PRESIDENT’S REPORT
Brandon Lewis, DO, MBA, FACOEP, FACEP
ALIGNING OUR EFFORTS
A
s 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 the continuing expansion of unpaid obligations like EMTALA and other federal obligations, the federal government continues to ratchet down pay for physicians. In 2022, coming out of the COVID pandemic in which Emergency Physicians were hailed as “front line heroes”, CMS enacted a pay cut of almost 1%. In
4 | THE PULSE FALL 2023/WINTER 2024
2023, physicians experienced a 2% pay cut in the Medicare reimbursement rate. The current proposed 2024 physician fee schedule would cut another 3.34% from our reimbursement. This does not even include a potential 4% cut due to a regulation known as “Pay go” intended to prevent deficit spending. These cuts all come at a time when inflation has been at its highest levels in decades. When compared to inflation, physicians have experienced a 22% decline in pay over the past two decades.
Second, I would point to the insurance companies who have very effectively lobbied to get a set of terrible implementation rules enacted around the No Surprises Act. Empowered by these rules, payers can unilaterally cancel long standing contracts with physicians and then offer a rate 20% or more lower with no recourse. If a physician group refuses, then they are out of network and must accept a “qualified payment amount” which is easily manipulated by insurers and is usually a markedly lower
