Emergency Medicine Advocacy Handbook, 5Th Edition, Furthering the Tradition of Promoting This and Other EMRA Activities

5th Edition Editors-in-Chief Hon. Nathaniel Schlicher, MD, JD, MBA, FACEP EMRA Legislative Advisor, 2008–2010 Associate Director, TeamHealth Litigation Support Program Regional Director of Quality Assurance, CHI Franciscan Health Emergency Departments Past President, Washington Chapter of ACEP 1st Vice President, Washington State Medical Association Alison Haddock, MD, FACEP EMRA Legislative Advisor, 2010–2012 Director of Health Policy: Advocacy Assistant Professor, Baylor College of Medicine Division of Emergency Medicine ACEP Board of Directors Associate Editor Rachel Solnick, MD, MSc EMRA Legislative Director, 2016–2018 Yale Emergency Medicine Residency National Clinical Scholars Program Research Fellow University of Michigan EMRA Board of Directors Omar Maniya, MD, MBA, President Hannah Hughes, MD, MBA, President-Elect Zach Jarou, MD, Immediate Past President Tommy Eales, DO, Secretary/Editor, EM Resident Nathan Vafaie, MD, MBA, Speaker of the Council Karina Sanchez, MD, Vice-Speaker of the Council Erik Blutinger, MD, MSc, Resident Representative to ACEP Sara Paradise, MD, Director of Education Angela Cai, MD, MBA, Director of Health Policy Greg Tanquary, DO, MBA, Director of Membership Nick Salerno, MD, Director of Technology Eric McDonald, MD, ACGME RC-EM Liaison Scott Pasichow, MD, MPH, EMRA Representative to AMA Venkat Subramanyam, MD, Ex-Officio Board Member Corey McNeilly, MA, Medical Student Council Chair Disclaimer The statements and opinions expressed in this book should not be construed as EMRA policy unless specifically referred to as such. EMRA and all sponsoring organizations disclaim any liability or responsibility for the consequences or any actions taken in reliance on those statements or opinions. The materials contained herein are not intended to establish policy or procedure. Get Involved If you'd like to become more involved in advocacy issues, please join the EMRA Health Policy Committee at www.emra.org/be-involved/committees/ health-policy-committee. Copyright © 2019. Emergency Medicine Residents’ Association. All rights reserved. ISBN 978-1-929854-53-0 4950 W. Royal Lane | Irving, TX 75063 972.550.0920 All rights reserved. This book is protected by copyright. No part of this book may be reproduced in any form or by any means without written permission from the copyright owner. Additional copies of this publication are available at emra.org/guides. ii US Acute Care Solutions is proud to offer an educational grant to support the Emergency Medicine Advocacy Handbook, 5th edition, furthering the tradition of promoting this and other EMRA activities. Our commitment to EMRA is grounded in the belief that emergency medicine residency training is the gold standard for the practice of the specialty. We take pride in hiring emergency medicine residency-trained physicians, and we are pleased to support residents throughout their training. The Advocacy Handbook is important because the practice of medicine is a business — yet there are fewer and fewer business models that put the physician at the center of the decision-making process. Therefore, participation in the legislative and policymaking arena is absolutely essential to delivering the highest level of patient care. We are pleased to help provide a key resource to create an informed, proactive voice for emergency medicine. With best wishes, US Acute Care Solutions www.usacs.com | 800.828.0898 4535 Dressler Road NW Canton, OH 44718 iii Foreword Over the past decade, the importance of health care advocacy in the practice of everyday clinicians has continued to grow exponentially. The picture on the front of this 5th Edition of the EMRA Advocacy Handbook seems an apt depiction of the struggle that many practicing doctors feel today. Medicine is being torn at the seams by the political whims of a partisan dysfunctional system that makes ventricular fibrillation looks like an organized plan! Since the first edition of the handbook, health care has seen tectonic shifts. The Affordable Care Act expanded coverage, provided mandated benefits, and changed the access to coverage equation for millions of Americans. Increasing cost, narrow networks, surprise billing, escalating deductibles, and stagnation of the family living wage has led to increased cost pressures for most consumers and challenged access to care. Increasing burnout among physicians, novel technologies, telemedicine, and the consumerization of health care has changed how physicians choose to provide care in the modern health system. New and novel mergers of different parts of the health care system and the creation of mega systems continue to challenge the importance of the physician as leader. Despite the world changing beneath our feet, nurses and