David Mabey, MD
To my Colleagues:
The practice of medicine presents an odd mix of stability and instability. There will always be a need for medical care, especially emergency medical care, but the specifics, details, and methods of delivery are forever in flux. Medicine—emergency medicine in particular—is under assault, the likes of which have probably never been seen. Like many threats in modern society, this current crisis is multifactorial and very complex. Consequently, it doesn’t easily lend itself to glib soundbites, and if we’re not careful, will be decided by people who have very little practical knowledge. Thus those very decision makers become susceptible to the messaging around them. We constantly face the financial juggernaut that is the health insurance industry. With record revenue swelling already massive profits, they are setting their sights directly on us. They are callously and cynically exploiting the very real pain of patients facing financial ruin from a broken health care system and a crisis that they themselves have deliberately created to steal from us any remaining ability to negotiate fair and appropriate compensation. Health insurance providers have steadily narrowed networks, limited competition in marketplaces, and made physicians the parties responsible for collecting progressively larger deductibles. This has put patients in steadily more tenuous positions, and has also conveniently cast us in the role of villains who are profiting off patient suffering.
Unfortunately, the insurance lobby has won a small skirmish in defining the terminology. Rather than the more accurate “surprise insurance,” the national dialogue is about “surprise billing.”(1) Fortunately, the war is far from over. With us bound by our sense of duty to our patients, our pride in being the medical safety net of the nation, and federal regulations under EMTALA, insurance companies already have little incentive to negotiate with us. Without the input of physicians, a badly written law on surprise billing could have a major adverse impact on our ability to practice emergency medicine.
For the past 2½ years, UCEP, in coordination with the Utah Medical Association (UMA), has been fighting for a seat at the table in negotiations on a statewide level. Two out of the past 3 legislative sessions, attempts have been made to address surprise billing and we have negotiated with members of the state legislature and insurance companies to find a solution that is fair to all parties. I want to extend appreciation to all those who wrote or called their legislators regarding these negotiations. Through all our efforts, the 2017 bill that heavily favored insurance companies was defeated. There was another attempt at a bill this past session. We had an even more coordinated effort with the UMA, as well as state societies for anesthesia, surgery, radiology, pathology, and OB/GYN. As a coalition, we continued to negotiate, and while we were unable to come up with a final bill that all parties could accept, we demonstrated that physicians will continue to provide a counterpoint to the insurance lobby.
Now the fight has gone national. As Dr. Smith reports later in this newsletter, we went to Washington, D.C. in May to advocate for a federal fix to this unfortunate situation, with a goal to protect patients while ensuring we can still negotiate with insurance companies for fair compensation. What hope do we as individual clinicians have in standing against the insurance industry? It towers over us in funding, organization, and professional lobbying resources. We can contribute in the form of our ACEP/UCEP dues and in donating to the National Emergency Medicine Political Action Committee (NEMPAC). However, while dues and donations are important in keeping a seat at the legislative table, even more important is our own individual participation.
As emergency physicians who provide a huge percentage of charity care, represent one of the most trusted professions in the nation, and are the last resort for patients who have nowhere else to go, we can and must talk to our elected representatives. In a recent poll of congressional staffers, it was discovered that it only takes a few contacts from any of their constituents for legislators’ decisions to be influenced. This is magnified by our profession, and even more by our membership in a professional organization. Whether we live in their district or work at a hospital in their district, congressional representatives respond to our concerns. Again, to each of you who contacted your state representatives about surprise billing, I extend my thanks. Now I ask again that each of you contact your senators and your house representatives. Send an email, make a phone call, attend a town-hall meeting, or even talk to their district offices to try to meet them in person when they are in town. Each one of these contacts makes a difference and give us as physicians a stronger voice in this critical negotiation.
Over the next few weeks, we will send out a sample email to which you can attach your name so you can send it to your representatives. Even better, talk about your own experiences and personalize it as you see fit. Lastly, to any of your partners who are not members of UCEP, please invite them to join, or at least forward this newsletter and the subsequent email to get them involved, as well. Thank you again for all your efforts in caring for your patients at the bedside, in management meetings, and at the legislative level.
- Synonymous with balanced billing.
David Mabey, MD
American College of Emergency Physicians, Utah Chapter President