LEGISLATORS IN THE NEWS
An Interview with Representative Mark Green, MD Lisa A. Moreno, MD MS MSCR FAAEM FIFEM — President, AAEM
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elcome to the second installment of our new Common Sense column, designed to help you get to know your legislators, understand the legislative process and how you can influence it, and strengthen the Academy’s relationship with our lawmakers for the purpose of improving the working conditions of physicians and the health care of the nation. This issue, we interview Congressman Dr. Mark Green (R-TN). Rep. Green is an emergency physician and has recently introduced health related legislation pertinent to emergency medicine. His brief bio and text of the legislation follows this article.
Dr. Moreno: As emergency physicians, we see trends in public health and the impact of public policy faster and more frequently than any other specialty. So, it’s natural for us to be involved in public health and public policy. But, you chose to make public policy your primary focus and the primary way in which you serve our patients. How did you make that decision? Rep. Dr. Green: When I was a practicing physician, I ran an emergency medicine management company. We wanted to see the delivery of care improve. I recognized there were serious flaws in the way that government impacted health care and I realized that I could have an impact there. I saw this as an opportunity to better serve both physicians and patients on a larger scale. One of the ways I made an impact was early in my career, while I was still a Tennessee State Senator. I passed a bill that required the insurance companies to get physician input when pre-approval for medical procedures was necessary. I believe that if an insurance company is going to say “no,” then a medical professional must be involved, and it should preferably be an MD. This bill impacted 6.9 million people in the State of Tennessee. That is 6.9 million people who did not have a non-medical administrative person denying their procedure, resulting in delayed care while the patient and the doctor file a request for a review of the denial.
Dr. Moreno: What do you think are the three most critical legislative issues facing emergency medicine today? Rep. Dr. Green: Telemedicine: We used to say in the military that certain elements are combat multipliers. Telemedicine can be a massive combat multiplier for EM. It can streamline the ED processes, and reduce backups. The use of telemedicine can enhance the impact of the physician intervention while decompressing the ED. It eliminates the need for a patient to have transportation to the ED and would certainly decrease the unnecessary use of EMS transport. It is a practical way of giving
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universal access for patients to the most highly skilled member of the ED health care team, the emergency physician, at a much, much lower cost than an ED visit. The physician would then be able to call in a prescription, send an ambulance, or get the patient an appointment with primary care or the appropriate specialist in the appropriate time frame. Rural EM: I am very concerned about critical access hospitals and the possibility that many of them may close. CMS has a 35-mile regulation that says that Medicare will only reimburse if the off-campus clinic is within 35 miles of the main campus hospital. Now, we know as emergency docs that many of our patients across the country live a lot more than 35 miles from a main campus hospital. We know the mantras that “time is muscle” and “time is brain,” and so it is critical that rural patients have access to urgent and emergent care when they have a potentially time critical chief complaint. Every patient deserves access to a physician competent to assess the patient for their chief complaint, start the appropriate intervention, stabilize the patient, and move them to definitive care if this is indicated. If critical access clinics and centers are not reimbursed, they will not be able to afford to stay open, and then all the patients who are served by these institutions could find themselves on a four or five hour ambulance ride to the nearest emergency department. And as we know, patients who are not stabilized prior to transport to definitive care have far worse outcomes. Something else that people fail to realize when discussing rural health is that critical access hospitals and clinics provide jobs in their communities. So, not only are they providing life- and limb-saving medical interventions and keeping doctors and nurses living in rural communities, but they are also providing jobs for housekeepers, pharmacists, pharmacy assistants, radiology technicians, transporters, security officers, clerical staff, and many others. Protecting these patients and these communities is an overlooked area and one that I champion, so much so that I have introduced two bills, the Rural ER Access Act and the Rural Healthcare
“My goal was to empower all health
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care professionals to be able to act with integrity around issues of patient safety and excellence in patient care without fear of retaliation.”
