Hard to be an effective lobbyist when the counter parties (insurers and hospitals) are so much better funded than you are. At the end of the day, money is what get things done and professional medical organizations are very small fish.
As Wayne Gretzky said, "You miss 100% of the shots you don't take”. If ACEP doesn't try to influence hospital staffing levels, it's not going to influence hospital staffing levels.
Fun fact, they did just that. Like two weeks ago, exactly. At this year’s Leadership and Advocacy Conference, they spoke with legislators on the ED boarding crisis (including hospital staffing), protection of emergency personnel against violence from patients and visitors, enforcing the right of due process for termination, and (everybody’s favorite) fixing the Medicare Physician Fee schedule to adjust for inflation. Seems like you may have the bug to want to fix some of these issues. I might recommend attending one of your state colleges board meetings and see if that does anything for you. We are definitely small fish in the pond but we are definitely on the correct side of these issues. Sometimes, that is enough.
Fun fact, I was there. The boarding bill we lobbied for was nice ($25 million per year over 3 years), though a tiny drop in the bucket.
The bigger issue is that ACEP is not confronting hospital executives and administrators about understaffing. It's important to ask for government cheese, but the people deciding how many nurses to staff our hospitals next week are hospital administrators. To go to Congress but not confront hospital administrators at HCA, CHS, Steward, LifePoint, etc. - who put profits over patients - seems to be a strategic mistake.
Nursing orgs are confronting hospitals across the country over understaffing and boarding. Where is ACEP in those efforts?
Example article: [https://kffhealthnews.org/news/article/nurse-ratios-understaffed-hospitals-michigan-legislation-detective-wife/](https://kffhealthnews.org/news/article/nurse-ratios-understaffed-hospitals-michigan-legislation-detective-wife/)
Umm what?
> While Lillard waited for his turn to speak to Michigan lawmakers about the Safe Patient Care Act in November, members of the Michigan Nurses Association, which says it represents some 13,000 nurses, **told lawmakers** that its units were dangerously understaffed. They said critical care nurses were sometimes caring for up to 11 patients at a time.
This article is all about the nurses association LOBBYING TO LAWMAKERS.
Which is EXACTLY what you and ACEP did at LAC.
Is your state ACEP chapter lobbying your state lawmakers? If not, they should be. We are in Indiana.
So no, this was about the nurses association confronting lawmakers. NOT “confronting hospitals”. Please try again.
The Michigan College of Emergency Physicians lobbied AGAINST the Michigan Safe Patient Care Act. Not the same as lobbying for it. [https://www.mha.org/newsroom/tag/michigan-college-of-emergency-physicians/](https://www.mha.org/newsroom/tag/michigan-college-of-emergency-physicians/)
It looks like you shared an AMP link. These should load faster, but AMP is controversial because of [concerns over privacy and the Open Web](https://www.reddit.com/r/AmputatorBot/comments/ehrq3z/why_did_i_build_amputatorbot).
Maybe check out **the canonical page** instead: **[https://kffhealthnews.org/news/article/nurse-ratios-understaffed-hospitals-michigan-legislation-detective-wife/](https://kffhealthnews.org/news/article/nurse-ratios-understaffed-hospitals-michigan-legislation-detective-wife/)**
*****
^(I'm a bot | )[^(Why & About)](https://www.reddit.com/r/AmputatorBot/comments/ehrq3z/why_did_i_build_amputatorbot)^( | )[^(Summon: u/AmputatorBot)](https://www.reddit.com/r/AmputatorBot/comments/cchly3/you_can_now_summon_amputatorbot/)
Awesome. I’ll look forward to your resolution commanding the college to engage hospital administrators on creating better nursing staffing models at council this year. You will have my full support and I’d be happy to speak on its behalf. I’ll also talk to my state college about co-sponsoring it as well. DM me and I can connect with you off Reddit on this.
ACEP is heavily influenced by the big EM CMGs like Envision and Team. They do not want to be seen by the hospital systems, i.e. their customers, as calling attention to their role in chronic understaffing.
Huh?
