Introduction to Health Policy NATHANIEL SCHLICHER MD JD

Introduction to Health Policy NATHANIEL SCHLICHER, MD, JD LEGISLATIVE ADVISOR EMERGENCY MEDICINE RESIDENTS’ ASSOCIATION EMERGENCY MEDICINE RESIDENT WRIGHT STATE UNIVERSITY ATTORNEY AT LAW JOHNSON, GRAFFE, KEAY, MONIZ & WICK, LLP

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

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

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

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

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

Advocacy = Politics

Advocacy is… SPEAKING FOR A CAUSE, OFTEN FOR A VULNERABLE PERSON

US!

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

Why should we care? EMTALA

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

On call Specialists ED OS CL Medical Home

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

Now Do you Care?

The Legislative Process

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

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

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

Health Care Reform

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

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

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

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

The Wrinkle Cost: $1. 5 Trillion / 10 years Areas of Savings: Physicians Hospitals Insurers Drug Companies

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

Tort Reform

Why? Insurance Premiums $26 billion annually 12% / year growth rate Cases more expensive 52% exceed 1 million Average verdict 4. 7 M Defensive Medicine? ? $70 -124 billion estimates

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

Where We Stand

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

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

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

Getting Involved

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

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

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

NEMPAC Election Cycle 2 years 2 million dollar goal Ranking 1 – Anesthesiology (3. 12 M) 2 – Orthopaedics (2. 37 M) 3 – Radiology (1. 70 M) 4 – Ophthamology (1. 69 M) 5 – Emergency Med (1. 68 M) Give-a-shift Goal $1000 / attending $100 / resident

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

Want More Information? 2009 EMRA ADVOCACY HANDBOOK

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

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, CA Thomas Masters, MD Wright State University, Kettering, OH Jamie “Akiva” Kahn, MA, MSIV University of California at Irvine, CA Marisa L Oishi, MD Mount Sinai School of Medicine, New York, NY Jawad Kassem, MD SUNY Upstate Medical University, Syracuse, NY Yogin Patel, MD, MBA Apollo MD, Atlanta, GA

Upcoming Advocacy Events Advocacy Webinar – May 21 st at 2 pm EST Target Audience – Junior Faculty Speakers – Nathan Schlicher and Gordon Wheeler ACEP Blog: Thecentralline. org Rotating Bloggers Twittering with LAC Emresidents LAC 09

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

Thank you!