Katy King, Government Relations Director
The Oregon Chapter of ACEP celebrates its 50th Anniversary this year! The list of 50 Reasons to Celebrate OCEP includes a number of legislative and advocacy accomplishments over the decades, including the creation of the state trauma system, passage of the prudent layperson standard, guidelines for navigating the opioid crisis, supporting and implementing the Emergency Department Information Exchange, leading the Emergency Healthcare Taskforce, supporting bills to prevent violence against health care workers, advocacy for fair reimbursement, leadership during the COVID-19 pandemic to provide care and to improve transparency of supplies for PPE, supporting measures to prevent gun violence (this is your lane!) And many, many, more issues. We are here to advocate for you, your patients and the practice of emergency medicine.
Here are some of the priorities that the chapter will be working on for the 2023 Legislative Session that starts next February:
Preventing violence against health care workers: Dr. Chris Richards, the chapter president and other board members, are working with the Oregon Emergency Nurses Association and the Oregon Nurses Association to improve reporting and enforcement of the existing laws related to assault of health care workers and to enhance penalties for harassment. OR-ACEP supported bills to increase penalties for HCW assault introduced in 2015, 2017, 2021 and 2022. OR-ACEP issued a joint release with the Oregon Emergency Nurses Association (OENA). It urged legislators to not wait until 2023 to address the problem of violence in hospitals and the trauma of health care worker assault, but to take decisive action during the interim to develop solutions. OR-ACEP has surveyed members and found that:
- Over half frequently feel unsafe at work
- 39 percent have been assaulted — most of those (71 percent) are not reported.
The reasons given are that most didn’t have confidence that reporting would affect anything (65 percent) or that the effort of reporting was burdensome (34 percent).
- Over 90 percent of emergency physicians surveyed said they would support a hotline for reporting hospital-based assaults.
In a July meeting with the Oregon District Attorney’s Association, Brian Powell, a Clackamas County Assistant DA, helped emergency physicians and nurses to better understand why some crimes are prosecuted and some are not. Harassment is one of those areas where crimes are lost and not reported. Increasing penalties for harassment may improve safety in the emergency department.
Opioid safety: Rep. Maxine Dexter, a family physician, will be introducing legislation in 2023 to improve access to naloxone and allow physicians and healthcare practitioners to provide narcan kids as handouts to people who would likely be at risk for an overdose. Dr. Alex Skog, the president-elect of OCEP has been named to a workgroup to help develop policies.
EMS modernization to improve the system and reduce ED gridlock: OR-ACEP has been working with OHA and key legislators to advocate for system improvements and re-start stakeholder conversations regarding long-term solutions for the EMS system. The Senate Health Care Committee is also putting a spotlight on health care capacity issues, including emergency department boarding and workforce shortages. State agencies are proposing investments to address the crisis, incentives to get people into adult foster care and to open beds coming into the fall with a possible surge in flu and COVID infections. Workforce challenges due to the Great Resignation, retirements and provider burnout, could be a generational issue. The health care staff that remain on the job are exhausted and in moral distress. Dr. Raymond Moreno, a hospital CMO and emergency physician, testified that the capacity improvement needs affect the entire system: ambulance and OB divert, ED boarding, patients leaving without being seen, ability to transfer patients between hospitals, backlog of operations and procedures and satisfaction for patients, providers and staff. Funding is needed now to compensate for unreimbursed care and planning is critical to modernizing the current system.
Final Rules for No Surprises Act are a win for emergency medicine
The final rule of the No Surprises Act was issued in August and ACEP has provided their regulation summary of the final rule. OR-ACEP has been advocating for and negotiating fair reimbursement policies related to balance billing since 2016. Past-President Chris Strear serves on the ACEP Reimbursement Committee.
A few takeaways:
- The rules addressed the policy included in the previous regulation that gave unequal weight to the Qualified Payment Amount (median, in-network) and unfair advantage to insurers. This was settled by the Texas lawsuit filed by ACEP, the American College of Radiology and the American Society of Anesthesiology. So, the QPA will no longer be the presumptive factor but it will be part of the IDR consideration.
- ACEP 911 says that in a” major win for emergency medicine, the rule adds an official definition of downcoding* and adds an a new requirement that if a QPA is on a down-coded service code or modifier, the plan must provide an explanation of why the claim was downcoded and the amount it would have been if it had not been downcoded.” This is an important transparency measure. *The final rules define the term “downcode” to mean the alteration by a plan or issuer of the service code to another service code or the alteration, addition, or removal by a plan or issuer of a modifier, if the changed code or modifier is associated with a lower QPA than the service code or modifier billed by the provider, facility, or provider of air ambulance services. Note: the chapter has reached out to regulators, speciality societies and hospitals to educate them about the detrimental practice of downcoding.
- CMS also recognized that United Health Care constructed an illegal process around the initiation of complaints under the NSA and said it is not compliant with the NSA statute and regulations.
Elections and Ballot Measures
OR-ACEP Board Members have been working with ACEP and meeting with members of Congress and Congressional candidates this summer to talk about violence in the emergency department (advocating for passage of the Safety from Violence for Healthcare Employees Act, which is modeled after protections that exist for aircraft and airport workers), provider wellness, the ED boarding crisis and insurance company misbehavior.
OR-ACEP Endorses Measure 114 Reduction of Gun Violence Act
Lift Every Voice Oregon introduced this measure which would require a permit for anyone to purchase any firearm, require universal, complete background checks and basic safety training, closing the “Charleston Loophole” and ban large-capacity magazines. OR-ACEP signed onto the OMA Voter’s Pamphlet Statement and Dr. Alex Skog spoke at a recent event with legislators about the impact of gun violence in the emergency department. Dr. Fred Cirillo, a chapter member, has been very active in promoting this ballot measure amongst his emergency medicine colleagues.