The EM Action Fund has been busy during its first 12 months, and has a clear plan of areas it would like to advance in the coming year.
While the awareness of emergency medicine’s integral role is now acknowledged by lawmakers and regulators,
EM Action Fund participants believe it is vital that this grassroots organization of emergency physicians shapes how the specialty’s role is positioned. “An avalanche of regulations is being written, and emergency physicians desperately need the EM Action Fund to keep them out of the regulatory and legal crossfire between payers, patients, policymakers, and hospitals,” said Dr. Wes Fields, Chair of the EM Action Fund.
The EM Action Fund, which includes participation from six associations, 68 physician groups, and more than 180 individuals, has unified the house of emergency medicine and become a powerful voice in federal regulatory and legal issues that matter to emergency physicians.
Since its launch in July 2011, the EM Action Fund has:
Committed $100,000 to the legal defense fund of the Washington ACEP Chapter, helping win injunctive relief in state court when the Medicaid agency attempted to limit their beneficiaries to three visits to the ED each year.
When Medicaid countered with an even more dangerous proposal that would have resulted in nonpayment for more than 500 ED discharge diagnoses, the EM Action Fund committed $55,000 to new research to show that the proposed plan would violate prudent layperson standards and raise
conflicts with EMTALA obligations. Ultimately, the state abandoned the ill-conceived plans of its own Medicaid agency and is moving forward with a physician-drafted plan that provides other cost-cutting measures. This victory could have a ripple effect – not only on Medicaid in other states, but also on other payer classes.
Funded a $50,000 grant to the Emergency Medicine Foundation (EMF) for research to determine how many diagnoses that would be deemed inappropriate by similar state Medicaid plans were from patients who presented with a prudent layperson–eligible complaint.
Met with acting CMS Administrator Marilyn Tavenner and advocated for fair payment of noncontracted ED providers treating patients covered by plans regulated by ACA and its state exchanges, and joined ACEP and EDPMA in advocating for the inclusion of FAIR Health by CMS as the new standard on usual and customary charges.
Commissioned the first of several major new studies to demonstrate the value of EM to policymakers and regulators.
“Unfortunately there is much work to be done to help regulators understand what policies will work to control costs and which policies may endanger patients. It is a fine line,” said Dr. James Adams, President of the Association of Academic Chairs in Emergency Medicine, another founding member of the EM Action Fund.
“Blunt decisions are being made that could have dangerous consequences. But nobody wants patients to be harmed, even as there is urgency to control costs. So the EM Action Fund plays a vital role as it is facilitating the discussions, promoting good analysis, and seeding key research that will lead to a wise and safe system.”
On the horizon for the EM Action Fund’s second year is a plan to use research to establish the value of emergency medicine in our current and future health care system, to act as a regulatory watchdog and fight any policies or practices that undermine the tenets of emergency medicine, and to continue to strengthen relationships with key regulators. The EM Action Fund may also participate in legal actions in states where the emergency medicine safety net is under attack.
“We have to protect against imprudent and indiscriminate actions that result when regulators have incomplete or inadequate information,” Dr. Adams said. “When it comes to emergency care, people’s lives really are at stake. This is why every EM organization that I know of is part of EMAF.”
The EM Action Fund was created to pool collective resources and together make an impact bigger than any one entity could make alone.
Find out more or contribute at www.emactionfund.org.