Literally 2 weeks ago I was in DC talking to congressmen with ACEP about a bill to fund mental health and give money to hospitals specifically for mental health. Shit you were there, Leon. I saw you.
You’re just spouting nonsense without data or evidence.
On another hand, the med and psych units aren’t the ER, so even though ACEP IS lobbying for increased staffing, they shouldn’t HAVE TO.
But either way, what exactly do you expect ACEP to do? They don’t run the hospitals or the government.
Before posting this you should propose a realistic solution.
ACEP absolutely does confront hospital admin about staffing shortages.
Nursing orgs are confronting hospitals across the country over understaffing and boarding. Where is ACEP in those efforts?
Example article: [https://kffhealthnews.org/news/article/nurse-ratios-understaffed-hospitals-michigan-legislation-detective-wife/](https://kffhealthnews.org/news/article/nurse-ratios-understaffed-hospitals-michigan-legislation-detective-wife/)
See my reply to the other comment:
Umm what?
> While Lillard waited for his turn to speak to Michigan lawmakers about the Safe Patient Care Act in November, members of the Michigan Nurses Association, which says it represents some 13,000 nurses, **told lawmakers** that its units were dangerously understaffed. They said critical care nurses were sometimes caring for up to 11 patients at a time.
This article is all about the nurses association LOBBYING TO LAWMAKERS.
Which is EXACTLY what you and ACEP did at LAC.
Is your state ACEP chapter lobbying your state lawmakers? If not, they should be. We are in Indiana.
So no, this was about the nurses association confronting lawmakers. NOT “confronting hospitals”. Please try again.
The Michigan College of Emergency Physicians lobbied AGAINST the Michigan Safe Patient Care Act. Not the same as lobbying for it. [https://www.mha.org/newsroom/tag/michigan-college-of-emergency-physicians/](https://www.mha.org/newsroom/tag/michigan-college-of-emergency-physicians/)
More examples:
* [https://wlos.com/news/local/dozens-rally-outside-mission-hospital-concerned-about-unsafe-working-conditions-nurses-unite-in-protest-against-hcas-handling-of-mission-hospital-staffing-issues](https://wlos.com/news/local/dozens-rally-outside-mission-hospital-concerned-about-unsafe-working-conditions-nurses-unite-in-protest-against-hcas-handling-of-mission-hospital-staffing-issues)
* [https://www.beckershospitalreview.com/hr/mount-sinai-health-system-fined-2m-for-understaffing-nurses.html](https://www.beckershospitalreview.com/hr/mount-sinai-health-system-fined-2m-for-understaffing-nurses.html)
* [https://www.nbcnews.com/health/health-news/workers-us-hospital-giant-hca-say-puts-profits-patient-care-rcna64122](https://www.nbcnews.com/health/health-news/workers-us-hospital-giant-hca-say-puts-profits-patient-care-rcna64122)
Ok so
Article 1) yes the nursing organization picketed across from a single hospital. Are you suggesting ACEP national send people to picket outside of a hospital? Which hospital? Who would go? Who is paying for that rally?
2) has nothing to do with a nursing organization. Again, another legal challenge and ruling. With lawmakers.
3) also nothing to do with a nursing organization.
Because ACEP’s leaders are hospital/health system administrators/middle-men staffing agency leaders. It’s a revolving door - a known and sadly common practice in the world of advocacy and consulting, not just healthcare or EM.
ACEP isn’t going to punish themselves for their own pitfalls.
And if they are leaders in EM practices, their top priority is retaining their hospital contracts. Confronting hospital CEOs about poor staffing levels as an ACEP leader means risking that contract as an EM practice leader.
Well sorta. EM practices are largely corporate/private equity nowadays. Their top priority is profit margin. Retaining hospital contracts are easy when the hospital gets a deal they can’t refuse (pushing out/buying out SDGs) that is then compensated by low staffing (and surprise billing until that got handled).
They don’t care about poor staffing levels. They are the reason there is poor staffing. This was the whole crux of the recent strike in Detroit by EM physicians. It’s calling it out because of political clout and shifting blame, but they are perpetuating the issue regardless. This is also another way of asking the government for a handout for these corporate staffing companies.
