What’s Hot and What’s Not in Our National Organizations: An Emergency Medicine Panel, Part 1

ABEM Director of Medical Affairs. ABEM has named its first ever Director of Medical Affairs (DMA): Melissa A. Barton, MD. Dr Barton is a former EM Residency Program Director and has been an ABEM Oral Examiner for the past 10 years. She is the recipient of several teaching and leadership awards. Dr Barton will focus on clinically oriented special projects and represent ABEM’s interests to external organizations.

Emergency Medicine Subspecialties. EM now has 13 subspecialty opportunities for EPs; that’s more than double the number from just 5 years ago. Emergency Medical Services (EMS) now has the most ABEM diplomates (445), followed by Medical Toxicology (367) and Pediatric Emergency Medicine (245).

Lifelong Learning and Self-Assessment (LLSA) Test Accessibility. To provide LLSA readings that better match a diplomate’s area of practice, the EMS and Medical Toxicology LLSA readings and tests can now be used by any diplomate to fulfill his or her Maintenance of Certification (MOC) Part II requirements. Pediatric EM LLSA readings and tests will eventually be made available to all diplomates at a later date. All LLSAs can be accessed through the ABEM Web site (https://www.abem.org).

Maintenance of Certification (MOC) Adds Value. In a survey of ABEM diplomates taking the 2014 ConCert Examination, 92.5% found value in maintaining their ABEM certification. In a follow-up survey in 2015, 90.4% stated their medical knowledge was reinforced and/or increased by preparing and taking the ConCert Examination. In addition to being relevant to our diplomates’ practice, ABEM has worked hard to control MOC costs. ABEM has not increased its fees for the last 5 years for the LLSAs; for all remaining examinations, there has been no fee increase for the past 4 years. When compared to all other boards, the expense of the ABEM MOC Program is at the median, costing EPs approximately $265 per year, or about $5 each week.

American College of Emergency Physicians

Jay A. Kaplan, MD, FACEP, ACEP President

Physician Burnout. Unfortunately, EM leads all specialties in the frequency of physician burnout. Emergency physicians must be aware of burnout, and take proactive steps to avoid it. To help EPs, ACEP has organized an “Emergency Medicine Wellness Week.” Prevention tips include eating well, getting the proper amount of sleep, regular exercise, and improving the work environment. In 2016, Wellness Week ran from January 24 to 30; there is a continuing focus on building resilience and preventing compassion fatigue.

Out of Network (OON) Balance Billing. Insurance companies know that it is solely the cost of insurance premiums that consumers pay attention to, not deductibles or exactly what the insurance covers. Those same insurance companies have been adept at portraying physicians as the cause of “surprise billing.” Emergency physicians need to change the conversation from “surprise billing” to “surprise coverage.” We need to talk about fair coverage for our patients, rather than asking for fair payment for physicians (the latter will follow the former and legislators believe that physicians are already fairly paid). ACEP is considering legal action against CMS and the Center for Consumer Information and Insurance Oversight regarding their final rule on “the greatest of three,” which establishes guidelines for how physicians are to be paid for services rendered.

Pay for Performance and Value-based Reimbursement. ACEP has created a joint task force with the Emergency Department Practice Management Association to create a toolbox for EPs to navigate the changing reimbursement landscape. This includes model legislation and best practices, and there is exploration regarding developing alternative payment models for EM.

Opioid Epidemic. ACEP is a participant in the White House working group exploring this epidemic and identifying strategies to combat this national problem. ACEP has sent a letter to CMS and Health and Human Services (HHS) requesting removal of the pain questions from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys. Emergency physicians should not be penalized on these surveys for not prescribing narcotic analgesics to patients who could be treated appropriately with nonnarcotic medications. ACEP similarly is considering sending a letter to The Joint Commission requesting removal of their emphasis on pain as the “fifth vital sign.”

Mass Casualty Incidents. ACEP has created a “New High-Threat High-Casualty Task Force” to identify best practice recommendations for provision of emergency care in high-threat environments and identify current clinical and operational knowledge gaps surrounding the issue. This in turn will help prioritize future ACEP research objectives based on these gaps. In addition, a white paper is being prepared, highlighting current national efforts and recommending clinical practice guidelines for adults and pediatric patients, as well as a future strategy for ACEP engagement as a national leader in the area of high-threat emergency care.