Viewpoint: CAPE must approve resolutions to break the stra …: Emergency Medicine News

The Board of Trustees of the American College of Emergency Physicians is to act swiftly and decisively at the 2021 Scientific Assembly by adopting Resolutions 29 and 44 in their entirety. Originally submitted by Robert McNamara, MD, in 2020, they rectify the two pillars of the abuses suffered by companies. by emergency physicians: lack of transparency on what is billed and collected on our behalf and lack of regularity of the procedure.

The board must also unequivocally reject candidates for the board of directors who present corporate conflicts of interest. Otherwise, it will send a clear message that our largest professional organization is irreparably compromised.

Corporate abuses in emergency medicine were first described extensively in the 1992 book, Emergency medicine rape. (https://bit.ly/RapeofEMThis paragon of satire illustrated how a minority of physicians conspired to exploit their colleagues, giving rise to contract management groups (CMGs). The recognition of CAPE’s leadership complicity spurred the formation of the American Academy of Emergency Medicine (AAEM), leaving us the only specialty with two competing professional organizations. Today, three decades after the creation of the AAEM, it is estimated that more than 50 percent of PEs are employed by CMGs, and a recent CAPE workforce study predicted an oversupply 20 percent of EP in less than a decade. (Forecast emergency medicine workforce for 2030. April 9, 2021; https://bit.ly/3aQb6CZ).

Much of this has been fabricated by a proliferation of corporate-backed residency programs and the rapid replacement of PEs with non-physician practitioners (NPPs). Too often this leaves bedside PEs with non-negotiable theoretical supervision demands that put patients at risk and reduce the remaining bedside physicians to nothing more than underpaid and underrated lightning rods.

The majority of bedside EPs recognize the plagues that plague our specialty, as evidenced by a slide of a CAPE presentation. (See image.) Membership numbers confer political power, but it is not clear to what extent CAPE’s membership numbers actually reflect support for its policies. The supposedly independent Association of Emergency Medicine Residents (EMRA) requires membership in CAPE, and some CMG contracts require membership as a condition of employment. Other employers simply include CAPE membership as a benefit. This passive adhesion flow results in a mismatch between adherents and supporters in urgent need of thrombolytics.

CAPE leadership has stood up to corporate medicine during this crisis with all the vigor of an off-duty internal medicine intern who aspires to master the arts of rheumatology. CAPE President Mark Rosenberg, DO, basically congratulated his colleagues on their sale: “A lot of my colleagues and friends who have ‘sold’ themselves to some of these larger groups, whether they are groups private independent earning a lot of money, are now independent or retired private groups. That’s wonderful. It’s the American way. (PE Monthly. March 2021; https://bit.ly/3mc5wRU.) CMGs have perpetrated countless abuses for over 30 years, but CAPE leadership fails to acknowledge it.

Private equity is pillaging industries on an accelerated schedule of three to five years. Both TeamHealth and Envision having been private equity acquired within the past five years, immediate intervention is required. (TeamHealth press release. October 31, 2016; https://bit.ly/3iU9I6F; Business thread. October 11, 2018; https://bwnews.pr/3g9Fvz0.)

US Acute Care Solutions says it bought out its group from private equity funds, perhaps hoping it would go unnoticed using a $ 470 million loan from Apollo Global Management, Inc., another private equity firm. , with two of their representatives joining their board. (Apollo. February 9, 2021; https://bit.ly/3z96guV.)

Two USACS executives also currently sit on the CAPE Board of Directors: Arvind Venkat, MD, who is the National Director of Research for USACS, and Anthony Cirillo, MD, who is the Director of Government Affairs. for USACS. (ACEP.org. Accessed August 18, 2021; https://bit.ly/37P81RA.) Such conflicts of interest between CAPE leadership underscore the importance of adopting Resolutions 29 and 44 in their entirety and ensuring that CAPE leadership is not in a position to be unduly influenced by the potential benefits resulting from or from relationships with an entity with priorities that may compete with those of emergency physicians and their patients.

This fall, if the board recommends adoption without an enforcement, it will amount to a meaningless signal of virtue and unequivocally reveal whether their allegiances are to bedside EPs or metaphorical rapists. We have good reason to be concerned; the board of directors has signaled its intention to hide behind the false fear of antitrust lawsuits as an excuse for not adopting resolutions 29 and 44 in their entirety.

Let’s be very clear: this fear lacks face validity. Even if there was a legitimate risk, a CMG or other entity would have to take legal action against CAPE while openly opposing due process and transparency, which would be doomed to the failure. Common sense dictates that a membership organization is not obligated to do business with entities that harm its members, just as the National Association for the Advancement of Colored People is not obligated to accept. sponsorship of the Ku Klux Klan and the Brady campaign. does not accept advertising from the National Rifle Association.

Even though this was insufficient, the Federal Trade Commission issued a letter in 2004 which stated: “Trade associations can, of course, respond to market conditions or to the behavior of market participants that they deem detrimental to their members or the market. public. (Letter to CAPE from Jeffrey Brennan, Assistant Director, Healthcare Products and Services, FTC. August 30, 2004.)

A long-standing precedent has already been set by AAEM, which has excluded undemocratic contract management companies for decades, backed by a 2002 independent legal opinion supporting the absence of risk that such a policy could violate antitrust laws. . (Letter to AAEM from Randal J. Brotherhood, Esq., March 7, 2002.)

It has never been clearer that the specialty of emergency medicine is in urgent need of aggressive resuscitation. CAPE has had 30 years to reaffirm its integrity and now has this last opportunity to resist corporate greed by passing Resolutions 29 and 44 in their entirety while purging their leadership of conflicts of interest detrimental to business.

Make no mistake, all eyes will be on CAPE. If the college fails, it will be time for PEs to call the CAPE code and potentially come together under the AAEM to advocate for PEs and our patients and reclaim the soul of our specialty.

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Dr leeis the Chief Medical Officer of AAEM Locum Group, Founder of Thrive Direct Care, PLLC and one of the Founders of Take Medicine Back (https://takemedicineback.org). Dr Galeris the CEO and Founder of ColGACare, LLC, and a 14 year military veteran. She was instrumental in establishing the army’s first heat center at Fort. Benning, GA, which became the joint service Warrior Heat- and Exertion-Related Events Collaborative.