Maureen Salamon

November 02, 2017

WASHINGTON, DC — About 500 physicians, researchers, and academics converged on Capitol Hill at the end of the American College of Emergency Physicians (ACEP) 2017 Scientific Assembly on Wednesday to advocate for protections for themselves and the patients in their care.

The white-coat-clad group, calm and focused, separated into state delegations to embark on 350 scheduled meetings with Congressional representatives and staff members.

There were two main talking points on the agenda of the ACEP members.

The first is to support legislation that extends liability protections to emergency and on-call physicians under the federal Emergency Medical Treatment and Labor Act (EMTALA), which requires them to treat and stabilize any patient coming to an emergency department, regardless of insurance status or ability to pay. Currently, only providers in federally supported health centers and scant others are legally protected for the care offered at those facilities.

We're the safety net, so patients end up in the ED when some of their illnesses are pretty advanced.

More than 140 million patients are treated in emergency departments each year in the United States, according to ACEP figures. Members typically engage with Congressional representatives during annual spring leadership and advocacy conferences, but took advantage of the Washington location of this year's scientific assembly to expand those efforts.

"We're trying to get leaders to mandate that, yes, we see the patients — it's not a problem — but we should have some legal protection," said Haresh Kathard, MD, from Duke LifePoint in Chapel Hill, North Carolina.

"Emergency rooms are becoming so busy and overburdened with all the turmoil in healthcare," he told Medscape Medical News. "We're the safety net, so patients end up in the ED when some of their illnesses are pretty advanced. We're taking care of some really sick patients and should have some federal coverage."

Physicians, researchers, and academics marched on Capitol Hill as part of White Coat Day, November 1.

ACEP members also urged more stringent oversight of the prudent layperson laws enacted in the 1980s, which require insurers to cover emergency care on the basis of symptoms, not final diagnosis.

Anthem Blue Cross and Blue Shield recently warned policyholders in Georgia, Kentucky, and Missouri that they might be denied coverage for emergency department visits if the insurance company decides that their final diagnosis isn't serious enough. But because many patients with life-threatening conditions present to the emergency department with the same symptoms as patients with milder ailments, this approach is unfair and potentially dangerous, ACEP officials said.

"Insurance companies currently want their patients to be smarter than their doctors," said William Felegi, DO, from Hackettstown Regional Medical Center in New Jersey

"This really puts patients in an unsafe position. Many times, people may have symptoms of a serious disease that also reflect something not so serious, and may decide not to come to the emergency department for fear their insurance will not cover it," he told Medscape Medical News.

"Political advocacy is important," Dr Felegi added. "When physicians go to the Hill, they have a very good understanding of day-to-day activities in the emergency department and the problems faced not only by physicians but, more importantly, by patients."

Rep Charlie Dent (R-Pennsylvania), who is sponsoring the legislation that would expand federal liability protection to emergency providers, cheered the White Coat Day efforts of ACEP members at a breakfast before the Congressional meetings.

"You are where the rubber meets the road," he told the group. "Every one of us from time to time is going to depend on you. I want the best physicians in the ED. I don't want you thinking about being sued; I want you thinking about giving the best care."

American College of Emergency Physicians 2017 Scientific Assembly. November 1, 2017

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