By Garreth Debiegun, MD, FACEP, FACS
It’s summer here in Maine and it’s easy to get lost in our own serene corner of the country where vacationland feels perpetually safe and isolated from the craziness around the country. But we are a piece of the American pie and are reminded so by the news. As the safety net system and the front line of any disaster or major event it feels as though emergency physicians are often highly involved with any major happenings. There are two significant things worth mentioning right now.
First is the recurrent senseless and tragic mass shootings. Emergency physicians come from across the political spectrum and have a variety of opinions on how to address these problems, but we all know we will be the ones caring for victims of any gun injury and we all feel a deep need to protect our patients from needless physical and emotional injury. ACEP actively participates with and supports the American Foundation for Firearm Injury Reduction in Medicine (AFFIRM)-a non-profit organization founded and led by emergency physicians working to end the epidemic of gun violence through research, innovation and evidence-based practice. Furthermore, ACEP supports legislation that:
- Encourage the change of societal norms that glorify a culture of violence to one of social civility;
- Investigate the effect of socioeconomic and other cultural risk factors on firearm injury and provide public and private funding for firearm safety and injury prevention research;
- Create a confidential national firearm injury research registry while encouraging states to establish a uniform approach to tracking and recording firearm related injuries;
- Promote access to effective, affordable, and sustainable mental health services;
- Protect the duty of physicians and encourage health care provider discussions with patients on firearm safety;
- Promote the development of technology that increases firearm safety;
- Support universal background checks for firearm transactions;
- Require the enforcement of existing laws and support new legislation that prevents high risk and prohibited individuals from obtaining firearms by any means; and
- Restrict the sale and ownership of weapons, munitions, and large-capacity magazines that are designed for military or law enforcement use.
ACEP also supports further research and legislation to address effectiveness and ramifications of Gun Violence Restraining Orders (GVRO) and Extreme Risk Protection Orders (ERPO), which President Trump mentioned in his national response. ACEP will continue to convene public health and injury prevention experts to review the current state of research and legislation regarding firearm violence.
The second major issue relevant to us right now is the current legislative work on surprise billing. There are a few major bills moving through the legislature right now that aim to address this. This may be the biggest issue for emergency physicians this decade. Surprise bills come from one of three realms. 1) Being out of network when the patient expects to be in network. 2) Having an unexpectedly high deductible 3) Insurance that does not cover all of the expense incurred. ACEPs goal is to take patients #outofthemiddle. We seek to create legislation that eliminates patient involvement in payment and has providers and insurers talking to each other on a level playing field both incentivized to treat each other reasonably. However, one of the currently proposed bills suggest setting a benchmark rate for payments which would be hard to adjust over the years, would give the insurers a major advantage as they would generally set the rate, and would continue to leave it advantageous for insurers to limit their networks so they can make patients pay out-of-network rates. Emergency Physician Raul Ruiz D-CA has proposed a different bill which ACEP fully supports that involves a baseball style arbitration for billing disputes between insurers and providers. This has already been implemented in NY where it has proved effective and health care costs have grown more slowly there than the rest of the nation. For more details on this issue you can reference the ACEP toolkit on out of network billing: https://www.acep.org/topics/out-of-network-billing/#Toolkit.
With those two issues in mind, I implore you to go to the ocean, eat a lobster roll, enjoy the summer, but also continue to take great care of all those visitors who come to our departments this summer, we are the face of Maine and of Emergency Medicine, and as Mel Herbert says, “what you do matters!”
Pictures from the Cabbage Island ACEP June 2019 Meeting.