President’s Message – May 2020

Tim Johnson, MD, FACEP

Dear Minnesota ACEP Members,

I usually like to be a little light and glib, but the coronavirus pandemic has left me a little short on both. It is truly the last thing I want to talk about, but it eclipses everything else I read or think or see or do. On the day I write this, Minnesota has had 614 deaths due to COVID-19.

There are 496 patients hospitalized with the disease today, and there have been 12,494 cases in our state, 1436 of them are healthcare workers. Some of our emergency departments are stabilizing many critically ill patients every day while a handful of others may not be certain that they have seen a verified coronavirus case yet. All emergency departments have drastically lower volumes and many of us are taking furloughs or cuts in pay. Governor Walz’s lockdown is slated to expire within the next week, but while it is likely to be a gradual and staged re-opening it will inevitably lead to an increase in cases, how many more we have yet to know. My prayer is that you and your loved ones are safe. 

Minnesota ACEP’s mission is to help its members preserve health and save lives in Minnesota by promoting the highest quality of emergency care. The value it strives to add to your professional life is through the three pillars of education, advocacy, and reimbursement. Here is a brief report on those three areas:

Education. We have cancelled our Education Summit that was scheduled for October 5th. The decision was difficult, but the odds of each of us having achieved immunity from disease recovery or having completed a vaccine regimen within 5 months is essentially zero, given that lasting immunity is hypothetical, and the vaccine is non-existent.  Bringing us all together from across the state without immunity is foolish. We briefly considered a webinar but there are plenty of those out there already. Odds are pretty great for autumn 2021 so be on the lookout for a save-the-date announcement.

Advocacy. The ACEP Leadership and Advocacy conference in Washington DC was cancelled due to the coronavirus. In its place, a virtual day on Capitol Hill took place on April 28th. Drs. Amy Cho, Tracy Marko, Bruce Parker, and myself held conference calls with the legislative assistants of Amy Klobuchar, Tina Smith, Ilhan Omar, and Dean Phillips. We spoke directly with Angie Craig. We discussed PPE and the need to fully utilize the national stockpile and the Defense Production Act. We let them know that there are nefarious attempts to slip median in-network rate clauses to “solve surprise billing” into big multiheaded COVID-19 relief bills and we asked that we not be kicked in the teeth while we are risking life and health; this needs to be addressed fairly, separately, and in the light of day. We asked that our patients be put first and asked for further legislation to expand on the CARES Act intention that patients with either government or commercial insurance be held harmless for cost-sharing for emergency department care for chief complaints that could ostensibly be due to COVID-19. We let them know that patients are scared to go to the emergency department, that volumes are down, and that we are seeing heartbreaking cases of disability and death from deferred care. We asked for a federal guarantee of increased malpractice immunity during the public health emergency. We believe that this is a global problem and that a federal solution is warranted. So far, the federal government has left this up to the states and 14 states have done this through their executive branches. Governor Walz is aware of the issue but I believe he feels the acuity of the situation here is not high enough to justify the executive order yet. A bill has been introduced through the Minnesota legislature for this as well (see Buck McAlpin’s piece in this newsletter): the odds of passage this session is 50% at best.

Advocacy is not just talking to government; it is also sharing our stories with the media. Two nice pieces about the emergency department response to COVID-19 have featured emergency physicians at Hennepin Health and Regions Hospital. There are others; all are grateful for your selfless work. My experience with the media has been, ahem, educational. I was contacted for a couple of hair-on-fire stories wherein the conclusions were already set; they already had the facts they wanted. There was less desire to enlighten the public than to garner eyeballs and clicks. Some of what I was asked to repeat as their talking head may have been true, but it would have also potentially caused some unintended behaviors (hoarding) and emotions (high anxiety). I demurred and suggested a more positive, responsible, and actionable message, but it was not what they were looking for. So now my phone is silent. My advice: as an emergency physician you have an amazing story to tell and you have the power to be heard, just fully think through all the possible ramifications of what you post, write, or say. Be positive, be right, heal always.

Reimbursement. Volumes are down 20-60% across all emergency departments and urgent care centers in Minnesota. Many of us are feeling financial pain, though many of our patients have it much worse. Hopefully, the return of non-emergency procedures to our hospitals next week will improve this situation. Over a week ago I signed on to a letter to the governor along with the Minnesota Medical Association and essentially every other medical specialty society urging him to lift the ban on non-emergency surgery and cancer treatment when it looked like this was not going to be addressed in the most recent extension of the lockdown order. The letter contained the caveat that sufficient PPE be available which has been a concern of nursing and congregate living care staff.   The CARES Act states that COVID-19 testing would be fully covered for all insured patients with provisions to cover the uninsured as well.  There is supposed to be waiver of cost-sharing associated with the medical visit associated with the test as well (a godsend to us and our patients), but there has been some backtracking on this, particularly with commercial insurers.  Benchmarked fixes to balance billing (I hate “surprise” billing when it’s really “surprise” coverage) are lurking in the shadows but are at bay for now. The shift toward telehealth has been accelerated by the pandemic, time will tell if many of the lower acuity visits amenable to telehealth ever come back to us.

Stay safe. Stay positive. Exercise more. Forgive yourself even if you have put on your quarantine 15 while you watched all the episodes of Tiger King. Make sure your bucket is full enough of good things. You will get through this and you will have even more amazing stories than you had before.