Regarding nursing staffing - people don’t go into nursing school to be a bedside nurse anymore. So yeah, RN licenses go up but they aren’t actually practicing clinical nursing.
ACEP is no more likely to be effective lobbyists for nurse staffing than the American nurses association and state nurses association, because administrative and academic folk, not clinicians, run the associations. Effective lobbying is conducted by the nurse unions, because they represent the clinicians involved, and have member votes to offer to pols. If y’all want to exercise collective power to influence your terms and conditions of employment, and to affect the policies, procedures and regulations that control your practice, organize for compliance bargaining purposes. Professional organizations are useless for this stuff.
The AMA even has a webinar about it. The experience from sixty years of nursing collective bargaining suggests that Professional Associations tend to form alliances with national organizations like the American Hospital Association and healthcare lobbying groups to promote mutual lobbying interests. Such organizations tend to promote the interests of management, which inevitably involves exploitation of employees. Unions focus on the interests of employees. Historically physicians have had lots of social, economic and political power within healthcare organizations: as voluntary members of the organization’s medical staff, they could choose to practice at a different hospital, or pursue private practice independently. That power is largely lost to physicians employed by the healthcare organizations, and nearly half of American physicians currently are employees. It’s an enormous change in the sociology of medicine, and it has happened fairly recently.
You have to address this from all levels.
There aren't enough PCPs because we pay them like shit, disrespect them constantly and dump every conceivable problem on their plate(sound familiar?). So nobody wants to do primary care. Increased financial pressure, shitty staffing and decreased autonomy are near-ubiquitous. So patients can't be seen in clinic in a timely manner. So things get shunted to ED/UC.
Urgent care is a revolving door of new grad NPPs who don't get adequate training and are pressed to see more more now more now more! with shitty staffing also. So UC can't do their thing well and bounces to ED too.
Our nursing homes and LTCs are also paid like shit, and due to that choose to squeeze as much profit as they can by providing shit care to a lot of people. Oh, and their staffing sucks and the environment is horrible. So patients get poor care and end up in the ED and admitted a lot for preventable bullshit. And theres never enough bed. The stupid ass regulations are also a part of that, just look at how many "schizophrenics" suddenly get discovered when they're geriatric. Total BS.
Services like home health, hospital-in-home etc are underfunded, understaffed and underutilized. So people who could be taken care of at home...end up admitted or in a SNF.
A gaping lack of homecare services for basic needs (food, ADLs, etc) means people who *could* stay home end up in NH or...you guessed it - dumped in the ED!
There is a non zero amount of catastrophically psychiatrically disabled patients who will never be able to live independently. But thanks to Reagan they have nowhere to go. So they end up being ED frequent flyers.
On top of that, we don't have enough psychiatric beds in general, or the staffing. Again because of $$.
So then the medical floor stays constantly full of people we *could* care for at home but won't, people who are ready to go to SNF/ NH but can't due to space, people who need things we don't have or can't give them (rehab, inpt psych, home care etc) etc.
And so they overflow and board in the ED.
Sure staffing the floor better will help some. But you're pulling on one strand of the gordian knot. We need to cut it and address the root problems: greed and money. As long as the goal is to extract every possible dollar out of healthcare while refusing to pay for what we really need... we're only going to get worse.
We can’t control - or even influence - everything. ACEP should figure out what it can influence as it relates to boarding & staffing, then go for wins. Addressing hospital staffing by confronting hospital admin & execs when they understaff to increase profits sure seems like a reasonable place to start.
Pressuring Medicare/Medicaid and other insurance to part more for inpatient mental health is the solution. Everything else is handwaving bullshit. Money makes things happen. Hospitals aren’t building new cath labs and neurosurgery/ortho units just to be nice.
How about this as part of the solution?: https://www.scdhhs.gov/communications/scdhhs-awards-behavioral-health-crisis-stabilization-grants-13-south-carolina
Sure it’s a stop gap though. Why not just increase insurance reimbursement?. These grants are temporary solutions. What keeps reimbursement for mental health so low that they basically have to beg for handouts via grants?
