Physician leaders of ACEP have been active in the ongoing transformation of that survey. In October 2014, we wrote to CMS: “On behalf of more than 33,000 members and the 136 million patients seen annually in the nation’s emergency departments, the American College of Emergency Physicians (ACEP) appreciates the opportunity to provide comments on the latest revision to the draft survey instrument, now titled ‘Emergency Department Patient Experience of Care’ (EDPEC). Overall, we urge CMS to rethink the objectives of gathering this information (aside from fulfilling the ACA mandate) and articulate how the information will advance and improve patient care.”

The original draft survey had 53 questions, of which 32 were about care and 21 were demographics. The questions on physicians included the following:

• “During this emergency room visit, how often did doctors treat you with courtesy and respect?”
• “During this emergency room visit, how often did doctors listen carefully to you?”
• “During this emergency room visit, how often did doctors explain things in a way you could understand?”
• “During this emergency room visit, how often did doctors spend enough time with you?”

There were four possible answers: Never, Sometimes, Usually, and Always. However, the only answer that counted as positive was “Always.”

The questions on pain were:

• “During this emergency room visit, did you have any pain?”
• “During this emergency room visit, did you get medicine for pain?”
• “During this emergency room visit, did the doctors and nurses do everything they could to help you with your pain?”

Patients could choose one of three responses: Yes, definitely; Yes, somewhat; and No. The only response that counted as positive was “Yes, definitely.”

ACEP’s Response

CMS asked for comments from the medical community. William Sullivan, DO, JD, FACEP, a member of ACEP’s Medical Legal Committee, clinical assistant professor emergency medicine at the University of Illinois at Chicago, attending physician at St. Margaret’s Hospital in Spring Valley, Illinois, and owner of Sullivan Law Office in Frankfort, Illinois, and I, in conjunction with Barbara Tomar, ACEP’s former director of regulatory affairs who is now retired, and ACEP’s Washington, D.C., office, did not just make comments but rewrote the survey for CMS. We suggested that 53 questions were too many, some were duplicative, and some were poorly worded.

We suggested a maximum of 15 questions. We recommended that the pain questions be removed entirely, as we were seeing the effects of the opioid epidemic and the pressure we had received for many years to treat “pain as the fifth vital sign.” We advised that “emergency room” should be changed to “emergency department” and that all of the questions should have the three-response option of “Yes, definitely; Yes, somewhat and No,” in view of the ED visit being a one-time event unlike the multiday inpatient experience.