Brandon Lewis, DO, MDA, FACOEP, FACEP - President-Elect As I read some of the ongoing angst and argument on social media about different EM groups and practice models, I was reminded of a line from one of my favorite movies, Braveheart. In a scene where the Scottish nobles are arguing over which of them should be able to name a king, William Wallace points out to them that “you are so busy squabbling over the scraps from Longshanks (English king) table, that you’ve missed your right to something better”. I can’t help but feel that applies to our specialty right now. While there are certainly things in our specialty that need to be cleaned up, there are so many other forces aligned against Emergency Physicians that we would be much better served aligning our efforts against these negative forces. So, who are the “Longshanks” and allies of our industry? First, I would point to the federal government. Aside from [...]

Jennifer Axelband, DO, FACOEP, President-Elect As I pen my first Pulse communication as President Elect, I must thank the membership, my mentors and the board for all the support and encouragement I have received as I embark into this new role. Leading a college is challenging, communicating with the written word with a goal to strike a sense of importance is humbling. In my attempt to write, a flight of ideas crossed my mind, what does the membership want to read? Do I write about the year ACOEP has had with our accomplishments and goals? Should I write about what my focus and aspirations are? Do I address current events such as healthcare news, legislation, and advocacy? I then realized the deluge of topics in my head was not a flight of ideas, it was writers block. An overwhelming feeling of being stuck in the writing process without the ability to move forward and write anything new. Everything that [...]

Tiffany Brown, DO Chair, DO, FACOEP-D The Physicians Wellness Committee recently sent out a survey to gauge the needs of our great organization. We had 148 survey participants from the college and will use this information to help us address the high level of both physician fatigue and lack of focus on provider wellness. We will do this by offering education, resources, options, and interventions to help providers thrive during their careers. As a committee, we want to create opportunities for wellness and health. Achieving wellness is a multifaceted journey that involves various strategies and practices. Some key actions people often take to attain wellness include regular exercise, eating a balanced diet and paying attention to nutritional value, getting adequate sleep, stress management practices, building social connections, focusing on mental health care, steps toward better self-care, participating in preventative healthcare, maintaining a healthy work life balance, working toward a positive mindset, limiting harmful habits, engaging in continuous learning, increasing [...]

Timothy Cheslock, DO, FACOEP-D As I sit here and write this open letter to the membership, our Scientific Assembly is less than 4 weeks away.  Our flagship CME event of the year is coming soon to Washington DC  from August 11-15, and I look forward to gathering with colleagues and friends for a great event. Our CME planning committee has worked hard to put together an outstanding roster of speakers and our staff has been planning additional activities to make this both educational and fun! Washington DC is host to many opportunities for sightseeing as our nation’s capitol and also institutions such as the Smithsonian Museums making for a great trip not only for education but family fun as well.  As we approach our meeting this year I have been made aware that our current registration numbers are very low. This is surely in part due to the change from our typical October time frame. Unfortunately, due to previously [...]

Jeremy Selley, DO, FACOEP Why are we still talking about congress and physician reimbursement?  If you remember back in 2015 congress finally passed a “fix” called the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) that fixed the Sustainable Growth Rate (SGR) that required 17 yearly fixes from 1998 to 2015 when the MACRA was passed.  This MACRA is what Center for Medicaid Services (CMS) uses to calculate the Physician Fee Schedule (PFS).  MACRA was supposed to streamline multiple quality programs under the new Merit Based Incentive Payment System (MIPS) and give bonus payments for participation in eligible alternative payment models (APMs).  In 2020 the No Surprises Act (NSA) was signed into law that allows for physician/groups to charge for their cost sharing amount.  This is calculated based on the median in-network amount for similar plans and services in that geographic area called the qualified payment amount (QPA). This has been the most recent legal battle you might [...]

Bill Bograkos, MA, DO, FAOAAM, FACOEP, FACOFP, COL MC FS COL (retired) My name is Bill Bograkos, and I am a retired military physician.  I became a member of the ACOEP in 1993, and have spent the last seven years serving as a consultant on Trauma Recovery, Psychiatry Continuity Service, at Walter Reed National Military Medical Center in Bethesda, Maryland.  Prior to that, I cared for Service Members with severe traumatic brain injuries.  My career extends from emergency medicine to rehabilitation medicine. It has been almost 40 years since living and training in New York City.  Thank you to all First Responders and First Receivers for your service.  You certainly are fighting the good fight, and finding the “good trouble”.  Hope you are all keeping the faith in yourselves, and in something greater than yourselves. I survived medical training in New York City, so the military sent me to the “Survival” school at Fairchild, AFB, Spokane, WA, USA.   [...]

Timothy Cheslock, DO, FACOEP As I write this article, the results of the 2023 Match have just been released and the internet is flooded with tweets and comments, opinions of many varieties as to what is happening to our profession. What went wrong? Why so many unmatched slots? Is EM no longer appealing to medical students? I do not profess to have the answers to all these questions and the opinions I express here are truly my own. Where does the future of our profession lie? One of the foremost issues we need to confront head-on is what is our current state? Based on conversations with EM physicians all over the country it’s clear that our state of affairs is not good. Many departments are functioning out of a physical space severely restricted by boarding patients, are chronically understaffed by nursing, and lack the resources to deal with the daily deluge of patients redirected from primary care offices, urgent [...]

Brandon Lewis, DO, MBA, FACOEP, FACEP In the previous decade, the increasing inability for Emergency Medicine groups to come to an agreement on reasonable compensation with payers who continued to ratchet down on physician reimbursement led to an increasing number of patients who found themselves being taken care of by a physician who was not in network with their insurance plan.   This was compounded by some physician groups who, as ‘bad actors’ took advantage of the lack of guidelines to purposely bill patients “out of network” to raise their revenue.  As a result, an increasing number of patients found themselves getting caught by the “surprise coverage gap” as it was referred to by physicians or a “surprise bill” as named by the insurance industry. As the problem continued to grow, all parties involved; physicians, payers, and patients, advocated for the government to step in and help take the patients out of the middle of these disputes.  After much [...]

Timothy Cheslock, DO, FACOEP It is amazing how quickly time passes us by. It seems like just yesterday that we were all together for Scientific Assembly and already we are embarking on a new year! The whirlwind of events surrounding holidays and family gatherings are now in the rearview mirror while the never-ending demands of our departments leave little time to ponder the future and where we are headed. Thankfully your ACOEP board has a plan for this new year, and I wanted to spend a few minutes sharing those plans with the membership. One of the challenges we have faced over the last few years was how to continue to provide high quality service to our members in light of the rising cost of business. Our plan was to transition away from a physical office space and our own staff to an association management model of services. This has helped save the college financially over the last three [...]

Brandon Lewis, DO, MBA, FACOEP, FACEP As we approach the new year, emergency physicians across the country can look forward to huge changes in how we work on a daily basis. The centers for Medicare and Medicaid services have introduced massive changes in how we will get paid for the work that we do. This has huge potential impacts on our practices and the healthcare system across the board. All emergency physicians know that when billing a patient for your care, the level of services is determined by how you have documented the encounter. For example, the number of history elements that are included in your history of present illness (HPI) can determine whether you get paid for a low-level visit or high-level visit. Similarly, for a higher level visit a comprehensive review of systems and a detailed physical exam is required. Unless you meet a set number of systems reviewed and physical exam body parts described, you cannot [...]