change announced by Anthem HMO that affected patients receiving care from nonparticipating physicians.
‘Various projects and initiatives bubble up from the states, and ACEP is more than willing to help state chapters.’
The change resulted in Anthem reimbursement at its internal fee schedule, far below the costs associated with the care provided—leaving the patient with the potential for a balance bill from a nonparticipating physician that was formerly covered in full by the insurer. In addition, physicians were often not reimbursed for the care they were obligated to provide under EMTALA.
“Because quality emergency care for our patients requires fair reimbursement, and because we work under the unfunded and underfunded mandate of EMTALA for about 60% of our patients, it’s imperative that commercial insurance reimbursement be fair and adhere to state patient protection laws,” said Todd L. Vanden Hoek, M.D., MBA, of Chesapeake Emergency Physicians. A member of VACEP’s board of directors, Dr. Vanden Hoek led the effort challenging Anthem’s reimbursement practices.
“We used the ACEP grant funds to enforce insurer compliance with current Virginia code protecting patients’ access to emergency services, as well as to properly define with the Bureau of Insurance what we do for patients under EMTALA,” Dr. Vanden Hoek continued. “A proper definition will ensure access to quality emergency care in Virginia, and will set an important precedent for the rest of the nation.”