2015 Council Meeting
Report of REFERENCE COMMITTEE B
Presented by:
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L. Anthony Cirillo, MD, FACEP, Chair
Mr. Speaker and Councillors:
Reference Committee B gave careful consideration to the several items referred to it and submits the
following report:
(1)
Unanimous Consent Agenda
For adoption:
 AMENDED RESOLUTION 13(15): ACEP and the Pharmaceutical Industry
 RESOLUTION 17(15): Electronic Nicotine Delivery Systems
 AMENDED RESOLUTION 19(15): Graduate Medical Education Funding
 AMENDED RESOLUTION 20(15): Group Purchasing Effects on Patient Care
 AMENDED RESOLUTION 21(15): Healthcare Information Exchanges
 RESOLUTION 23(15): Integrating Emergency Care into the Greater Health Care System
 AMENDED RESOLUTION 26(15): Powdered Alcohol
 AMENDED RESOLUTION 27(15): Reimbursement for Ultrasound Performed by Emergency
Physicians
 AMENDED RESOLUTION 28 (15): Standards for Fair Payment of Emergency Physicians
 AMENDED RESOLUTION 29(15): Support for Drug “Take-Back” Programs
 RESOLUTION 30(15): Use of Body Cameras Worn by Law Enforcement in the Emergency
Department
Not for adoption:
 RESOLUTION 14(15): Body-Worn Cameras for Police
 RESOLUTION 15(15): CARERS Act of 2015
For referral:
 RESOLUTION 18(15): ER is for Emergencies
 RESOLUTION 24(15): Interstate Medical Licensure Compact Legislation and Opposition to
National Medical License
AMENDED RESOLUTION 13(15): ACEP and the Pharmaceutical Industry
RECOMMENDATION:
Mr. Speaker, your Reference Committee recommends that Amended Resolution 13(15) be adopted.
RESOLVED, That ACEP evaluate the expanding role and cost for pharmaceutical drugs pharmaceuticals
affecting the practice of emergency medicine and identify and collaborate, where appropriate, with pharmaceutical
manufacturers and other interested parties interested parties/stakeholders, including pharmaceutical
manufacturers and others to best assure an appropriate, cost-effective, sustainable, access to emergency care
treatments and identify methods to best facilitate dissemination of factual and data driven information about
alternative uses of medications and develop appropriate policies to support this effort and report back to the ACEP
Council on a periodic basis next year.
Reference Committee B
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Testimony
Limited testimony was heard that working strictly with the pharmaceutical industry would not be fruitful, and
ACEP should work with a larger group of stakeholders to advocate for cost-effective access to pharmaceuticals used
in emergency medicine practice.
RESOLUTION 17(15): Electronic Nicotine Delivery Systems
RECOMMENDATION:
Mr. Speaker, your Reference Committee recommends that Resolution 17(15) be adopted.
RESOLVED, That ACEP support legislative and regulatory efforts to control the use of electronic nicotine
delivery systems and regulate the toxicity of vapor(s) produced for primary and second hand exposures; and be it
further
RESOLVED, That ACEP develop recommendations for tobacco and nicotine cessation that avoid the use of
unregulated electronic nicotine delivery systems; and be it further
RESOLVED, That ACEP promote awareness of the risk of primary inhalation injury and direct toxicity from
electronic nicotine delivery systems to ACEP members and the physician community as a whole.
Testimony
Limited but compelling testimony was heard regarding the benefits of encouraging patients to stop using
tobacco products. Testimony was also heard regarding concerns with the use of unregulated electronic nicotine
delivery systems.
AMENDED RESOLUTION 19(15): Graduate Medical Education Funding
RECOMMENDATION:
Mr. Speaker, your Reference Committee recommends that Amended Resolution 19(15) be adopted.
RESOLVED, That ACEP create a policy statement supporting that all funding distributed to institutions for
the purpose of graduate medical education be used solely for that purpose; and be it further
RESOLVED, That ACEP work with the agencies that provide graduate medical education funding to create
measures to ensure that all institutions that receive graduate medical education funding be required to maintain
publicly available records of the distribution and utilization of these funds.
