Introduction to Health Policy

1. Introduction to Health Policy Nathaniel Schlicher, MD, JD Legislative Advisor Emergency Medicine Residents’ Association Emergency Medicine Resident Wright State University Attorney at lawJohnson, Graffe, Keay, Moniz & Wick, LLP

2. Why Are You Here? • Maybe… • Cool Location • Meet and Greet • Program Paid For it • Or Maybe… • Want to Make a Difference • Want to Guide Change • Care about an issue

3. History of this Program Where We Were • Resident Focused Track • Chair’s Challenge • Social Reception to Meet the Leaders What We Have Added • Added First-Timers from YPS Section of ACEP • Integrated Media Training • Roundtable discussions

4. Today’s Speakers • 1:00 – 1:40 Introduction • Nathaniel Schlicher, MD, JD • 1:40 – 2:20 Health Care Economics • James Eadie, MD, FACEP • 2:20 – 3:00 Current Issues • Jennifer Wiler, MD, MBA

5. Afternoon Agenda • 3:00 – 4:00 Roundtable Discussion • 10 Hot Topics • 4:00 – 6:00 Media Training • Speakers Bureau Pre-Requisite • 6:15 – 7:15 Reception • Cocktails and Networking

6. Objectives • What is Advocacy? • Legislative Process • Health Care Reform • Medical Malpractice Reform • Getting Involved

7. Advocacy = Politics

8. Advocacy is… speaking for a cause, often for a vulnerable person

9. US!

10. What is Advocacy to You? • Calling Consultants • Getting that Test • Free Care for All • Hospital Boards • Medical Staff Meetings • Overcrowding Solutions • State Laws • Regulations • Federal Policy • Reimbursement

11. Why should we care? EMTALA

12. $138,300 / year per ER Physician $12, 300 / year Average Physician

13. On call Specialists Medical Home CLOSED

14. We Need a Seat at this Table! • President Obama’s Health Reform Summit

15. Now Do you Care?

16. The Legislative Process

18. The Start • Bill is Introduced • Referred to Committee • Referred to a Subcommittee • Bart Gordon (HR 1188) • Energy and Commerce • Ways and Means • Subcommittee On Health in both Committees

19. The Hearings • Subcommittee Hearings • Report out or Table it • Committee Hearings • Report out or Table it • Full Chamber Considers • Approve, Defeat, Refer Back, or Table it • Second House Consideration

20. The Home Stretch • Compromise • Amendments referred back to original chamber • Conference committee • Presidential Consideration • Sign • Veto • No Action Pass • Pocket Veto

21. Health Care Reform

22. The Rationale • 46 million uninsured • 1 in 3 Americans under 65 without health insurance in 2007/2008 • Bankruptcy every 30 seconds from medical costs • 72% of Americans favor increasing government control on costs

23. Obama Campaign Plan • EHR 10 billion over 5 years • Increased Prevention • Align incentives for excellence – PQRI • Malpractice insurer reform • Competitive Insurance • National Health Ins. Exch. • SCHIP Expansion • Eliminate Medicare Advantage • Negotiate Drug Prices • Tax Credits

24. Moments of Pause • Expanded Pay for Performance • SGR like cuts are likely • More Medicaid or Medicare unclear • Decrease specialist utilization via incentives

25. Funding the Plan • Stimulus Bill • 17 billion for EHR • 60% subsidy for COBRA • 87 billion for 2 years of Medicaid • 50-65 billion / year via • Tax cut rollbacks on >$250,000 • Keep the Estate Tax • 634 billion over 10 years • Reduced deductions • Medicare Advantage gone • Provider cuts

26. The Wrinkle Cost: $1.5 Trillion / 10 years Areas of Savings: Physicians Hospitals Insurers Drug Companies

27. Hope and Change • Allocation for SGR Reversal in 10 year plan • “Restructuring” of payments to physicians • Can We Get a Bailout?

28. Tort Reform

29. Why? • Insurance Premiums • $26 billion annually • 12% / year growth rate • Cases more expensive • 52% exceed 1 million • Average verdict 4.7M • Defensive Medicine?? • $70-124 billion estimates

30. What are the issues? • Malpractice Caps • Statute of Limitations • Statute of Repose • Attorney Fee Limits • Expert Witness Qualifications

31. Where We Stand

32. http://www.atra.org/files.cgi/8291_Record_12-08.pdf

33. Data from the CBO (2004) • Caps improved costs • Decreased costs of health insurance • Decreased cost of malpractice coverage • Increased insurance premiums • Increased physicians • Collateral Source Reform • Limited decline

34. Many Issues Remain • State or Federal Issue? • Clumping of tort reform • Stigma of greed • Powerful Plaintiff Bar

35. Getting Involved

36. EMRA • 35th year of existence • 8457 Members • 33% of all ACEP • Health Policy Committee • Legislative Advisor • Advocacy Handbook

37. ACEP Projects • 911 Network • Speakers Bureau • Access to Emergency Medical Services Act of 2009 • S. 468 / H.R. 1188 • Jen Wiler

38. ACEP Committees • Federal Governmental Affairs Committee • State Legislative / Regulatory Committee • Medical-Legal Committee

39. NEMPAC • Election Cycle 2 years • 2 million dollar goal • Ranking • 1 – Anesthesiology (3.12M) • 2 – Orthopaedics (2.37M) • 3 – Radiology (1.70M) • 4 – Ophthamology (1.69M) • 5 – Emergency Med (1.68M) • Give-a-shift Goal • $1000 / attending • $100 / resident

40. You May Be Involved But… • Rally your group / residency / friends • Give a Lecture / Journal Club on Advocacy • Become a Spokesperson • Give your Time and Money

41. Want More Information? 2009 EMRA Advocacy Handbook

42. Thank Yous • Anthony Foianini, MD, • Maine Medical Center, Portland, ME • Christopher S. Jones, MD • Eastern Virginia Medical School, Norfolk, VA • Eric Goralnick, MD • Yale New Haven, New Haven, CT • Daniel Freess, MD • University of Connecticut, Farmington, CT • George Leach MD • Emory University, Atlanta, GA • Edwin F. Lopez, MD • Sinai-Grace Hospital, Wayne State University, Detroit, MI • Chet Schrader, MD • Washington University in St. Louis, St. Louis, MO • Michael Dorrity, MD • MSU-Sparrow Hospital, Lansing, MI • Erin E. Schneider, MD • Oregon Health and Science University, Portland, OR

43. Thank Yous • Kaedrea Jackson, MD, MPH • SUNY Downstate Medical Center, Kings County Hospital Center, Brooklyn, NY • Malika Fair MD, MPH • Carolinas Medical Center, Charlotte, NC • Stephen Tantama, MD • Naval Medical Center San Diego, San Diego, CA • Thomas Masters, MD • Wright State University, Kettering, OH • Jamie “Akiva” Kahn, MA, MSIV • University of California at Irvine, Irvine, CA • Marisa L Oishi, MD • Mount Sinai School of Medicine, New York, NY • JawadKassem, MD • SUNY Upstate Medical University, Syracuse, NY • Yogin Patel, MD, MBA • Apollo MD, Atlanta, GA

44. Upcoming Advocacy Events • Advocacy Webinar – May 21st at 2pm EST • Target Audience – Junior Faculty • Speakers – Nathan Schlicher and Gordon Wheeler • ACEP Blog: • Thecentralline.org • Rotating Bloggers • Twittering with LAC • Emresidents • LAC09

45. Take Away Points • Advocacy is a core competency for us • Get involved, we need you! • Medical Malpractice Liability Reform may live • Health Care Reform Details Coming Soon! • Stay involved

47. Thank you!