Jeffrey M. Goodloe, MD, FACEP
Much to the dismay of many loyal OCEP newsletter readers, make that a few loyal OCEP newsletter readers….okay….so my mother may miss me writing these OCEP President Messages. Actually, I’m pretty sure my mother is very confused about what I’ve done since leaving medical school. And by leaving, I mean graduating, Bo Burns! So there. My mother makes some association with me and ambulances….and that’s about it. Close enough, mom. Now, what was my point? Oh yes….
My primary point is I’m thrilled to help announce that Chad Phillips, MD, FACEP is our new OCEP President as of November 1st! Chad has penned a self-introductory message that you’ll have hopefully read by now. For those of you lucky enough to work with Chad and/or know Chad, you’ll already know what I’m sharing in the next paragraph.
Dr. Phillips is an outstanding emergency physician, both in clinical care and in ED leadership. I had the good fortune to work alongside him at St. John Medical Center in Tulsa from mid-2009 to mid-2011. I always felt encouraged when I saw his name on the schedule next to mine. It doesn’t take long in EM to know the importance of that feeling. He’s a true patient advocate, hard-working partner, and a great role model. OCEP is in outstanding presidential hands as we move onward in representing your interests – in the present and for the future.
I want to spend most of this space highlighting others and covering important to you OCEP work – work accomplished and work planned into 2020. Before I do, please accept my heartfelt appreciation for the honor of serving these last few years as your OCEP President. Honestly, there’s been so much our OCEP Boards of Directors over these same years have worked to accomplish, I can’t remember the exact month I started, in part because we’ve moved OCEP officer terms to start nearer the annual ACEP Council meeting. It’s been a blur and as I look back I’m both humbled by and proud of the opportunity you gave me to represent you across Oklahoma and beyond.
OCEP leaders diligently worked to more accurately and more timely track legislation that impacts emergency medicine, our members, and our patients. We’ve been representing you annually in DC in the springs as part of ACEP’s Leadership and Advocacy Conferences (LAC), speaking directly with Oklahoma’s Senators and Representatives and their respective health legislative aides. I’m proud that we’ve made OCEP more recognized as an important, informed voice in medicine among our Oklahoma delegation in the US Congress. We’ll continue these accomplishments with Dr. Phillips at the helm. I personally and sincerely encourage you to support ACEP’s NEMPAC. Talk is cheap, so I’ll share my walk. I’ve given at NEMPAC’s “Give A Shift” level ($1000+) for a decade now (and lesser amounts prior to that – every bit does count in advocacy) and promise to continue my personal contributions. Please continue your contributions or join us if you haven’t. It’s simply reality that money creates access to share our message, influencing congressional decisions and who the decision makers are in DC. NEMPAC is neutral to political parties, making decisions about political donations based on the issues and key decision makers important to the practice of emergency medicine. To learn more, visit https://www.acep.org/get-involved/facts-about-nempac/ to get basic facts about NEMPAC and to access the NEMPAC site through your ACEP member online login.
OCEP leaders also worked with significant energies to elevate our presence at the Oklahoma State Capitol. For the first time, we mobilized multiple members to testify at House of Representative committee hearings, had OCEP officers serving as “Doctor of the Day” this past session (as detailed in prior newsletter columns), and formed working relationships with multiple members of the Oklahoma legislature. We could not have realized the success in making OCEP known at 23rd & Lincoln in OKC without Jim Kennedye, OCEP Vice President throughout my time as President. Jim was the consummate VP, always ready and willing to represent us. Dr. Kennedye is focusing on family and ED life in the immediate time, though fortunately remaining on your OCEP BOD. I hope you will take a moment to personally thank him for all he has done to date for emergency medicine, for us, and for our patients in Oklahoma when you see him in/near the OU hospitals in OKC and Edmond.
With the enthusiastic support of our OCEP BOD, Jim and I worked over the past four years to make your dues more tangible in social events, both nationally at the annual ACEP conventions (Las Vegas, Washington DC, San Diego, and most recently Denver – see photos below) and within OKC and Tulsa. We will continue these networking forums of fun and fellowship, optimized with new ideas from Dr. Phillips and new BOD members. Stay tuned for 2020 details!
As we look ahead, it’s always important to recognize the past leaders that made our present and future more positive. We initiated a long overdue recognition program for past OCEP Presidents that remain active within OCEP. The OCEP “Buffalo” is a gesture of gratitude to these leaders and we bestowed the following award statues at our 2019 OCEP Business & Membership Meeting in Tulsa in early October:
Craig Sanford, MD, FACEP (see picture below) – OCEP President 1994-1996
Magnum Health Care (affiliated with multiple St. John facilities in metro Tulsa)
Jeffrey D. Dixon, MD, FACEP – OCEP President 2005-2007
Green Country Emergency Physicians (locations throughout NE OK, SE KS, SW MO, NW AR)
Dana H. Larson, MD, FACEP – OCEP President 2007-2009
USACS at Saint Francis Hospital South in Tulsa
Carolyn K. Synovitz, MD, MPH, FACEP – OCEP President 2013-2016
Jackson County Memorial Hospital in Altus
We additionally made a special recognition OCEP “Buffalo” for our perpetual Secretary/Treasurer Timothy Hill, MD, FACEP. We thought about engraving his term as “Since Dirt & For Life” but the extra wording would have cost more and Tim would be the first to nix that!