Testimony
Testimony was heard from individuals involved with GME training that the first Resolved could potentially
reduce funds for GME programs that were available from outside sources. Testimony was unanimous on the need for
greater transparency on how the funds are used.
AMENDED RESOLUTION 20(15): Group Purchasing Effects on Patient Care
RECOMMENDATION:
Mr. Speaker, your Reference Committee recommends that Amended Resolution 20(15) be adopted.
Reference Committee B
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RESOLVED, That ACEP develop a policy statement on the effects that group purchasing has on medication
shortages and use of orphan devices in the emergency departments; and be it further
RESOLVED, that ACEP study the effects on patient care from the lack of availability of appropriate
medications and medical equipment due to group purchasing practices, medication shortages, and orphan
product restrictions.
RESOLVED, That ACEP work with stakeholders such as the American Medical Association to develop
model legislation that protects physicians and pharmacists from liability as a result of the inability to provide adequate
equipment optimal care due to lack of appropriate medical devices or pharmaceuticals to diagnose and treat
emergency patients.; and be it further
RESOLVED, That ACEP create a list of “never events” as it relates to orphan devices and drug shortages.
Testimony
Limited testimony was heard supporting the need for legislation, but there was consensus that emergency
physicians should not be held legally accountable when appropriate pharmaceuticals and equipment are not available
to them in the ED. Testimony was also given that creation of a list of “never events” could be problematic for
physicians.
AMENDED RESOLUTION 21(15): Healthcare Information Exchanges
RECOMMENDATION:
Mr. Speaker, your Reference Committee recommends that Amended Resolution 21(15) be adopted.
RESOLVED, That ACEP create a recommended standard minimum amount of information to be contained in
the Healthcare Information Exchanges; and be it further
RESOLVED, That ACEP promote the standardized requirements to the Healthcare Information Exchanges
currently in the process of development.
Testimony
It was noted that as users of HIE, ACEP members have a vested interest in HIEs at the national and local
level. In emergency medicine, it is critical to have health information that crosses healthcare delivery settings in realtime fashion. There was overall support but concern over the minimum data set, when additional information may be
necessary at the point of care but unavailable. It was also noted the ability of HIEs to push notifications to emergency
physicians within their own EHR at the point of care was essential to avoid the distraction of logging onto a separate
HIE system.
RESOLUTION 23(15): Integrating Emergency Care into the Greater Health Care System
RECOMMENDATION:
Mr. Speaker, your Reference Committee recommends that Resolution 23(15) be adopted.
RESOLVED, That ACEP pursue reimbursement strategies to promote care coordination in the Emergency
Department; and be it further
RESOLVED, That ACEP promote reimbursement strategies to incentivize ED’s to perform intensive case
management to optimize ED utilization for high utilizers; and be it further
Reference Committee B
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RESOLVED, That ACEP promote effective ED information sharing systems across health systems to
facilitate care coordination and effective resource utilization.
Testimony
Unanimous testimony was heard regarding the need for emergency physicians to have incentives built into
current and evolving payment systems to recognize the work they perform in coordinating care and providing support
for care transitions for many of their patients. The committee heard testimony that the college is actively working on
this issue.
AMENDED RESOLUTION 26(15): Powdered Alcohol
RECOMMENDATION:
Mr. Speaker, your Reference Committee recommends that Amended Resolution 26(15) be adopted.
RESOLVED, That ACEP supports banning the production, sale, distribution or possession of powdered
alcohol for personal consumption use; and be it further
RESOLVED, That ACEP request that the FDA ban powdered alcohol; and be it further
RESOLVED, That ACEP request the Alcohol and Tobacco Tax Trade Bureau (TTB) to reverse its decision
on Palcohol; and be it further
RESOLVED, That ACEP endorse and support S.728/H.R. 1717, which would ban the production, sale,
distribution or possessions of powdered alcohol; and be it further
RESOLVED, That ACEP support legislation to ban the production, sale, distribution, or possession of
powdered alcohol on a state level for personal consumption use.