physicians remain the most respected and trusted professionals. The value of our opinions and ability to shape policy has never been more important. We have seen physicians run for office and win. Emergency medicine has become one of the largest political action committees with an annual leadership conference in Washington, D.C., that brings the message directly to the representatives. State chapters have wielded powerful voices on numerous issues, from the opioid epidemic to the fight for fair coverage and network advocacy. Now is our time to lead. Lead not only the house of medicine but also the work to improve the lives of those we serve. We must be the light in the window, the missing link of health care, that is the beacon of hope for our patients, burnt out providers, and the next generation deciding if a career in medicine is worth it. Maybe Napoleon Bonaparte put it best: “A leader is a dealer in hope.” Emergency physicians are the best dealers in hope I know. We stand in the darkness and see people often at the worst moments of their lives. We offer hope to those society has forgotten. We find a way despite the sorrow to come back and provide care 24/7/365. Each of you is the living embodiment of hopeful leadership. Your work on advocacy will be the difference in our future, and we cannot do it without you. I hope you find this handbook to be a valuable resource in your efforts and that it inspires you to make advocacy a regular part of your medical practice. Thank you for being an advocate and leader! Hon. Nathaniel Schlicher, MD, JD, MBA, FACEP iv Contributors Jessica Alvelo, MD Callan Fockele, MD, MS New York Presbyterian Hospital University of Washington Michael S. Balkin, MD Tom Fowler, MD JPS Health Network Einstein Healthcare Network, Philadelphia Erik A. Berg, MD Justin Fuehrer, DO, FAWM LAC+USC Medical Center Long Island Jewish Hospital Andrew I. Bern, MD, FACEP Cameron Gettel, MD InPhyNet TeamHealth Brown University Jessica Best, MD Hannah Gordon, MPH Victoria Emergency Associates FIU Herbert Wertheim College of Medicine Jason K. Bowman, MD Class of 2019 Massachusetts General Hospital/ Michael A. Granovsky, MD, CPC, FACEP Brigham and Women’s Hospital Logix Health Bradley Burmeister, MD Puneet Gupta, MD, FACEP Medical College of Wisconsin-Green Bay Harbor-UCLA Medical Center Kristopher M. Carbone, MSBS, MS, MD Victoria “Tory” Haddad, MD Northwell Health-Long Island Jewish Medical Center Central Michigan University Jordan Celeste, MD, FACEP Rosalia Holzman, MD Emergency Physicians of Central Florida BerbeeWalsh Department of Emergency Medicine, Nidal Nagib Choujaa University of Wisconsin Ohio University Heritage College of Osteopathic Eleni K. Horattas, MD Medicine Class of 2019 Cleveland Clinic Akron General Kathleen Cowling, DO, MS, MBA, FACEP Dennis Hsieh, MD, JD Central Michigan University Harbor-UCLA Medical Center Petrina L. Craine, MD Adnan Hussain, MD Alameda County Medical Center-Highland Hospital Saint Joseph Medical Center Cedric Dark, MD, MPH, FACEP Courtney Hutchins, MD, MPH Baylor College of Medicine University of Chicago Elizabeth Davlantes, MD Aya Itani, MD, MPH Envision Baylor College of Medicine Nathan Deal, MD, FACEP Udit Jain, MD Harris Health System John Peter Smith Hospital Bryn DeKosky, DO, MBA Hannah Janeway, MD Kent Hospital Harbor-UCLA Medical Center Jasmeet Dhaliwal, MD, MPH, MBA Nicholaus Josey, MD St. Anthony Hospital Ascension Genesys Medical Center Ramnik Dhaliwal, MD, JD Kristin Kahale, MD Hennepin County Medical Center Beaumont Health Kenneth Dodd, MD Jamie Akiva Kahn, MD, MBA Advocate Christ Medical Center Providence Little Company of Mary, Torrance Marisa K. Dowling, MD, MPP (Emergency Department) University of Maryland Medical Center Sushant Kapoor, DO, MS Aaran Brooke Drake, MD Christiana Care Health System George Washington University Benjamin Karfunkle, MD Muhammad Durrani, DO, MS University of Texas Health Science Center Houston Inspira Medical Center Ramu Kharel, MD, MPH Christopher Evans, DO Emory University Doctors Hospital/OhioHealth Peter S. Kim, MD John Peter Smith Hospital v Natalie Kirilichin, MD, MPH Nicholas Robbins, MD George Washington University Medical Faculty John Peter Smith Hospital Associates William M. Ross Luke Knapp, MD University of Mississippi Medical Center John Peter Smith Hospital School of Medicine Class of 2019 Heidi Knowles, MD, FACEP Elizabeth A. Samuels, MD, MPH, MHS John Peter Smith Health Network Department of Emergency Medicine, Ryan Koski-Vacirca Alpert Medical School, Brown University Wake Forest School of Medicine Class of 2020 Jesse Schafer, MD Brittany CH Koy, MD Beth Israel Deaconess Medical Center, Harvard Cleveland Clinic Akron General & Northeast Ohio Medical School Medical University Adam Schefkind Chadd K. Kraus, DO, DrPH, MPH, FACEP University of

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