VACEP plays lead role on Capitol Hill
VACEP and ACEP chapters remind legislators: Boarding crisis, Workplace violence, and low Medicare reimbursements continue to torment ED’s
Plus: 2024 issue one-pagers within, to keep you informed
Members of VACEP’s Board of Directors, and other leaders from the state chapter, advocated in Washington on April 16, 2024. They met with eight lawmakers, including aides from the offices of both Virginia U.S. Senators Mark R. Warner and Timothy M. Kaine.
By Dan Carrigan for VACEP.org
With a delegation of nearly 20 physicians and support staff, Virginia emergency medicine leaders took a front-row seat in Washington last week at the American College of Emergency Physicians Leadership & Advocacy Conference.
Spangler
“We’re here fighting and trying our hardest to make things better for you each and every day,” said Jesse Spangler, MD, President of VACEP and an emergency physician at VCU Health.
For the conference, emergency physicians from all 50 states (and D.C.), along with those from Puerto Rico, government agencies and Canada descended on Washington for three days to talk about some of the toughest issues affecting emergency departments. Brush-up lessons on the latest legislation and advocacy efforts included a conference-wide call for, among other things, storytelling to illustrate the day-to-day toll of the boarding crisis, workplace violence, lack of due process rights, and the impact of an unstable Medicare payment system.
VACEP members took the call to heart as they piled into mini-vans to travel to Capitol Hill to meet with members of Congress and their staff. After a quick bite of trail mix and a group photo, the group representing emergency physicians from across the state crisscrossed the U.S. Capitol grounds – moving from one federal office building to the next as they pushed for nationwide fixes.
From sharing stories of behavioral health patients waiting weeks to receive care in the right environment to being forced to practice what Spangler called “waiting room medicine,” the group provided lawmakers and aids a window inside emergency departments in Virginia.
VACEP seated in front row during plenary sessions at ACEP Leadership and Advocacy Conference 2024.
Perhaps the most profound perspective was provided by Ashley Nicholson, MD, FACEP. While practicing at a hospital in northern Virginia, she shared an encounter during which – while treating a patient – she feared for her life. With security staff attempting to subdue a violent patient, it was Nicholson who had to put her self-defense training to use and restrain the individual.
“I had to put him in a headlock,” she said.
Hear from VACEP President Jesse Spangler, MD
on the work being done in both D.C. and Virginia.
Members of VACEP pose for a photo following a session. Pictured, from left: Aimee Perron Seibert, Commonwealth Strategy Group; Courtney Zydron, MD, MBA, Secretary, VACEP; Ashley Nicholson, MD, FACEP, Board Member, VACEP; Theodore “TJ” Tzavaras, MD, ACEP Councillor; Jesse Spangler, MD, President, VACEP; Todd Parker, MD, FACEP, Immediate Past-President, VACEP.
Immediate Past-President Todd Parker, MD, FACEP presents during ACEP Leadership and Advocacy Conference 2024 during a session, titled “Leading by Example: ACEP's Model Legislation to Fight Scope Creep/Expansion.”
Pictured, from left: Eunice Cho, medical student; Aisha Terry, MD, MPH, FACEP, ACEP President; Victoria Edwards, medical student.
AN OVERVIEW OF 2024’s ISSUES
BOARDING
Pictured is an Infographic provided to ACEP to help VACEP attendees and others illustrate the complex burden of boarding in emergency departments.
The issue: Hospital emergency departments (EDs) have reached a breaking point due to a long-standing problem known as “boarding,” where patients are held in the ED following stabilization and care awaiting an inpatient bed or space in a tertiary facility.
Boarding has significantly increased nationwide and become a public health emergency. ACEP collected more than 140 personal stories from emergency physicians across the country. Nearly all respondents (97%) cited boarding times of more than 24 hours, with one-third stating they had patients stay more than one week, and 28% citing they had patients boarding more than two weeks. Patients with behavioral health needs wait on average three times longer than medical patients. Research has shown that 75 percent of psychiatric emergency patients, if promptly evaluated and treated in an appropriate location – away from the active and disruptive ED setting – have their symptoms resolved to the point they can be discharged in less than 24 hours.