Testimony
Overwhelming testimony was heard in support of the resolution to ban powdered alcohol for personal
consumption. The resolution was amended to remove the reference to the specific bill because the other provisions of
the bill and status of the bill at the present time are unknown. However, the spirit of the resolution that ACEP support
legislation that bans the production, sale, distribution or possession of powdered alcohol is preserved.
AMENDED RESOLUTION 27(15): Reimbursement for Ultrasound Performed by Emergency
Physicians
RECOMMENDATION:
Mr. Speaker, your Reference Committee recommends that Amended Resolution 27(15) be adopted.
RESOLVED, That ACEP issue develop a statement declaring that insurance companies and other payers
reimburse emergency physicians for ultrasound studies and services that they perform and interpret as part of
separate and identifiable procedures while providing patient care services in the Emergency Department; and be it
further
RESOLVED, That ACEP support efforts to reduce payment denials for appropriately performed and
documented clinical ultrasonography.
Reference Committee B
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Testimony
Unanimous testimony was heard in opposition to bundling payment into evaluation and management codes
and in support of this resolution.
AMENDED RESOLUTION 28(15): Standards for Fair Payment of Emergency Physicians
RECOMMENDATION:
Mr. Speaker, your Reference Committee recommends that Amended Resolution 28(15) be adopted.
RESOLVED, That ACEP develop a set of standards for fair payment for Emergency Physician services, and
compliance with which to be included in the next edition of America's Emergency Environment, A State by State
Report Card;” and be it further
RESOLVED, That ACEP devote increased resources to monitor the state-by-state status and changes in law
concerning the standards for fair payment of Emergency Physicians and establish a single point of contact at the
national level as a resource for assisting all chapters; and be it further
RESOLVED, That ACEP shall work with other medical specialties, ambulatory services, and hospitals to
develop Model Fair Payment Legislation and then devote resources to promoting adoption in every state; and be it
further
RESOLVED, That ACEP shall use its influence with the National Emergency Medicine Political Action
Committee to devote resources to developing state-by-state influence upon each state’s legislative and regulatory
process; and be it further
RESOLVED, That ACEP work with the Emergency Medicine Foundation to research, publish, and
disseminate the detrimental effects of legislation that limits the rights of emergency physicians to fairly bill and
collect, and to develop effective educational materials explaining the facts concerning emergency physician billing
and collection, for use at the national and local level in educating legislators, regulators, policy-makers, and the
public; and be it further
RESOLVED, That ACEP and the Emergency Medicine Action Fund develop and support explore the
development of a national “strike team” that can be deployed by ACEP leadership to help chapters in states where
emergency physicians are facing an immediate legislative threat to the fair payment process.
Testimony
Testimony reflected concerns with the growing trend by commercial payers to greatly reduce payment to
emergency physicians, particularly those out of network. They also described increasingly aggressive efforts by the
insurance industry working with state legislatures to ban balance billing for emergency physicians and expressed an
urgency that ACEP increase resources to fight these trends.
AMENDED RESOLUTION 29(15): Support for Drug “Take-Back” Programs
RECOMMENDATION:
Mr. Speaker, your Reference Committee recommends that Amended Resolution 29(15) be adopted.
RESOLVED, That ACEP supports the requirement that pharmaceutical companies coordinate with hospitals
to pay for appropriate hospital-located development of drug “take-back” programs at no cost to patients; and be it
further
Reference Committee B
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RESOLVED, That ACEP endorses and supports local ordinances, state, and national laws that require drug
“take-back” programs; and further be it
RESOLVED, That the AMA Section Council on Emergency Medicine submit consider submitting a
resolution to the American Medical Association to support drug “take-back” programs.
Testimony
Testimony strongly supported drug take-back programs, and some mentioned successful programs in their
states that were administered by a variety of entities. There were concerns expressed about imposing requirements on
the industry through support of legislation at local, state, and national levels.
RESOLUTION 30(15): Use of Body Cameras Worn by Law Enforcement in the Emergency
Department
RECOMMENDATION:
Mr. Speaker, your Reference Committee recommends that Resolution 30(15) be adopted.
