ALIGNING OUR EFFORTS

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 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 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 amount. If the physician wants to dispute it, they pay $350 and wait for a dispute resolution process that is severely backlogged (only 9% of all claims filed since the law was enacted have been adjudicated).

Next on the list are the Plaintiff’s attorneys. While some states have enacted medical malpractice reform and the frequency of malpractice claims have decreased, the payout of average claims have gone up significantly. For example, there was a recent case in Georgia where a jury awarded $75 million to a patient in whom a stroke diagnosis was delayed. There are more and more “lottery” type cases which can devastate a physician practice.

While “Braveheart” is fiction and the quote attributed to William Wallace is as well, there is one historical quote from Benjamin Franklin that remains as true today as when he said it at the signing of the Declaration of Independence, “we must all hang together, or we will all hang separately”. If the house of emergency medicine cannot come together to focus on those trying to destroy our practices from the outside, there will be very little for us to squabble over internally!! –•–