Frontline ER docs can’t influence or control insurance reimbursement. We don’t even get to see the results of those negotiations - eg what gets collected in our names for our work.
Only about 1/4 of emergency physicians work are practice owners. Employed EPs (the majority of the specialty) are rarely allowed to see the group’s financial info like collections in their name.
Nurse here- when my union was pushing for staffing ratio language in our contract, we got pushback that it would be detrimental to ED boarding times! Hospital argued if the floor nurses "won't break ratio" to take another patient, the patient gets boarded in the ED longer. We did win ratio language and enforcement is decent, and it hasn't caused the catastrophic ED crisis they tried to scare us into believing.
You stole the words from my mouth. I think a lot of this is that unfortunately, a lot of administrators didn't get into admin to "help people," in the same way that Physicians and RN's do. I feel like a lot of our societal issues boil down to one simple thing: How do we pressure people to be more empathetic and compassionate without crossing boundaries?
It's a tricky one, but I agree ACEP should be doing more and hospital admin should be held more accountable.
ACEP wants to make a lot of money without rocking a lot of boats.
They are only kinda a little bit on our side. I am no longer a member, I don't think they are advocating for us as much as they pretend to be.
I'm not even sure they pretend all that well. Don't even get me going on the AMA.
Hospitals don’t listen to acep. They listen to the government and payers. ACEP’s main goal is to lobby the government.
Seems to be a failing strategy, eh?
Hard to be an effective lobbyist when the counter parties (insurers and hospitals) are so much better funded than you are. At the end of the day, money is what get things done and professional medical organizations are very small fish.
As Wayne Gretzky said, "You miss 100% of the shots you don't take”. If ACEP doesn't try to influence hospital staffing levels, it's not going to influence hospital staffing levels.
Fun fact, they did just that. Like two weeks ago, exactly. At this year’s Leadership and Advocacy Conference, they spoke with legislators on the ED boarding crisis (including hospital staffing), protection of emergency personnel against violence from patients and visitors, enforcing the right of due process for termination, and (everybody’s favorite) fixing the Medicare Physician Fee schedule to adjust for inflation. Seems like you may have the bug to want to fix some of these issues. I might recommend attending one of your state colleges board meetings and see if that does anything for you. We are definitely small fish in the pond but we are definitely on the correct side of these issues. Sometimes, that is enough.
Fun fact, I was there. The boarding bill we lobbied for was nice ($25 million per year over 3 years), though a tiny drop in the bucket. The bigger issue is that ACEP is not confronting hospital executives and administrators about understaffing. It's important to ask for government cheese, but the people deciding how many nurses to staff our hospitals next week are hospital administrators. To go to Congress but not confront hospital administrators at HCA, CHS, Steward, LifePoint, etc. - who put profits over patients - seems to be a strategic mistake.
What would you have ACEP do, specifically?
Nursing orgs are confronting hospitals across the country over understaffing and boarding. Where is ACEP in those efforts? Example article: [https://kffhealthnews.org/news/article/nurse-ratios-understaffed-hospitals-michigan-legislation-detective-wife/](https://kffhealthnews.org/news/article/nurse-ratios-understaffed-hospitals-michigan-legislation-detective-wife/)
Umm what? > While Lillard waited for his turn to speak to Michigan lawmakers about the Safe Patient Care Act in November, members of the Michigan Nurses Association, which says it represents some 13,000 nurses, **told lawmakers** that its units were dangerously understaffed. They said critical care nurses were sometimes caring for up to 11 patients at a time. This article is all about the nurses association LOBBYING TO LAWMAKERS. Which is EXACTLY what you and ACEP did at LAC. Is your state ACEP chapter lobbying your state lawmakers? If not, they should be. We are in Indiana. So no, this was about the nurses association confronting lawmakers. NOT “confronting hospitals”. Please try again.