RESOLVED, That ACEP modify and extend its current policy statement “Recording Devices in the
Emergency Department” to promote and endorse the expectation of patient privacy and limitations on recording
devices by law enforcement personnel, visitors, and other individuals or organizations, during the provision of
healthcare to patients in the emergency department; and be it further
RESOLVED, That ACEP promote a position that institutions and physicians should restrict the use of
recording devices during patient care and in areas in which discussions containing confidential, HIPAA-protected
patient information are likely to occur within the Emergency Department.
Testimony
Testimony was heard in support of the importance of protecting patient privacy with current restrictions, but
some noted that in circumstances of dangerous patients or events in the ED, video is important to protect staff. It was
noted that ACEP’s Ethics Committee is currently addressing the issue of body cameras in the ED.
RESOLUTION 14(15): Body-Worn Cameras for Police
RECOMMENDATION:
Mr. Speaker, your Reference Committee recommends that Resolution 14(15) not be adopted.
RESOLVED, That ACEP believes that all armed police officers be equipped with and required to use bodyworn cameras; and be it further
RESOLVED, That ACEP endorse and support local ordinances and state laws that require police officers to
wear body-worn cameras.
Testimony
Most testimony was in opposition to ACEP taking a formal position on this issue, as it would not be
appropriate for the College to make recommendations about requirements for other professions.
Reference Committee B
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RESOLUTION 15(15): CARERS Act of 2015
RECOMMENDATION:
Mr. Speaker, your Reference Committee recommends that Resolution 15(15) not be adopted.
RESOLVED, That ACEP endorse and support the CARERS Act of 2015; and be it further
RESOLVED, That the AMA Section Council on Emergency Medicine submit a resolution to the AMA to
endorse and support the CARERS Act of 2015.
Testimony
The majority of the testimony expressed concerns with several issues contained in the resolution and the
underlying legislation. It was also noted that this Senate bill could be changed or amended, and ACEP should not
provide support at this time.
RESOLUTION 18(15): ER is for Emergencies
RECOMMENDATION:
Mr. Speaker, your Reference Committee recommends that Resolution 18(15) be referred to the ACEP Board
of Directors.
RESOLVED, That ACEP work with the American Medical Association and other interested parties to study
the possibility of expanding the “ER is for Emergencies” program to a national scale.
Testimony
Authors of the resolution spoke about the great strides in care coordination that have been achieved through
Washington State’s 7 Best Practices. They noted that they had been contacted by the Washington State Medical
Society about implementing the best practices on a national level, but the authors wanted to bring the opportunity to
the ACEP Council first. While there was widespread support for the concept of the 7 Best Practices, there was equally
widespread distaste for the name “ER is for Emergencies.” Several noted that the perceptions and messaging around
the 7 best practices must be consistent with ACEP’s support for the prudent layperson standard in all instances.
Supportive testimony also cautioned that all 7 best practices may not be best for all states, and asked that ACEP
consider piloting some or all of the best practices in additional states before rolling out all practices nationwide.
ACEP Board members stated that the Board is working to address several issues highlighted by the 7 best practices
and encouraged referral of this resolution to the Board.
RESOLUTION 24(15): Interstate Medical Licensure Compact Legislation and Opposition to National
Medical License
RECOMMENDATION:
Mr. Speaker, your Reference Committee recommends that Resolution 24(15) be referred to the ACEP Board
of Directors.
RESOLVED, That ACEP evaluate the proposed state legislative language, often referred to as the “Interstate
Medical Licensure Compact,” allowing reciprocity by state physician licensing boards for board certified physicians,
for its potential effect on emergency physicians’ practice and the potential for unintended consequences.
Reference Committee B
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Testimony
Members of the ACEP Board stated that the State Legislative Regulatory Committee has an objective to
address this issue. Additional testimony was heard both in favor of as well as opposed to the resolution. Most
testimony heard was in favor of reciprocity between states. There was consensus that interstate medical licensure is a
complex issue and that it should be referred to the Board.
End of Consent Agenda
(2)
RESOLUTION 16(15): Decriminalization and Legalization of Marijuana
RECOMMENDATION:
Mr. Speaker, your Reference Committee recommends that Resolution 16 (15) not be adopted.