Now, in the category of people often remember what is said last… reimbursement for your work in the future. We are working very closely with national ACEP and our sisters and brothers in the Texas College of Emergency Physicians. The Oklahoma Insurance Department (OID) has already announced to key stakeholders, and fortunately they include OCEP (and you!) as a key stakeholder, that they will promote Texas Senate Bill 1264 from the 2019 legislative session as the starting point for legislation they favor for Oklahomans to be passed in the 2020 Sooner State’s legislative session. I have worked with Dr. Theresa Tran, an outstanding and gifted emergency physician from Houston that heads up TCEP’s Legislative Committee. Dr. Tran was a key leader in marshalling the Texas legislation to a point far more favorable for emergency physicians at its passage than at its initiation. We are taking all of the TCEP victories and including them in our messaging to the OID, further assisted by national ACEP staff in Irving, TX.
It’s rare that I’d add this length to your reading, but this is your livelihood for the remainder of your career at stake. Here’s one site to access the version of Texas SB1264 signed by Governor Greg Abbott and effective since September 1st: https://legiscan.com/TX/bill/SB1264/2019
I’ll end this column by sharing the text of the letter we recently sent on your behalf to OID that best explains the issues and our talking points at present:
September 19, 2019
Mr. Buddy Combs, Deputy Commissioner of Licensing Services Policy Counsel Oklahoma Insurance Department
Five Corporate Plaza, 3625 NW 56th, Suite 100 Oklahoma City, OK 73112
RE: Balance billing and out of network reimbursement
Dear Mr. Combs:
On behalf of the Oklahoma College of Emergency Physicians, I appreciate the opportunity to provide comment on the above referenced issue. Emergency physicians across our state provide diagnostic services and stabilizing medical treatment to Oklahoma citizens 24 hours per day, 365 days per year, regardless of ability to pay. As such, we provide the most essential rung of Oklahoma’s health care safety net.
Because we treat patients at the time of their greatest medical vulnerability, we share your concern that financial fears do not cause a person experiencing a prudent layperson perceived medical emergency to delay receiving care. As such, we join with you in an interest in addressing this issue on behalf of patients while also protecting the solvency of this essential element of our health care system. In addition, while we understand that Congress is presently also dealing with this issue, we also appreciate that the state has a responsibility under the McCarran Ferguson Act to provide adequate insurance regulation on behalf of its citizens.
We understand from correspondence received from you that consideration is being given to Oklahoma adapting legislation passed earlier this year in Texas, Senate Bill 1264, addressing balance billing and out of network reimbursement. Notably, the Texas legislation resulted from an extensive vetting process that included negotiations among that state’s legislators, medical organizations, health plans, consumer groups, and other stakeholders. Because SB 1264 thus resulted from negotiation and compromise, it would not be regarded by any of the groups that worked on it as ideal, and undoubtedly our own legislature will have opportunities to improve upon it. We would agree with you that the Texas legislation provides a good starting point for creating Oklahoma legislation that will protect our patients from balance bills.
The strengths of the Texas legislation can be found in its provisions that provide for appropriate disclosures of information to patients while protecting them from balance bills, thus removing them from the middle of the process. The legislation seeks to create incentives for appropriate billing and reimbursement while avoiding rate setting or price fixing. In particular, the legislative decisions to support a baseball style arbitration system with transparent criteria for consideration by the arbitrator create a system that should be efficient, appropriately predictable for the parties involved, and likely to result in reasonable outcomes that protect the viability of emergency care. This arbitration system has proven its success to all parties involved in New York, involving less than 1% of patient visit billings, simultaneously enabling cost conservation for insurers and healthcare practitioners. It’s the responsible method of resolving disagreements of remuneration for out of network billing.
As a result of these provisions, we are supportive of the primary approaches taken in the legislation. We believe that in some of the details the legislation can be improved when applied to Oklahoma. We believe that some protections are needed to ensure that payments and processes are managed efficiently so as not to endanger the viability of small group physician practices in the state. These small group physician practices disproportionately serve rural and frontier areas of Oklahoma, particularly vulnerable populations in acute, unscheduled health care emergencies. Certainly, a goal of the legislation should be to remove patients from the middle of the process without creating cumbersome bureaucracies when resolving disputes. As such we would suggest the following:
- Language regarding interim payments made by third party payers should be strengthened. Health plans should be discouraged from offering unreasonably low reimbursement amounts in anticipation of improving offers if arbitration should result. Long delays in insurance payments to small groups, particularly those providing services in hospitals serving areas of large populations of uninsured and underinsured patients, could be devastating to those groups. It is important that initial payments prior to arbitration be timely and reasonable.
- Careful attention should be given to whether arbitration timeframes can be shortened. Again, the purpose of this would be to make a fair system also efficient.
- Language that requires the loser of the dispute to pay costs would create an incentive to pay or bill fairly and avoid disputes.
- The arbitration maximum language in the Texas legislation is arbitrary and unnecessary. Permitting the bundling of similar claims involving identical parties would make the system more efficient.
While we continue to work through other details of the Texas model, we would identify these as primary areas of improvement. Again, we appreciate your leadership on this issue and look forward to working with you on behalf of both our members and our patients.
If I can answer any questions, please don’t hesitate to contact via email or phone.
Jeffrey M. Goodloe, MD, FACEP, FAEMS