Introduction to Advocacy

							Introduction to Advocacy
Emergency Medicine Residents Association
Advocacy Week 2011

Created by Alison Haddock, EMRA Legislative Advisor
Objectives
             • Defining Advocacy

             • Healthcare Crises

             • Health Care Reform

             • Getting Involved
Advocacy
    =
 Politics
Advocacy

                   noun.

   the act of supporting an idea or cause.
US!
Advocacy = Every Day
•   Negotiating with consultants
•   Aligning resources for our patients
•   Patient education
•   Public health efforts
•   Hospital boards and medical staff meetings
•   Solutions for crowding and boarding
•   State Laws
•   Federal Laws
•   Reimbursement
•   Regulatory Issues
Advocacy

   Physician’s public role: advocacy for and
   participation in improving the aspects of
communities that affect the health of individuals.



      Gruen RL, Pearson SD, Brennan TA. Physician-Citizens – Public Roles and Professional Obligations.
                                                                             JAMA. 291: 94-98. 2004.
We are the safety net.

• Average physician = $12,300 in bad debt

• Emergency physicians =
       $138,300
How much does the US spend on
health care each year?
$2.5 trillion
From 2000 OECD data
Basis for Health Care Reform
• Solutions to our crises
  ▫ Coverage
  ▫ Cost
  ▫ Quality

• Popular support for concept of reform
Patient Protection and Affordable Care
Act (ACA): The Past
• Kids on parents’ policies until 26yo
• No preexisting conditions for kids
• State-based high-risk pools
• Small business tax-credits
• Covering the Medicare “donut hole”
• No lifetime benefit limits or recissions
• Expanded quality reporting
Patient Protection and Affordable Care Act
(ACA): The Future

• “Individual Mandate” in 2014
• Preexisting conditions eliminated for all

• 2019 Projections
  ▫ Cover 60% of the uninsured
  ▫ Cost ~4% of health expenditures
  ▫ Cut the deficit by <1%
From “What Will Happen Under Health Reform— and What’s Next?” by the Commonwealth
Fund, published in May/June 2010 Columbia Journalism Review.
Patient Protection and Affordable Care
Act (ACA): The Future
• State insurance exchanges
  ▫ For individuals and small businesses
  ▫ Premium subsidies
  ▫ Regulated benefits
• Cost offsets
  ▫ Cutting Medicare Advantage
  ▫ Decreased Medicare provider payments
  ▫ Taxes (tanning salons, high-income Medicare
    beneficiaries, penalties)
Emergency Medicine and the ACA

• Essential Health Benefits Package

• Prudent Layperson

• EM Research

• Regionalization
(Un)Sustainable Growth Rate
                 • Medicare’s flawed
                   formula for physician
                   reimbursement

-29.5%           • Patched 5 times in 2010

                 • Now stable until…
                     January 1st, 2012
SGR Solutions?
• Too expensive to fix!

• More than $369.8 billion
And there’s more!
• Access to care
• Overcrowding and boarding
• Workforce shortages
• On-call coverage
• Accountable Care Organizations (ACOs)
• The IPAB
Get Involved!
                   EMRA
• 36 years representing
  residents
  ▫ 9,000+ members
  ▫ 33% of ACEP

• Health Policy Committee

• EMRA-ACEP Health Policy
  Mini-Fellowship
ACEP
       • 9-1-1 Legislative Network
       • Leadership and Advocacy
         Conference
       • Ongoing advocacy efforts
         from the Washington DC
         Office
       • ACEP Committees
         ▫ Federal Governmental
           Affairs
         ▫ State Legislative and
           Regulatory
         ▫ Medical-Legal
NEMPAC   • 2 year election cycle
           fundraising

         • Raised $1,090,166 in 2010

         Physician PAC Rankings:
           Orthopedics (2.6M)
           Anesthesia (2.3M)
           **AMA (2.0M)
           Radiologists (1.8M)
           Emergency Medicine (1.5M)

         • Give-A-Shift!
Get involved!
Give a lecture or journal club on advocacy

                Donate some of your time or $$


                                  Speak out!
Take-Home Points
• Advocacy is a core competency…
 ▫ Bring it home to your fellow residents!

• The healthcare reform process
     has only just begun…

• And we need YOU to reach
    our goals!!!
Thank you!