Health Policy and strategic steps in US

1. NATHANIEL SCHLICHER, MD, JD
L E G I S L A T I V E A D V I S O R
E M E R G E N C Y M E D I C I N E R E S I D E N T S ’ A S S O C I A T I O N
E M E R G E N C Y M E D I C I N E R E S I D E N T
W R I G H T S T A T E U N I V E R S I T Y
A T T O R N E Y A T L A W
J O H N S O N , G R A F F E , K E A Y , M O N I Z & W I C K , L L P
Introduction to Health Policy

2. Why Are You Here?
 Maybe…
 Cool Location
 Meet and Greet
 Program Paid For it
 Or Maybe…
 Want to Make a Difference
 Want to Guide Change
 Care about an issue

3. History of this Program
Where We Were
 Resident Focused Track
 Chair’s Challenge
 Social Reception to Meet
the Leaders
What We Have Added
 Added First-Timers from
YPS Section of ACEP
 Integrated Media
Training
 Roundtable discussions

4. Today’s Speakers
 1:00 – 1:40
Introduction
 Nathaniel Schlicher, MD, JD
 1:40 – 2:20
Health Care Economics
 James Eadie, MD, FACEP
 2:20 – 3:00
Current Issues
 Jennifer Wiler, MD, MBA

5. Afternoon Agenda
 3:00 – 4:00
Roundtable Discussion
 10 Hot Topics
 4:00 – 6:00
Media Training
 Speakers Bureau
Pre-Requisite
 6:15 – 7:15
Reception
 Cocktails and Networking

6. Objectives
 What is Advocacy?
 Legislative Process
 Health Care Reform
 Medical Malpractice Reform
 Getting Involved

7. Advocacy
Politics
=

8. SPEAKING FOR A CAUSE, OFTEN
FOR A VULNERABLE PERSON
Advocacy is…

9. US!

10. What is Advocacy to You?
 Calling Consultants
 Getting that Test
 Free Care for All
 Hospital Boards
 Medical Staff Meetings
 Overcrowding Solutions
 State Laws
 Regulations
 Federal Policy
 Reimbursement

11. EMTALA
Why should we care?

12. $138,300 / year per ER Physician
$12, 300 / year Average Physician

13. On call
Specialists
Medical
Home

14. We Need a Seat at this Table!
 President Obama’s
Health Reform Summit

15. Now Do you Care?

16. The Legislative Process

18. The Start
 Bill is Introduced
 Referred to Committee
 Referred to a
Subcommittee
 Bart Gordon (HR 1188)
 Energy and Commerce
 Ways and Means
 Subcommittee On Health
in both Committees

19. The Hearings
 Subcommittee Hearings
 Report out or Table it
 Committee Hearings
 Report out or Table it
 Full Chamber Considers
 Approve, Defeat, Refer
Back, or Table it
 Second House
Consideration

20. The Home Stretch
 Compromise
 Amendments referred
back to original chamber
 Conference committee
 Presidential
Consideration
 Sign
 Veto
 No Action Pass
 Pocket Veto

21. Health Care Reform

22. The Rationale
 46 million uninsured
 1 in 3 Americans under 65
without health insurance in
2007/2008
 Bankruptcy every 30
seconds from medical costs
 72% of Americans favor
increasing government
control on costs

23. Obama Campaign Plan
 EHR 10 billion over 5 years
 Increased Prevention
 Align incentives for
excellence – PQRI
 Malpractice insurer reform
 Competitive Insurance
 National Health Ins. Exch.
 SCHIP Expansion
 Eliminate Medicare
Advantage
 Negotiate Drug Prices
 Tax Credits

24. Moments of Pause
 Expanded Pay for
Performance
 SGR like cuts are likely
 More Medicaid or
Medicare unclear
 Decrease specialist
utilization via incentives

25. Funding the Plan
 Stimulus Bill
 17 billion for EHR
 60% subsidy for COBRA
 87 billion for 2 years of
Medicaid
 50-65 billion / year via
 Tax cut rollbacks on
>$250,000
 Keep the Estate Tax
 634 billion over 10 years
 Reduced deductions
 Medicare Advantage gone
 Provider cuts

26. The Wrinkle
Cost:
$1.5 Trillion / 10 years
Areas of Savings:
Physicians
Hospitals
Insurers
Drug Companies

27. Hope and Change
 Allocation for SGR
Reversal in 10 year plan
 “Restructuring” of
payments to physicians
 Can We Get a Bailout?

