Inside The 2011 ACEP Council

An inside look at this year’s most influential emergency medicine gathering

It started with the usual – a blessing, the Pledge, the Anthem, reports and announcements – but then it was off to the races for the annual gathering of The Council of the American College of Emergency Physicians. In October, 338 Councillors met in the Grand Ballroom of the San Francisco Hilton in what has become the single most important meeting in emergency medicine. They came together to consider 39 resolutions and act as the common voice of the ACEP membership, and be at the tip of the spear for burgeoning emergency medicine issues.

As I have assisted Council Speaker Arlo Weltge, MD, FACEP, during these past two years, I have been in awe of the talent, knowledge, and dedication of the 338 Councillors and ACEP Staff.  Composed of Councillors from each of the 53 chapters, 29 sections, the Emergency Medicine Residents’ Association, the Association of Academic Chairs in Emergency Medicine, and the Council of Emergency Medicine Residency Directors – and now the Society for Academic Emergency Medicine – the Council is the deliberative body of the College, which gives direction to the Board of Directors.

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A few of the resolutions were for commendations and revisions to the bylaws and the Council Standing Rules (rules that govern Council operations).  The remainder dealt with a wide variety of important issues ranging from transitions of care and end-of-life care issues to convincing Congress to repeal the dreaded Independent Payment Advisory Board (IPAB).

The town hall-style meeting featured some of the current leaders in ACEP and in the American Medical Association (AMA). Steven J. Stack, MD, ACEP Councillor and Chair-Elect of the AMA Board of Trustees, stated that health care costs are consuming more and more of the U.S. economy, which is made worse by less people supporting federal entitlement programs, higher uninsured rates and a higher proportional financial burden on those with health insurance.

Although Americans prefer autonomy over equity, he added, the free market has yet to provide solutions to universal access. Dr. Stack also predicted that government involvement in health care will increase in the future. When some audience members asked about the future of the Patient Protection and Affordable Care Act and the possibility of its repeal, Dr. Stack responded by saying, “The law is a game changer, and we needed a game changer. Instead of repeal, repeal, repeal, we should be looking at how to fix the things that are clearly wrong in it and go forward.”

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David Seaberg, MD, then ACEP president-elect, described a new medical paradigm: Value = Quality/Cost + Service Excellence. The future trend will revolve around value-based medicine, said Seaberg. “Fee-for-service is going to fade out, and we have to start preparing for that.” Dr. Seaberg went on to describe how ACEP and the AMA are working together to further the efforts of medical liability reform.

Sandra Schneider, MD, then ACEP president, said “All of emergency care is just 2% of the national health care budget. For that 2%, [emergency physicians]provide 28% of all acute care, treat 45% of the underinsured, and more than 60% of the uninsured. This is really a bargain. We should be applauded.” On day two, debate on the council floor was a veritable nail-biter for two controversial resolutions, both having been submitted in one shape or form multiple times in the past and never adopted. “Regulate Marijuana Like Tobacco” essentially suggested adding the words “and cannabis” or “marijuana” after the word “tobacco” in ACEP’s document “Tobacco-Products – Public Policy Measures.” There was extensive testimony in Reference Committee which mainly focused on incorrectly equating the use of tobacco with marijuana and tarnishing the image of ACEP. Abiding by the overwhelming wishes of the Council, debate on the floor was limited to one minute pro and one minute con. The other controversial resolution was to support the adoption of single-payer health insurance and explore opportunities to partner with other organizations that favor the single-payer approach. Again, there was extensive testimony in Reference Committee and heated debate on the floor. However, in the end, both resolutions were not adopted. Again.

There were other resolutions considered that deserve attention. “End-of-Life Care” specifically called ACEP to study how emergency medicine can positively affect patients’ end-of-life care and to work with other appropriate professional societies to present a unified voice in addressing end-of-life care. Reference Committee testimony called for GME-recognized geriatric emergency medicine fellowships, the impact of palliative care guidelines, and the observation that end-of-life care discussions should more appropriately begin with the primary care provider. An amended resolution was adopted and will be assigned to the Emergency Medicine Practice Committee and the Geriatric Emergency Medicine Section.

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A late resolution concerned the use of scribes and their ability to use Computer Physician Order Entry (CPOE) and other Health Information Technology (HIT) initiatives. The resolution was adopted and calls for ACEP to work with stakeholders to define the full potential of scribes.

Other adopted resolutions include:

• ACEP calling on CMS to ensure uniform interpretation and fair application of EMTALA that ACEP work with appropriate entities to devise and support a solution to the medication shortage problem and the resulting patient safety issues;
• That ACEP take a bigger role in providing professional liability litigation support;
• That ACEP work with CORD to provide sexual assault training in emergency medicine residencies.

Resolutions referred to the Board of Directors include those concerning alternative considerations to the IPAB, tax relief for providing under-and uncompensated care, and the inappropriate use of ACEP credentials to further corporate business practices.At the last hour, the Council elected its next Vice Speaker, Kevin Klauer, DO, EJD. Four new members of the Board of Directors were elected in three successive elections.  Finally, Andrew Sama, MD, was elected as President-Elect.From now until the next meeting in Denver, the Council Steering Committee (CSC) will act on behalf of the Council.  Meeting in Dallas in January, 2012, and in Washington, D.C. in May, the CSC will work hard to continue to improve all aspects of the Council meeting and improve our governance process. I am particularly proud to have been elected as your Council Speaker. Serving the Council is an honor and a privilege and I am particularly excited to be joined by Kevin for the next two years. We plan to be innovative and will continue making the Council Meeting the foremost professional activity in our College.