Articles

Originally published by the San Diego Union Tribune on January 23, 2022 By Paul Sisson
Videography By Nelvin C. Cepeda, John Kelley, Sam Hodgson

Dr. Clay Whiting, IEPC member, was featured in Front-Line Voices with the San Diego Union Tribune. Here is an excerpt of the article in the San Diego Union Tribune.

On Dec. 31, Dr, Clayton Whiting was feeling burnt out after battling through the week after Christmas when the pressure on emergency departments grew particularly heavy. Then, on Jan. 2, he started having coronavirus symptoms that ultimately forced him to skip a planned vacation with his family.

That vacation was to provide the decompression he needed to return refreshed. Instead, he got to spend 10 days quarantined at home. Putting on his scrubs on Jan. 10 for his first shift after his non-vacation, Whiting said he happened to spot a shot of himself back in 1994 as a third-year medical student at Creighton University. The smile on his face in that picture, he said, was so full of hope and desire and compassion that he couldn’t put it away.

“I decided to bring that with me to the front lines so that at 2 a.m., when I was, you know, bearing witness to the pain and suffering of my fellow humanity, I could remind myself of the importance of treating each individual with that same level of compassion and love and caring that I had when I was a third-year medical student,” Whiting said.

Another antidote for 2022? He now starts every shift with a visit to Mercy’s chapel, praying for strength.

To view the interview with Dr. Whiting click here.

To view the full February 2022 newsletter click here.

Written by Roneet Lev, MD
Executive Director, IEPC

I had the honor of discharging a 23-year-old patient with autism, let’s call him Austin, who presented to the emergency department on a 5150 psychiatric hold due to violent behavior. There were no locked mental health beds in the area and so Austin remained in our emergency department for two weeks. Austin awoke and went to sleep day after day in the Emergency Department – eating, drinking, and I imagine brushing his teeth. In total he was in the ED more shifts than I was. Some call this psychiatric boarding. I don’t like that term – it’s misleading, it sounds like no medical care was delivered. Stop Calling It Boarding – It’s ED Psychiatric Care During those two weeks Austin had a sitter next to him 24/7. He received regular vital signs, medications, counseling, rounding by the psychiatric team, consultation and orders by different emergency physicians, and daily consultation by a psychiatrist. He received successful medical and psychiatric treatment over those weeks. The treatment, in fact, was so good that Austin was safely discharged home. A mental health bed never opened. Austin was not just boarding in the ED, Austin received Emergency Department based psychiatric treatment. ED psychiatric treatment works, but unfortunately it is not the best place for mental health patients and disastrous for overall ED flow. 2 Now picture yourself as the health insurer who needs to pay for Austin’s care. Austin’s bill would include one hospital ED visit, one ED physician visit, perhaps an observation code, some medications, and a psychiatrist bill. What a bargain! That beats a two week stay in a mental health facility. Health plans must love ED “psychiatric boarding”! What is the incentive to transfer a patient or create new mental health beds if care is provided in the ED for less? What if the health plans were charged a daily ED hospital and ED physician rate for every day that their patient cannot be placed? Now that would align incentives.

To view the full November 2021 newsletter click here.

IEPC is proud to present the 2021 Speaker Series, to continue on Monday, November 22 at 9 AM Pacific! This free speaker series will welcome leaders in the field to cover timely and engaging topics that are important to independent emergency physicians. The sessions will precede each monthly conference call and are open to all IEPC members and those who may be interested in joining.

Session: California Hospital Association and Independent Emergency Physicians
Presented by: Andrew Selesnick – Shareholder, Chairman of the Healthcare Litigation Practice Group
Time & Date: Monday, October 25 from 9:00 AM – 9:30 AM 

This series will be presented on the fourth Monday of the month May – November. Advance registration is required and can be completed here. After registering, you will receive a confirmation email containing information about joining the meeting.

We hope to see you Monday!

Click here to view a PDF of the newsletter.

In this issue:

• Stop Calling It Boarding – It’s ED Psychiatric Care
• California ACEP 2021 Legislative Review
• California Hospital Association 2021 Update
• AAEM Highlights of Legal Advocacy For Independent Emergency Physicians
• Trigger Point Injections
• Viewpoint In Emergency Medicine News
• IEPC Speaker Series

There is still time to fight back and contact Congress about the second regulation released by the Biden Administration on surprise billing. A strong showing of bipartisan concern is critical to bring the Administration’s attention to the overreach and gross misinterpretation of the IDR section of this law and to compel their action to amend it to align with congressional intent.

Your advocacy is working, but we must keep the pressure on.

The letter circulating in Congress by Reps. Tom Suozzi (D-NY), Brad Wenstrup (R-OH), Raul Ruiz (D-CA) and Larry Bucshon (R-IN) is up to 124 signatures, equally supported by Democrats and Republicans in Congress. As stated in our communication to you last week, the letter addressed to HHS Secretary Becerra, Labor Secretary Walsh, and Treasury Secretary Yellen, urge their respective departments to follow the letter of the law and amend the IFR section of the No Surprises Act to align the law’s implementation with the legislation that Congress passed.

If you have not yet emailed your U.S. Representative, there is still time!

The second regulation, which sets forth how the critical independent dispute resolution (IDR) process will be implemented, is completely out of step with the final legislation, the No Surprises Act, that Congress voted on and passed last December. As intentionally designed by Congress, the IDR process was to offer a fair interaction between insurance companies and physicians once patients are out of the middle of billing disputes.

But instead, the new rule undermines the entire IDR process by requiring arbiters to greatly prioritize the artificially low Qualified Payment Amount (QPA), or median in-network rate, set by insurance companies, rather than giving equal weight to a mix of other factors which were prominently emphasized in the legislation (such as complexity of the case, level of training of the physician, etc.). 

This approach is sure to drive payment rates lower and encourage insurance companies to narrow their networks even further, which would make it harder for patients to get emergency care. We now fear the viability of physician practices is at stake, and it will be harder for emergency physicians to care for patients, particularly in small or rural communities. 

Click here to send a message to your U.S. House member. Ask them to sign on to the Suozzi/Wenstrup letter regarding the implementation of the IDR process in the No Surprises Act. 

We must keep the pressure on the Biden Administration to enact the changes necessary to make sure this important legislation is implemented as Congress intended. Let them know that now is not the time to take away resources from emergency physicians who are needed on the front lines in communities across the country.

The letter closes on November 5, so please contact your legislator as soon as possible.