Editors’ Note: This article was accepted on April 17, 2020, and was accurate at that time. We are seeing sweeping regulatory changes and new bills passed at an incredible pace, so we may have more updaates by the time you read this. Visit www.acep.org/COVID19-advocacy for the latest news as this crisis evolves.
Explore This IssueACEP Now: Vol 39 – No 05 – May 2020
Our mission statement says it loud and clear: ACEP is the leading advocate for emergency physicians, their patients, and the public. And never has our mission been more important than during this COVID-19 pandemic.
While you have been digging in on the front lines, we have been deep in the federal trenches, pressing for physician safety and regulatory improvements to help you save more lives.
The political environment is moving at an unprecedented pace, but that’s fine with us—after all, emergency physicians thrive on urgency and action. Your collective calm and competence during this crisis are shining a spotlight on what makes this specialty so…special. Never has the voice of emergency medicine been so instrumental.
That Escalated Quickly
When COVID-19 came on the scene, your ACEP advocacy team quickly developed a comprehensive list of policy changes that would address our complicated concerns: workforce protection and mobility, access to care, and frontline financial support. We sent this list to all members of Congress and policymakers involved in the development of COVID-19 legislation and regulations, and our chapters have used the same list for state-level advocacy.
Social distancing was already in place, but we made sure your voices were heard. ACEP hosted two virtual Hill briefings for congressional staff: The first featured emergency physicians from Washington state who gave frontline accounts from the first significant outbreak of COVID-19 patients in the United States, and the second included ACEP leaders who spoke directly to our policy priorities while providing perspective on what it’s like to be a frontline physician during a pandemic. On April 28, we hosted 306 legislative meetings during Virtual Hill Day in lieu of our normal Leadership & Advocacy Conference.
On the regulatory side, we sent a letter to Alex Azar, secretary for the Department of Health and Human Services (HHS), outlining specific changes and regulatory waivers that would protect emergency physicians and other frontline health care staff while increasing patient access to care.
These initial letters to Congress and the policies therein kicked off a quick cascade of significant changes that have had a major impact on emergency medicine. Here’s a progress report outlining where we stand on our federal and regulatory COVID-19 policy priorities.
Pushing for PPE
ACEP Policy Priority: Increase availability of personal protective equipment (PPE) for emergency physicians and other frontline personnel responding to the epidemic. Fully utilize Strategic National Stockpile to maximize dissemination of critically needed PPE.
Progress: We led a grassroots campaign that generated more than 120,000 letters to members of Congress, urging them to prioritize PPE for frontline personnel and to release of PPE in the Strategic National Stockpile. This was one of our most successful grassroots efforts ever!
ACEP found out some hospitals were sanctioning staff for wearing donated or self-purchased PPE. We discussed this problem with The Joint Commission (TJC), sharing firsthand accounts from our members, and then TJC issued a statement of support for allowing staff to bring their own standard face masks or respirators to wear at work.
ACEP is also addressing this problem with the American Hospital Association (AHA), the Centers for Disease Control and Prevention (CDC), the Occupational Safety and Health Administration (OSHA), and the Food and Drug Administration (FDA). ACEP is working with GetUsPPE.org to connect private industry with hospitals and clinicians in need.
Expanding Access to Care Through Telehealth
ACEP Policy Priority: Guarantee telehealth services can be fully utilized by removing originating site limitation under CMS telemedicine rules and allowing emergency physicians to bill for ED evaluation and management (E/M) codes.
Progress: The Centers for Medicare & Medicaid Services (CMS) has significantly expanded existing telehealth policies under Medicare in an effort to enable patients to communicate with their doctors remotely during this national emergency. The initial CMS guidance was unclear about how emergency physicians could, in fact, deliver telehealth services. ACEP was in constant contact with CMS, successfully advocating for two major CMS policy changes:
Allowing medical screening exams (MSEs), a requirement under EMTALA, to be performed via telehealth Adding the ED E/M codes to the list of approved Medicare telehealth services
Both policy changes are critical. Being able to perform MSEs via telehealth will help protect emergency physicians from unnecessary exposure to the virus and help preserve limited supplies of PPE. Having the ED E/M codes on the approved list of Medicare telehealth services enables emergency physicians to be appropriately reimbursed for the high-quality and high-intensity services they deliver remotely.
