ACEP Now Medical Editor in Chief Cedric Dark, MD, MPH, FACEP, conducted interviews with each emergency physician running for Congress in 2022. The abridged versions of the interviews were published in the September 2022 print issue.
Explore This IssueACEP Now: Vol 41 – No 10 – October 2022
What do you think emergency physicians need to be paying attention to in Congress?
Dr. Ruiz: One is the reversal of Roe v. Wade. And why is that important? It’s important because in many states you’ll start to see the criminalization of medical practices. In some states and in Congress already there have been attempts to be able to imprison OB/GYN physicians or fine them extraordinary amount of monies or bar them from practicing with their license for a medical procedure, whether it’s done for an emergency or for other reasons. Some bills that the Republicans try to pass through the House would also deputize technicians, nurses, and anybody that works in a clinic or hospital to bring charges up against physicians. Now that’s very concerning.
The second thing I think that we should be paying attention to is the transformation of our health care delivery system. I believe we need to focus on telemedicine and figure out the opportunities that exist for physicians. We saw that the pandemic really forced the house of medicine to be innovative in their use of telemedicine, innovative in the use of what I call tech medicine or medicine through apps in your iPhone, your smartphone, your iPads, etc. And even before the pandemic, I know that there’s been conversations within members of ACEP that look at employing telemedicine consultation at nursing homes for triage reasons, or with paramedics in the field to be able to help reduce congestion and expand our reach.
Third, I think there’s a lot of opportunities for follow ups from the emergency department and other types of care that we do for patients experiencing emergencies in our emergency department. So that is something that we really need to pay attention to, because there’s opportunity and we need to start looking at establishing more opportunities with that and the whole home care delivery system.
What do you think we should be doing about medical school debt in this country?
Dr. Ruiz: Obviously, the cost of a medical school has gone extremely high. So, we need to figure out a way where we can reduce those costs. Also, there’s a lot of loan to scholarship opportunities that we need to create in order for individuals who may initially take out a loan to pay for their medical school.
And if they fulfill certain requirements, whether practicing in a medically underserved area or whether their practice serves over 60 percent Medicare and Medicaid patients, or whether they actually take on certain community service hours in their practice, or sign into some kind of program with a government that focuses on equity, then those loans can be converted into scholarships and there would be no need to pay them back.
Just to clarify a little bit on this. Does it sound like you think that for medical students in general, if we are to forgive their loans or convert it into scholarship, something along those lines, you think it should be tied to service in an underserved area or some other kind of thing, not just sort of a blanket type of waving of these federal loans?
Dr. Ruiz: Currently, for individuals who have student loans, I’m advocating to forgive their loans or a certain dollar amount of their loans. That’s only going to happen one time, if it happens. Moving forward, I believe that we should create loan to scholarship programs where if the practicing physician meets certain criteria, which I would propose a criteria that would advance the cause of equity to reduce social disparities. In other words, if doctors move into areas where they’re needed the most, where historically there has been a lack of physicians—and I do believe that there should be some kind of requirement to do that.
How can we improve our approach to future pandemics and public health threats?
Dr. Ruiz: One of the factors that we need to improve is the ability for the CDC to collect data so that they can in real time, through either surveillance, through emergency department or hospital or state public health department reporting be able to act on that data much quicker and make better targeted decisions in terms of the precautions that are necessary. Right now, it’s a hodgepodge. They have to join into over 200 data use agreements with counties [and] with states. Some entire states don’t even report data. Some states leave it for their individual counties to form these data use agreements. And then some states do it as a state entity.
That is not efficient. That is not good. And the scientists [need to] know that our decisions and strategies are based on accurate information and accurate assumptions, as well.
The other thing that we need to really focus on is modernization of that data, standardization of that data, and making it efficient through electronic records to provide that data to the CDC, without burdening physicians. The second issue is focusing on our workforce. We need to bolster our supply of epidemiologists. We need to bolster our supply of community health workers, our public health workers, to be in the field, to collect data, to provide the programs that are necessary in order to combat this pandemic.
What do you think has been your greatest accomplishment since you have been in Congress that has benefited your fellow emergency physicians?
Dr. Ruiz: first and foremost, my soul, my thinking, my problem solving is rooted in my training in emergency medicine. And that is very important, because having gone to Washington I’m still in the emergency department. The other major accomplishment is my battle on surprise billing. As you know, it was a big issue last Congress, we were successfully able to resolve balance billing [for] emergency physicians and other specialties that have been getting under reimbursed [or] low balled by insurance companies. My bill to protect patients from surprise medical billing was the most popular bill in the House…so what I did with my colleague, Dr. Buchan, who’s Republican, and I’m a Democrat, is very bipartisan. We defended the house of medicine with a lot of support from ACEP and other organized medical associations. And we were able to, one, completely eliminate the patient from the middle of this problem so that they would not receive a surprise medical bill. They do not have to give consent or anything else like that. They just simply will not receive a surprise medical bill, but the way we resolve the dispute is by an independent baseball style arbitration, which is my bill’s problem solving format. We were able to put that in. That was big victory. It protects emergency physicians from unfair, low balling payments from insurance companies.
There’s a court case in Texas that has the CMS and HHS reevaluating their [regulations]. My advocacy has always been to go back to the original intent of the law, which means that if there was any major discrepancies, the provider would give their estimate of what the care cost, the payers would give their estimate of what they think it costs, they would give their reasoning. And all factors would be independently weighed with equal weight. And the arbitrator would then decide who has the more accurate request for payment and that person would win and the loser would have to pay those arbitration bills. That is a fair way of bringing the payer and the providers to the table for negotiation. So that has been a big battle that I’m very proud of for emergency physicians in particular.
So the intent, as you were saying, sounds like it was for this baseball style arbitration where each side puts their numbers out and the arbiter picks, which number is the right number, and not necessarily focusing on the insurance number to begin with.
Dr. Ruiz: Yeah, there was different categories of factors that the arbitrator can take into consideration. No one factor would outweigh another. However, the HHS regulators said that the factor of the median payment for that region would be the anchor for the payment. And that would be the most weighted and anything beyond that would need justification. That clearly still gives the upper hand and gives much more weight to the insurance companies [and their] ability to manipulate the payments in those markets. And when I spoke with them, I specifically said, I wrote the bill and that was not my intent. And the intent of the legislation was to give equal weight independent factors so there’s honest, independent arbitration in the dispute resolution between the providers and the payers in order to foster more collaboration and a fair negotiated practice.