John Powell, MD, MCHDS, FACEP
Happy Spring! I trust that this note finds you well, and closer to summer fun and warmth. It was great catching up with our colleagues from Beebe and Nanticoke at the January DE ACEP meeting in Lewes. Dr. Emily Granitto was unanimously elected President-Elect. Dr. Granitto attended medical school at The Ohio State University and completed her Emergency Medicine residency at Christiana Care. She has been active in state issues, an alternate councilor at ACEP Council and a representative at Leadership and Advocacy. We are excited for her to officially join the team!
I’d like to thank Dr. Kate Groner for her leadership of Delaware ACEP for the past two years. Kate’s advocacy directly improved the care of our emergency patients. She represented DE ACEP during the initial phases of the opioid care discussions and will continue this work as a representative on the state’s opioid systems of care council.
In addition to opioids, we are actively engaged in several issues to protect our patients, described below.
The state seeks to re-engineer reimbursements under the personal injury protection (PIP) insurance, moving towards a fee schedule similar to workers compensation. Our primary concern is to maintain the safety net of on-call providers who provide emergency patient care. We fear that an erosion of PIP reimbursement will make it more difficult to staff on-call panels, and will ultimately result in costly patient transfers, away from their support network. Draft versions of prior PIP legislation were modeled off the workers compensation statute; practitioners providing EMTALA-based care had been exempt from the workers compensation fee schedule. This exemption was inadvertently removed due to an oversight in prior legislation edits. We are working with the workers compensation oversight committee, senate and house leaders to remedy this. If restored, this exemption should carry over to PIP discussions. We remain steadfastly engaged to any proposed revisions of PIP legislation.
We are actively engaged with National ACEP and Senator Carper’s office regarding federal legislation targeting out-of-network billing, aka “surprise bills”. Surprise medical bills occur anytime a patient is “surprised” by a gap in their insurance. This may occur when a patient receives a medical bill, not realizing they must match a high deductible before getting assistance from their insurance carrier. It also occurs when patients unexpectedly receive a high medical bill from a provider who was out-of-network with their insurance firm. Emergency out-of-network bills are not an issue in Delaware. Current Delaware legislation encourages provider and insurance carriers to negotiate and provides an arbitration process to manage impasses. In addition, current regulations instruct carriers to send payments directly to providers during arbitration, thus removing patients from the middle of the process. We believe the Delaware process could inform a national solution.
Legislation regarding OON billing presents a unique circumstance of bipartisan congressional and presidential support. Early draft federal legislation includes pieces that are favorable to emergency medicine, such as direct payment from insurers to providers. Other parts, including the mechanisms to establish reimbursement, heavily favor insurers and do not account for emergency providers working under EMTALA. Our DE ACEP team sent to comments addressing the senate and house versions. We remain engaged, and will continue face-to-face discussions with our elected representatives.
OON legislation was the primary discussion point during our Hill visit as part of the ACEP’s Leadership & Advocacy (LnA) Conference, that occurred in Washington, DC on May 5-8. It prepared us for engaging with the aforementioned legislation. Next year, consider signing up and joining your chapter and representatives from all the state chapters of ACEP in learning about national legislative issues and in lobbying Congress directly to preserve our interests! You may find additional LnA information on the ACEP website, located at http://www.acep.org/lac/
Congratulations to our emergency providers at Bay Health for the successful opening of their new facility, located in Milford just of Route 1. They essentially performed a mass evacuation exercise, transferring operations to the new site across 24 hours.
Nemours AI duPont hosted their Pediatric Emergency Medicine Skills Course on May 16. Unanimous opinion is this is a phenomenal course. I attended for the first time this year due to the accolades, and concur that the education was superlative. DE ACEP sponsored ten of our members to attend this year. Please consider attending next year.
We’d love to see at the next Delaware ACEP meeting to be held in the Summer timeframe, exact date and location to be determined.
Please call me or Emily Granitto at any time with questions, concerns or if you would like to get involved in particular issues in our state. We wish you all the best as you continue to work each day to serve our patients and provide the highest level of compassionate emergency care.