Written by Lauren Falvo, MD PGY3
From May 5th-8th, members of IUEM’s Advocacy Committee visited Washington, DC to attend ACEP’s Leadership and Advocacy Conference (LAC).
Residents (pictured above) representing included Tommy Eales PGY2; Lauren Falvo PGY3; Ashley Satorius PGY3; Jennica Siddle PGY3; and Emily Wagner PGY4 (EM-Peds).
We had excellent tutelage and guidance of faculty and Indiana Emergency Physicians: JT Finnell, IU faculty, serving as an ACEP Board of Directors member; Chris Ross, former Indiana Chapter of the American College of Emergency Physicians; Lindsay Weaver, IU faculty; and Jamie Shoemaker, community doctor from northeast Indiana.
Over 72 hours, emergency physicians, consultants, and politicians came together to discuss policies affecting emergency physicians and the patients we serve. LAC 2019 focused on two of the many important issues facing emergency medicine: mental health access and “surprise” billing.
Emergency departments serve as a haven for those with nowhere else to go. For patients in mental crises, close monitoring in a psychiatric care unit is the safest place to receive treatment and take steps towards healing. Due to budget constraints, there are limited inpatient beds and mental health resources across the state of Indiana and nationwide. As a result, these patients remain in the emergency department, sometimes for days, until beds are available. During this time, these patients are exposed to continuous stressful stimuli (unavoidable by nature of the emergency department), with limited access to psychiatric care. During their wait, those emergency beds can no longer be used to see the patients in the waiting room with medical complaints. Additionally, depending on the cause of their crises, these patients are required to have 1:1 sitters, which often means that one of our techs or nurses is pulled off the floor to stay in the room with the patient for the entirety of their shift. A prolonged stay in the emergency department is a disservice to our mental health patients, and a danger for our patients stuck in the waiting room. For more details regarding legislative efforts, please refer to House Bill HR2519 and Senate Bill S-1334.
“Surprise” billing, as it has become more colloquially known, but we prefer the more apt descriptions of “surprise coverage gap” is in part a consequence of discrepancies between in-network and out-of-network coverage that are not readily apparent to patients at the time of receiving care.
For example—a hypothetical patient, Sarah, may go to IU Methodist Hospital for a broken ankle. IU Methodist is considered in-patient with Sarah’s insurance plan. Sarah is evaluated by a nurse and physician and undergoes an x-ray, receives a splint, and goes home. She knows that she will owe a flat-fee copay for her visit, and that she will owe a portion of the cost of her x-ray; money that will go towards her deductible. However, 3 months later, Sarah gets an additional bill for several hundred dollars. While IU Methodist is in-network with her insurance company, the radiologist responsible for reading her x-ray could be a contracted employee who does not have an in-network agreement with her insurance company. Sarah is then expected to pay the bill for the radiology read, a medical service that she was not able to evaluate for or choose, in full, as her out-of-network deductible is far more than her in-network deductible. This is not the radiologist’s fault; they are providing the service they were hired to do, and do not necessarily have the negotiating power to obtain contracts with some of the larger insurance companies. However, Sarah is now left with an additional bill that she was not prepared for, and possibly cannot afford. Although there is not a current bill in the House or Senate to address this issue, emergency physicians have come to the Hill to discuss leveling the playing field by equalizing in-network and out-of-network deductibles to protect patients receiving emergent treatment. For a brief account of how states like New York are attempting to improve this healthcare issue, go to https://www.vox.com/health-care/2019/3/19/18233051/surprise-medical-bills-arbitration-new-york.
Additional highlights of Washington, DC included scootering around the Mall to visit some our most beloved non-Indianapolis monuments, meeting our caffeine fixes with cereal milk lattes at Milk Bar, and consuming copious amounts of Szechuan cuisine.
Thank you to Senator Mike Braun, Senator Todd Young, Representative Jackie Walorski, Representative Andre Carson and their respective legal aides, Reily Inman, Jaymi Light, Martin Schultz, and Ryan Shay for making time in their busy schedules to discuss healthcare concerns in Indiana. And thank you, IUEM and IUEM’s Advocacy Track for sponsoring residents to “have a seat at the table” of health policy!
We look forward to more opportunities like this to advocate for our patients with national decision makers. Join us next year!