Opening Remarks from ACEP’s New Lead Doc

 

Incoming ACEP president Angela Gardner (pictured with Chuck Grassley (R-IA) talks about lobbying, legislation and her blue sky goals for the American College of Emergency Physicians

On her leadership trajectory
I served on the Texas College of Emergency Physicians for six years and I was their president in 2003. That was the year we got tort reform in Texas and that’s the year I ran for the board of ACEP and got elected. I was lucky enough to be the national spokesperson for the group Doctors for Medical Liability Reform, which gave me a lot of exposure.

I’ve always been involved in leadership. I’m one of those people who was in student government and I’ve been involved in politics from an early age. For my first presidential election I went to the caucus and I got elected as one of the delegates. I got elected to be a delegate at the county level. I had to go back to medical school before I had the chance to be a national delegate, but it was a great experience. I sort of grew up in politics, seeing what the average citizen can do.

I love medicine and I love emergency medicine. At the time I went into emergency medicine we were underdogs. I got lots of advice not to go into emergency medicine. It was a specialty worth fighting for. I got involved in Texas in efforts for tort reform, and that was something worth fighting for too. At the time I was serving on the Texas board, emergency physicians were being sued regularly. In fact, most of the leadership had lawsuits pending – not because they were bad doctors, but simply because if you practice long enough you’re going to get sued. Many of us had more than one lawsuit pending, most of them frivolous. It was a huge problem.

I represented ACEP with the group Doctors for Medical Liability Reform, a coalition of several specialties, including radiologists, plastic surgeons, orthopedists, etc… We did these 30-minute video-mercials aimed at specific candidates who were running for national election. The goal was to change the outcome of the election and to educate people about what was going on and why tort reform was needed nationally. DMLR had one purpose, to get national tort reform. While it was disappointing to not achieve this, it was an enormous learning experience, teaching me about lobbying and about how the media works. I learned so much about effective use of the media.

The vast majority of funds spent by the National Emergency Medicine Political Action Committee (NEMPAC) go to support candidates for office. This is almost evenly divided between republicans and democrats. This doesn’t buy votes, it simply supports candidates who will be open to listening to our points of view or who have been sympathetic in the past. This candidate support also helps open a dialogue with that particular politician. Over the years, as time goes by, you develop relationships. You don’t always have to pay for that privilege.

The candidates who ultimately get NEMPAC support are chosen by a board of trustees, based on past voting record and the candidates’ willingness to listen to medicine’s concerns. We are the fourth largest medical specialty PAC – in terms of total funds available – and closing in on third very quickly. The administrative costs of lobbying in Washington are born by ACEP.

I meet with people regularly. I’m going to Washington next week and I’ll be meeting with Harry Reid. I’ve met with Grassley and Conrad. Over the past several months I’ve met with many people who are influential in the health reform debate. These meetings can take a number of forms. I met with Grassley at a fundraiser breakfast for Johnny Isaacs from Georgia. At this sort of event they’ll have 20 or 30 people at a breakfast from different areas. You talk with the candidates briefly beforehand, and they usually make a few remarks. They give you an opportunity to ask questions or make comments. One of the biggest things we’re fighting on the hill are the myths revolving around emergency medicine, the big one being that there are a lot of people in the emergency department who don’t belong there. That is a myth; only 12.2% of our patients are non-urgent. And all of emergency spending is only 3% of the healthcare budget, so changing emergency medicine isn’t going to fund healthcare reform. I said these two exact things to Senator Grassley and he said he was unaware. He said they would check on the facts and get back to us. What happens then is that his health liaison checks the facts and gets back with our men on the Hill to discuss the issue. Now, the senator may ultimately decide he doesn’t believe the CDC or that it’s not politically expedient for him to do anything about these facts publicly, but at least we’ve had the opportunity to make that point.

We have our own bill, the Access to Emergency Medical Services Act, which we’ve been trying to get through several congresses. But over the past few months we’ve been able to meet with legislative representatives from various offices and get a lot of the language from that bill included in some of the bills that are currently going for mark-up.

For instance, we’ve worked on getting language included that would make the emergency care coordination center – currently a presidential directive and subject to budget cuts – a permanent part of the Department of Health and Human Services. We’ve also got some trauma regionalization language in there, as well as some studies on regionalization of care. We’ve been working on the professional liability issue – that’s a fight we keep fighting – but it’s a yo-yo. We’ll have one person who agrees to introduce it as an amendment and then a similar amendment will get shot down, so they’ll pull it back. They’ll put it out there and then pull it back. We’re still working, and we won’t give up that fight.

I have three really big things that I’m going to accomplish, maybe not be the end of my term, but definitely by the end of my career. One of them is correcting some of these myths of emergency medicine, like the idea that our patients don’t need to be there. Or that a large percentage of emergency medicine spending goes towards expensive and inefficient care. We are very efficient, and we’re open three times as long as your average doctor’s office. I want to educate the public that they need to support emergency care as a basic fundamental right.

The second thing is that I’d like to position emergency physicians to come out ahead, no matter what reform brings. Regardless of what passes through Congress, there are some changes coming for EPs. We are going to face bundled payments and accountable care organizations and the need for comparative effectiveness research. Those things are going to happen whether there is a public option or not. So I’d like to help emergency medicine to be in a winning position when those things happen. And that will mean fair reimbursement, treating patients in a medically correct manner and providing access to emergency care to those who need it.

The third thing – and this is a blue sky goal – would be to establish an emergency medicine registry. In this country, we have no idea how many physicians are practicing emergency medicine and where they are practicing and what that environment is. There have been a couple of workforce studies recently, each attempting to answer this question, but each fell short because the information doesn’t exist. There is no excuse for that. And it’s more than simply knowing who is practicing where. It’s knowing what kinds of patients we see, where we see them and how many beds are available. There is so much we don’t know. The CDC gets its information, and it’s all coded from the chart after the visit. It’s not coded by what the patient says they have when they walk through the door. We’re looking at dealing with a possible H1N1 pandemic this fall, and we cannot report how many emergency beds are occupied at this moment. How in the world could we expect to handle any surge in patients? And while having the numbers will be great, ultimately it’s what we do with those numbers that matters. If we established a database, we could make decisions based on the data. Let’s say you want to regionalize stroke care. If we actually had contact with every emergency department and we could track stroke care, we could tell you whether regionalization is an improvement or not.

I was very distressed to hear him say, “expensive emergency care.” I counted four times. I was distressed that in spite of all of our efforts he was still characterizing emergency care as inefficient and expensive. I was glad to hear him move a little bit in terms of liability reform. I think that setting up a group to look at liability reform, in terms of early reporting, and the “I’m Sorry” campaign are not enough. But I’m happy to hear him at least entertain the idea.

We are being listened to, and we’re being able to make some changes, but we’re holding back from weighing in on one side or the other on some of the more potent issues because we don’t want to make political enemies too soon. However, by the time this issue goes to press, you’ll see a new PR campaign that we’re launching on the myths and realities surrounding emergency medicine. I imagine we’ll get a lot more exposure through that.

I don’t think so. For one thing, if you talk about most polarizing issues in medicine, like the public option, half of our members feel one way, and half feel the other way. What we do have are policies that support universal coverage for every American.