The ask: There is no one-size-fits-all solution to ED boarding, but there are legislative efforts that will help alleviate the strain.
To help alleviate psychiatric patient boarding, ACEP urges legislators to cosponsor the bipartisan “Improving Mental Health Access from the Emergency Department Act” (H.R. 5414/S. 1346) to ensure appropriate treatment and follow-up care for our patients with acute psychiatric needs.
WORKPLACE VIOLENCE
VACEP leaders are photographed with Rep. Jennifer Kiggans (R), fourth from left.
The issue: Violence in the emergency department is a serious and growing concern. More than 91% of emergency physicians reported that they or a colleague had been attacked or threatened on the job within the past year, according to a January 2024 ACEP poll of its members. Nearly three-quarters (71%) said that violence in their ED is worse than last year. In addition to the immediate physical threat to emergency physicians and other ED personnel, workplace violence causes significant stress for health care providers and patients seeking treatment in the ED and contributes to job dissatisfaction and burnout.
As Congress has looked at ways to address broader issues of increased violence in our communities, we ask legislators to establish important, common-sense procedures to protect emergency physicians, health care workers, and patients from violence in the health care workplace.
The ask: ACEP urges legislators to cosponsor bi-partisan legislation to address this problem - the “Workplace Violence Prevention for Health Care and Social Service Workers Act” (H.R. 2663/S. 1176) and the “SAVE Act” (H.R. 2584/S.2768). Congress needs to swiftly consider these bills to help protect emergency physicians and our colleagues in the emergency department.
DUE PROCESS RIGHTS
The issue: The best interests of all patients are served when emergency physicians practice in a fair, equitable, and supportive environment. The right to due process provides the foundation for this supportive environment, ensuring that emergency physicians can fully advocate for their patients without the fear of retribution or termination by employers.
Pictured, from left: Rep. Jennifer McClellan (D), Jesse Spangler Jesse Spangler, MD, and Ashley Nicholson, MD, FACEP, outside of McClellan’s D.C. office.
Safeguarding the right to due process for emergency physicians helps sustain and advance quality patient care and safety. All emergency physician contracts should include a due process clause.
The ask: ACEP urges legislators to cosponsor the “Physician and Patient Safety Act,” bipartisan legislation sponsored by Senators Roger Marshall, MD (R-KS) and Elizabeth Warren (D-MA) and Representatives Raul Ruiz, MD (D-CA) and John Joyce, MD (R-PA), to guarantee due process protections for emergency physicians, ensuring that those who provide our nation’s health care safety net can effectively advocate for all patients without fear of retaliation or termination.
MEDICARE PHYSICIAN PAYMENT STABILITY
The issue: For decades, Medicare physician reimbursements have failed to keep up with inflation, despite other Medicare participants receiving annual inflationary updates. Further, the yearly threat – and implementation – of significant cuts to Medicare physician payments continues to destabilize our nation’s health care safety net. Rather than face a yearly scramble to address steep payment cuts, emergency physicians welcome the opportunity to work with Congress to identify policy solutions that will provide long-term stability for Medicare beneficiaries and the physicians who manage and provide their health care.
The ask: ACEP urges Congress to work with emergency physicians to provide long-term stability for Medicare and to support and contribute to ongoing bipartisan efforts to stabilize the Medicare physician payment system.
A special thanks to the offices of Virginia’s representatives for meeting with Virginia emergency physicians and willingness to review information on our issues.
VA-01 Rep. Rob Wittman (R)
VA-02 Rep. Jennifer Kiggans (R)
VA-03 Rep. Bobby Scott (D)
VA-O4 Rep. Jennifer McClellan (D)
VA-07 Rep. Abigail Spanberger (D)
VA-08 Rep. Donald Beyer (D)
VA-09 Rep. Morgan Griffith (R)
VA-S Sen. Mark Warner (D)
VA-S Sen. Tim Kaine (D)