28. Tort Reform

29. Why?
 Insurance Premiums
 $26 billion annually
 12% / year growth rate
 Cases more expensive
 52% exceed 1 million
 Average verdict 4.7M
 Defensive Medicine??
 $70-124 billion estimates

30. What are the issues?
 Malpractice Caps
 Statute of Limitations
 Statute of Repose
 Attorney Fee Limits
 Expert Witness
Qualifications

31. Where We Stand

32. http://www.atra.org/files.cgi/8291_Record_12-08.pdf

33. Data from the CBO (2004)
 Caps improved costs
 Decreased costs of health
insurance
 Decreased cost of
malpractice coverage
 Increased insurance
premiums
 Increased physicians
 Collateral Source Reform
 Limited decline

34. Many Issues Remain
 State or Federal Issue?
 Clumping of tort reform
 Stigma of greed
 Powerful Plaintiff Bar

35. Getting Involved

36. EMRA
 35th year of existence
 8457 Members
 33% of all ACEP
 Health Policy Committee
 Legislative Advisor
 Advocacy Handbook

37. ACEP Projects
 911 Network
 Speakers Bureau
 Access to Emergency
Medical Services Act of
2009
 S. 468 / H.R. 1188
 Jen Wiler

38. ACEP Committees
 Federal Governmental
Affairs Committee
 State Legislative /
Regulatory Committee
 Medical-Legal
Committee

39. NEMPAC
 Election Cycle 2 years
 2 million dollar goal
 Ranking
 1 – Anesthesiology (3.12M)
 2 – Orthopaedics (2.37M)
 3 – Radiology (1.70M)
 4 – Ophthamology (1.69M)
 5 – Emergency Med (1.68M)
 Give-a-shift Goal
 $1000 / attending
 $100 / resident

40. You May Be Involved But…
 Rally your group /
residency / friends
 Give a Lecture / Journal
Club on Advocacy
 Become a Spokesperson
 Give your Time and
Money

41. 2009 EMRA
ADVOCACY
HANDBOOK
Want More Information?

42. Thank Yous
 Anthony Foianini, MD,
 Maine Medical Center, Portland,
ME
 Christopher S. Jones, MD
 Eastern Virginia Medical School,
Norfolk, VA
 Eric Goralnick, MD
 Yale New Haven, New Haven, CT
 Daniel Freess, MD
 University of Connecticut,
Farmington, CT
 George Leach MD
 Emory University, Atlanta, GA
 Edwin F. Lopez, MD
 Sinai-Grace Hospital, Wayne State
University, Detroit, MI
 Chet Schrader, MD
 Washington University in St.
Louis, St. Louis, MO
 Michael Dorrity, MD
 MSU-Sparrow Hospital, Lansing,
MI
 Erin E. Schneider, MD
 Oregon Health and Science
University, Portland, OR

43. Thank Yous
 Kaedrea Jackson, MD,
MPH
 SUNY Downstate Medical
Center, Kings County Hospital
Center, Brooklyn, NY
 Malika Fair MD, MPH
 Carolinas Medical Center,
Charlotte, NC
 Stephen Tantama, MD
 Naval Medical Center San
Diego, San Diego, CA
 Thomas Masters, MD
 Wright State University,
Kettering, OH
 Jamie “Akiva” Kahn, MA,
MSIV
 University of California at
Irvine, Irvine, CA
 Marisa L Oishi, MD
 Mount Sinai School of
Medicine, New York, NY
 Jawad Kassem, MD
 SUNY Upstate Medical
University, Syracuse, NY
 Yogin Patel, MD, MBA
 Apollo MD, Atlanta, GA

44. Upcoming Advocacy Events
 Advocacy Webinar – May 21st at 2pm EST
 Target Audience – Junior Faculty
 Speakers – Nathan Schlicher and Gordon Wheeler
 ACEP Blog:
 Thecentralline.org
 Rotating Bloggers
 Twittering with LAC
 Emresidents
 LAC09

45. Take Away Points
 Advocacy is a core competency for us
 Get involved, we need you!
 Medical Malpractice Liability Reform may live
 Health Care Reform Details Coming Soon!
 Stay involved

47. Thank you!