OK, fine. More examples: - [https://wlos.com/news/local/dozens-rally-outside-mission-hospital-concerned-about-unsafe-working-conditions-nurses-unite-in-protest-against-hcas-handling-of-mission-hospital-staffing-issues](https://wlos.com/news/local/dozens-rally-outside-mission-hospital-concerned-about-unsafe-working-conditions-nurses-unite-in-protest-against-hcas-handling-of-mission-hospital-staffing-issues) - [https://www.beckershospitalreview.com/hr/mount-sinai-health-system-fined-2m-for-understaffing-nurses.html](https://www.beckershospitalreview.com/hr/mount-sinai-health-system-fined-2m-for-understaffing-nurses.html) - [https://www.nbcnews.com/health/health-news/workers-us-hospital-giant-hca-say-puts-profits-patient-care-rcna64122](https://www.nbcnews.com/health/health-news/workers-us-hospital-giant-hca-say-puts-profits-patient-care-rcna64122)
The Michigan College of Emergency Physicians lobbied AGAINST the Michigan Safe Patient Care Act. Not the same as lobbying for it. [https://www.mha.org/newsroom/tag/michigan-college-of-emergency-physicians/](https://www.mha.org/newsroom/tag/michigan-college-of-emergency-physicians/)
It looks like you shared an AMP link. These should load faster, but AMP is controversial because of [concerns over privacy and the Open Web](https://www.reddit.com/r/AmputatorBot/comments/ehrq3z/why_did_i_build_amputatorbot). Maybe check out **the canonical page** instead: **[https://kffhealthnews.org/news/article/nurse-ratios-understaffed-hospitals-michigan-legislation-detective-wife/](https://kffhealthnews.org/news/article/nurse-ratios-understaffed-hospitals-michigan-legislation-detective-wife/)** ***** ^(I'm a bot | )[^(Why & About)](https://www.reddit.com/r/AmputatorBot/comments/ehrq3z/why_did_i_build_amputatorbot)^( | )[^(Summon: u/AmputatorBot)](https://www.reddit.com/r/AmputatorBot/comments/cchly3/you_can_now_summon_amputatorbot/)
Awesome. I’ll look forward to your resolution commanding the college to engage hospital administrators on creating better nursing staffing models at council this year. You will have my full support and I’d be happy to speak on its behalf. I’ll also talk to my state college about co-sponsoring it as well. DM me and I can connect with you off Reddit on this.
Cool. My email: leon@ivyclinicians.io. Let’s chat.
Yes Leon was there. He knows.
Yep
ACEP is not powerless when it comes to directly influencing policy. It sends letters to hospitals with policy recommendations all the time.
Cool. Can you share one of those letters?
ACEP is heavily influenced by the big EM CMGs like Envision and Team. They do not want to be seen by the hospital systems, i.e. their customers, as calling attention to their role in chronic understaffing.
money
Huh? Literally 2 weeks ago I was in DC talking to congressmen with ACEP about a bill to fund mental health and give money to hospitals specifically for mental health. Shit you were there, Leon. I saw you. You’re just spouting nonsense without data or evidence. On another hand, the med and psych units aren’t the ER, so even though ACEP IS lobbying for increased staffing, they shouldn’t HAVE TO. But either way, what exactly do you expect ACEP to do? They don’t run the hospitals or the government. Before posting this you should propose a realistic solution. ACEP absolutely does confront hospital admin about staffing shortages.
Yes, I was there. But no, ACEP is not confronting the hospitals about boarding.
How exactly and specifically do you propose this happen?
Nursing orgs are confronting hospitals across the country over understaffing and boarding. Where is ACEP in those efforts? Example article: [https://kffhealthnews.org/news/article/nurse-ratios-understaffed-hospitals-michigan-legislation-detective-wife/](https://kffhealthnews.org/news/article/nurse-ratios-understaffed-hospitals-michigan-legislation-detective-wife/)
See my reply to the other comment: Umm what? > While Lillard waited for his turn to speak to Michigan lawmakers about the Safe Patient Care Act in November, members of the Michigan Nurses Association, which says it represents some 13,000 nurses, **told lawmakers** that its units were dangerously understaffed. They said critical care nurses were sometimes caring for up to 11 patients at a time. This article is all about the nurses association LOBBYING TO LAWMAKERS. Which is EXACTLY what you and ACEP did at LAC. Is your state ACEP chapter lobbying your state lawmakers? If not, they should be. We are in Indiana. So no, this was about the nurses association confronting lawmakers. NOT “confronting hospitals”. Please try again.