RESOLVED, That ACEP believes that the federal and state governments should decriminalize the possession
of small amounts of marijuana for personal use for people aged 21 and older; and be it further
RESOLVED, That ACEP believes that state and the federal government should legalize, regulate, and tax
marijuana for adult use.
Testimony
There was mixed testimony with significant support for decriminalization, but strong consensus opposed to
actual legalization. Those from states where marijuana has been legalized noted the ill effects of the impact of
legalization. Testimony also noted that many states already have decriminalization efforts underway, and that it is not
an appropriate issue for ACEP’s involvement. Overall consensus was against adoption of the resolution.
(3)
AMENDED RESOLUTION 22(15): Increasing Use of Advance Directives by Designation on Drivers
Licenses and Use of Registry
RECOMMENDATION:
Mr. Speaker, your Reference Committee recommends that Amended Resolution 22(15) be adopted.
RESOLVED, That ACEP support efforts to encourage adults of all ages and states of health to talk with
family, friends, spiritual advisors, health professionals, and physicians about advance directives and to record and
keep these wishes updated. these wishes on an online advance directive registry; and be it further
RESOLVED, That ACEP support the creation and distribution of educational materials on advance directives
to distribute at states’ Department of Motor Vehicle offices, tested on license application examinations, and mailed or
electronically distributed to individuals obtaining and renewing drivers licenses; and be it further
RESOLVED, That ACEP advocate that individuals over 18 applying for or renewing a driver license or
identification card be given the option to indicate whether they have an advance directive; and be it further
RESOLVED, That ACEP advocate for states’ Department of Motor Vehicles to create an advance directive
icon to be available for placement on the front of the license for individuals who declare that they have an advance
directive during license registration or renewal; and be it further
RESOLVED, That ACEP supports legislation for and innovations to further integrate advance directive
information with state driver license and identification cards in efforts to promote greater accessibility, usability, and
Reference Committee B
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awareness of advance directives.
Testimony
Although there was a consensus of testimony in support of expanding the focus on advanced directives and
their utility in the emergency department, there was equal concern opposed to the DMV setting as that mechanism for
advanced directives may be premature and is not the appropriate venue to have these conversations. It was also noted
that many of the oldest Americans do not currently drive and therefore those that have greatest need for advanced
directives might also be missed using a drivers’ license methodology. Given that the majority of support in favor of
promoting the use of advanced directives, and the preponderance of testimony against the driver’s license
methodology, the reference committee compromised with the amended resolution.
(4)
RESOLUTION 25(15): Medicare 3-Day Rule
RECOMMENDATION:
Mr. Speaker, your Reference Committee recommends that Resolution 25 not be adopted.
RESOLVED, That ACEP create a white paper elucidating the barriers this rule creates to appropriate care, the
costs it creates for the system, and the costs it transfers to the patients; and be it further
RESOLVED, That ACEP partner with the American Medical Association and other healthcare organizations
to author a white paper and work together to eliminate the Medicare 3-Day Rule; and be it further
RESOLVED, That ACEP make elimination of the Medicare 3-Day Rule a top legislative priority for the
coming year.
Testimony
Although many recognized the importance of the issue, testimony was heard about ACEP’s longstanding
efforts, including in conjunction with the Emergency Medicine Action Fund and other stakeholders, to address this
issue with the Centers for Medicare and Medicaid Services. CMS has emphasized that they already offer a number of
three day stay waivers through alternative payment models such as Medicare Advantage and accountable care
organizations. CMS has told ACEP that any additional waivers would only be offered under alternative payment
models and that the Innovation Center was not likely to give further consideration to waivers under the fee-for-service
system. It was recommended that ACEP continue its advocacy efforts to address the 3-Day stay issue as outlined in
the background information.
Mr. Speaker, this concludes the report of Reference Committee B. I would like to thank Gregory Cannon,
MD, FACEP; Alison Haddock, MD, FACEP; Kristin McCabe-Kline, MD; Mildred Willy, MD, FACEP; Anne Zink,
MD, FACEP; Stacie Jones, MPH; and Barbara Tomar, MHA, for their excellent work in developing these
recommendations.