To facilitate these important changes, ACEP cohosted a webinar with CMS so our members could ask questions about the new EMTALA and telehealth policies.
Expanding Liability Protections
ACEP Policy Priority: Enact temporary liability protections for the duration of the pandemic for health care professionals who are screening and treating COVID-19 patients.
Progress: On behalf of every emergency physician who may be forced to make difficult or impossible treatment decisions during this pandemic, ACEP is actively working to secure immunity from liability. ACEP President William Jaquis, MD, FACEP, explained the need for increased liability protections in a meeting he had with Vice President Mike Pence and other Trump administration officials and we are working directly with Congressional lawmakers to include liability protections in future COVID-19 legislation.
A lot of the liability movement will happen on the state level, so we provided a template letter asking for full immunity to every state chapter.
To date, New York, Illinois, Massachusetts, and Connecticut have made declarations that have included strong liability protections for frontline health care practitioners. Several other states have indicated that they believe statutes related to declared emergencies provide this protection. A couple of other states have indicated that the governors do not believe they have authority to do this. There is political momentum on this issue, and ACEP believes we will see this addressed in many more states soon.
Medical liability reform has always been a priority for ACEP. When we’re on the other side of this pandemic, we will make the case that liability protections are still appropriate after the crisis.
Seeking Financial Support
ACEP Policy Priorities: 1) Ensure federal and state emergency funding is targeted and distributed beyond hospitals, such as for EMS, emergency physicians, and other relevant hospital-based specialty physicians who are not hospital-employed. 2) Provide financial stability so emergency physicians can treat patients, maintain readiness, and be fully prepared for patient surges. 3) Furnish temporary relief for student loan borrowers by providing all necessary flexibility for repayment during this uncertain time.
Progress: We have consistently pressed for emergency physicians and other frontline health care workers to be prioritized during the distribution of stimulus funding.
On March 24, ACEP sent a letter to Congress requesting financial support so emergency physicians can treat patients, maintain readiness, and be fully prepared for patient surges. We sent a letter to HHS Sec. Azar in response to the passage of the Coronavirus Aid, Relief, and Economic Security (CARES) Act, which provides $100 billion to the Public Health and Social Services Emergency Fund. We asked HHS to prioritize funding for frontline health care workers, especially emergency physicians, who are risking their lives combating the virus and are at the highest risk of being exposed to COVID-19 and missing work. On April 3, we sent a follow-up letter to the HHS secretary specifically requesting $3.6 billion to support emergency physician practices.
When the initial $30 billion wave of funding was distributed, we disagreed with the methodology and terms because ACEP felt basing distribution on historical Medicare spending was preferential toward hospitals, unfairly penalized emergency medicine practices for caring for underserved populations, and did not prioritize frontline health care practitioners. On April 14, we sent another letter to HHS Sec. Azar reiterating our previous requests and expressing our questions and concerns about the initial $30 billion wave of funding and the associated terms and conditions that health care practitioners must agree to in order to keep their share of the funds. We continue to track new waves of funding from this “Provider Relief Fund” and are keeping our members apprised of announcements at www.acep.org/covid19financialsupport. We are in constant contact with HHS to reiterate our concerns.
On April 15, ACEP signed on to an American Medical Association (AMA) letter on issues including direct financial support, temporary Medicare and Medicaid payment changes, liability relief, support for medical students and residents, and small business loans.
Our work is not done. ACEP remains engaged with legislators as negotiations continue on future COVID-19 response packages to ensure our legislative priorities are addressed, including liability reform, student loan relief for emergency physicians with privately held student loans, hazard pay and other financial assistance, mental health access for frontline physicians and other health care workers responding to the pandemic, and many others.
While we press for COVID-related progress, other factions are trying to slide one-sided, insurer-favored surprise billing legislation into the response packages. ACEP is pushing back on that as hard as possible, explaining that now is not the time to introduce divisive surprise billing legislation into this critical debate about how to responsibly and adequately respond to the pandemic.
Through all the noise, ACEP will continue to be your voice. We will push for what’s right. We have never been prouder to represent you, our health care heroes on the front lines.
Ms. Grantham is ACEP’s communications manager.