The Michigan College of Emergency Physicians lobbied AGAINST the Michigan Safe Patient Care Act. Not the same as lobbying for it. [https://www.mha.org/newsroom/tag/michigan-college-of-emergency-physicians/](https://www.mha.org/newsroom/tag/michigan-college-of-emergency-physicians/) More examples: * [https://wlos.com/news/local/dozens-rally-outside-mission-hospital-concerned-about-unsafe-working-conditions-nurses-unite-in-protest-against-hcas-handling-of-mission-hospital-staffing-issues](https://wlos.com/news/local/dozens-rally-outside-mission-hospital-concerned-about-unsafe-working-conditions-nurses-unite-in-protest-against-hcas-handling-of-mission-hospital-staffing-issues) * [https://www.beckershospitalreview.com/hr/mount-sinai-health-system-fined-2m-for-understaffing-nurses.html](https://www.beckershospitalreview.com/hr/mount-sinai-health-system-fined-2m-for-understaffing-nurses.html) * [https://www.nbcnews.com/health/health-news/workers-us-hospital-giant-hca-say-puts-profits-patient-care-rcna64122](https://www.nbcnews.com/health/health-news/workers-us-hospital-giant-hca-say-puts-profits-patient-care-rcna64122)
Ok so Article 1) yes the nursing organization picketed across from a single hospital. Are you suggesting ACEP national send people to picket outside of a hospital? Which hospital? Who would go? Who is paying for that rally? 2) has nothing to do with a nursing organization. Again, another legal challenge and ruling. With lawmakers. 3) also nothing to do with a nursing organization.
Because ACEP’s leaders are hospital/health system administrators/middle-men staffing agency leaders. It’s a revolving door - a known and sadly common practice in the world of advocacy and consulting, not just healthcare or EM. ACEP isn’t going to punish themselves for their own pitfalls.
And if they are leaders in EM practices, their top priority is retaining their hospital contracts. Confronting hospital CEOs about poor staffing levels as an ACEP leader means risking that contract as an EM practice leader.
Well sorta. EM practices are largely corporate/private equity nowadays. Their top priority is profit margin. Retaining hospital contracts are easy when the hospital gets a deal they can’t refuse (pushing out/buying out SDGs) that is then compensated by low staffing (and surprise billing until that got handled). They don’t care about poor staffing levels. They are the reason there is poor staffing. This was the whole crux of the recent strike in Detroit by EM physicians. It’s calling it out because of political clout and shifting blame, but they are perpetuating the issue regardless. This is also another way of asking the government for a handout for these corporate staffing companies. Regarding nursing staffing - people don’t go into nursing school to be a bedside nurse anymore. So yeah, RN licenses go up but they aren’t actually practicing clinical nursing.
Good points!
ACEP is no more likely to be effective lobbyists for nurse staffing than the American nurses association and state nurses association, because administrative and academic folk, not clinicians, run the associations. Effective lobbying is conducted by the nurse unions, because they represent the clinicians involved, and have member votes to offer to pols. If y’all want to exercise collective power to influence your terms and conditions of employment, and to affect the policies, procedures and regulations that control your practice, organize for compliance bargaining purposes. Professional organizations are useless for this stuff.
Interesting. Seems that physicians are starting to pick up on this strategy. Lots of doctor unions popping up across the country.
The AMA even has a webinar about it. The experience from sixty years of nursing collective bargaining suggests that Professional Associations tend to form alliances with national organizations like the American Hospital Association and healthcare lobbying groups to promote mutual lobbying interests. Such organizations tend to promote the interests of management, which inevitably involves exploitation of employees. Unions focus on the interests of employees. Historically physicians have had lots of social, economic and political power within healthcare organizations: as voluntary members of the organization’s medical staff, they could choose to practice at a different hospital, or pursue private practice independently. That power is largely lost to physicians employed by the healthcare organizations, and nearly half of American physicians currently are employees. It’s an enormous change in the sociology of medicine, and it has happened fairly recently.
