NATHANIEL SCHLICHER, MD, JD

LEGISLATIVE ADVISOREMERGENCY MEDICINE RESIDENTS’ ASSOCIATION

EMERGENCY MEDICINE RESIDENTWRIGHT STATE UNIVERSITY

ATTORNEY AT LAWJOHNSON, GRAFFE, KEAY, MONIZ & WICK, LLP

Introduction to Health Policy

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

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

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

Pre-Requisite

6:15 – 7:15 Reception Cocktails and

Networking

Objectives

What is Advocacy?

Legislative Process

Health Care Reform

Medical Malpractice Reform

Getting Involved

AdvocacAdvocacyy

PoliticsPolitics==

SPEAKING FOR A CAUSE, OFTEN FOR A VULNERABLE PERSON

Advocacy is…

US!

What is Advocacy to You?

Calling ConsultantsGetting that TestFree Care for AllHospital BoardsMedical Staff MeetingsOvercrowding SolutionsState LawsRegulationsFederal PolicyReimbursement

EMTALA

Why should we care?

$138,300 / year per ER Physician

$12, 300 / year Average Physician

On call On call SpecialistSpecialist

ss

Medical Medical HomeHome

CLO

SED

CLO

SED

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

Referred to Committee

Referred to a Subcommittee

Bart Gordon (HR 1188)

Energy and Commerce

Ways and Means

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 PreventionAlign incentives for

excellence – PQRIMalpractice insurer reformCompetitive InsuranceNational Health Ins. Exch.SCHIP ExpansionEliminate Medicare

AdvantageNegotiate Drug PricesTax 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:PhysiciansHospitalsInsurers

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 4.7M

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

35th 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 (3.12M) 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

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

2009 EMRA ADVOCACY HANDBOOK

Want More Information?

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

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

Jawad Kassem, MD SUNY Upstate Medical

University, Syracuse, NY

Yogin Patel, MD, MBA Apollo MD, Atlanta, GA

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

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!