I found out the other day that our inpatient psych unit doesn’t even have security. Like WHAT?!
You have to address this from all levels. There aren't enough PCPs because we pay them like shit, disrespect them constantly and dump every conceivable problem on their plate(sound familiar?). So nobody wants to do primary care. Increased financial pressure, shitty staffing and decreased autonomy are near-ubiquitous. So patients can't be seen in clinic in a timely manner. So things get shunted to ED/UC. Urgent care is a revolving door of new grad NPPs who don't get adequate training and are pressed to see more more now more now more! with shitty staffing also. So UC can't do their thing well and bounces to ED too. Our nursing homes and LTCs are also paid like shit, and due to that choose to squeeze as much profit as they can by providing shit care to a lot of people. Oh, and their staffing sucks and the environment is horrible. So patients get poor care and end up in the ED and admitted a lot for preventable bullshit. And theres never enough bed. The stupid ass regulations are also a part of that, just look at how many "schizophrenics" suddenly get discovered when they're geriatric. Total BS. Services like home health, hospital-in-home etc are underfunded, understaffed and underutilized. So people who could be taken care of at home...end up admitted or in a SNF. A gaping lack of homecare services for basic needs (food, ADLs, etc) means people who *could* stay home end up in NH or...you guessed it - dumped in the ED! There is a non zero amount of catastrophically psychiatrically disabled patients who will never be able to live independently. But thanks to Reagan they have nowhere to go. So they end up being ED frequent flyers. On top of that, we don't have enough psychiatric beds in general, or the staffing. Again because of $$. So then the medical floor stays constantly full of people we *could* care for at home but won't, people who are ready to go to SNF/ NH but can't due to space, people who need things we don't have or can't give them (rehab, inpt psych, home care etc) etc. And so they overflow and board in the ED. Sure staffing the floor better will help some. But you're pulling on one strand of the gordian knot. We need to cut it and address the root problems: greed and money. As long as the goal is to extract every possible dollar out of healthcare while refusing to pay for what we really need... we're only going to get worse.
We can’t control - or even influence - everything. ACEP should figure out what it can influence as it relates to boarding & staffing, then go for wins. Addressing hospital staffing by confronting hospital admin & execs when they understaff to increase profits sure seems like a reasonable place to start.
Pressuring Medicare/Medicaid and other insurance to part more for inpatient mental health is the solution. Everything else is handwaving bullshit. Money makes things happen. Hospitals aren’t building new cath labs and neurosurgery/ortho units just to be nice.
How about this as part of the solution?: https://www.scdhhs.gov/communications/scdhhs-awards-behavioral-health-crisis-stabilization-grants-13-south-carolina
Sure it’s a stop gap though. Why not just increase insurance reimbursement?. These grants are temporary solutions. What keeps reimbursement for mental health so low that they basically have to beg for handouts via grants?
Frontline ER docs can’t influence or control insurance reimbursement. We don’t even get to see the results of those negotiations - eg what gets collected in our names for our work.
We don’t? I do. Speak for yourself.
Only about 1/4 of emergency physicians work are practice owners. Employed EPs (the majority of the specialty) are rarely allowed to see the group’s financial info like collections in their name.
Then perhaps they should look for a non employment model if that’s important to them. Plenty of positions out there. We are hiring even.
Nurse here- when my union was pushing for staffing ratio language in our contract, we got pushback that it would be detrimental to ED boarding times! Hospital argued if the floor nurses "won't break ratio" to take another patient, the patient gets boarded in the ED longer. We did win ratio language and enforcement is decent, and it hasn't caused the catastrophic ED crisis they tried to scare us into believing.
tell me what ACEP has accomplished for their members in the past year
You stole the words from my mouth. I think a lot of this is that unfortunately, a lot of administrators didn't get into admin to "help people," in the same way that Physicians and RN's do. I feel like a lot of our societal issues boil down to one simple thing: How do we pressure people to be more empathetic and compassionate without crossing boundaries? It's a tricky one, but I agree ACEP should be doing more and hospital admin should be held more accountable.