PACEP Advocacy Priorities

Nurse Scope of Practice
While valued members of any medical team, nurses are not physicians. They do not have equivalent education, training, or experience. Nurses should not have independent practice authority.

Various nurse associations, however, have successfully lobbied for the introduction of various bills to expand their scope of practice and to create direct patient care.

PACEP opposes these initiatives. In the 2023 – 2024 legislative session, PACEP and fellow organizations that comprise “The House of Medicine have diligently limited legislative action on these legislative proposals. We continue our efforts to ensure patients receive care from physician-led medical teams.

Behavioral Health
The opioid addiction crisis combined with the COVID 19 pandemic has laid bare the numerous holes in Pennsylvania’s behavioral health safety net. The lack of available and appropriate behavioral health facility beds, at any price, is causing patients without physician health conditions to be boarded in Emergency Departments (EDs). These conditions demise care for all patients and can endanger ED staff as well as patients. Tragically, pediatric ED boarding is at the critical stage putting our most vulnerable patients at greater risk of harm.

PACEP is working with the Children’s Hospital of Philadelphia and others to seek reasonable relief for patients and ED staff. Remedial measures, such as models adopted in other states such as Massachusetts, Ohio, and Colorado, have been advanced to the Shapiro Administration and legislative champions. Although the General Assembly recently allocated $100 million for adult behavioral health services, gaping holes remain in the safety net’s fabric.

Outpatient Emergency Departments
Outpatient Emergency Departments (OEDs) staffed by non-physicians is a dangerous and growing trend, even in Pennsylvania. The early 2023 UPMC announcement that its Lock Haven facility would close its ED and open an OED is a harbinger of more service reductions to come across the Commonwealth.

Authorized by the Pennsylvania Department of Health, OEDs and Tele-emergency Department (tele-ED) are believed to be a remedy for rural patient emergency care. But with board definitions of “rural counties” that include suburban Philadelphia’s Montgomery County, OEDs and tele-EDs may simply be a means for integrated health systems or private equity owners to squeeze more revenue out of existing facilities while diminishing emergency services. To read more about the Department of Health’s new hospital models, please see the link below:

Innovative Hospital Models (pa.gov)

Medical Liability Reform
The August 2022 state Supreme Court reversal of the medical liability venue rules could plunge Pennsylvania into the depths of a medical liability insurance crisis not seen in two decades. Prior to the Court’s action, medical liability cases were to be heard in the county of the alleged injury.

Since January 1, 2023, any county with a nexus to the medical treatment can be the venue for a lawsuit. This means, for example, a medical liability claims for emergency services provided at Lancaster General Hospital (LGH) could be brought in Philadelphia County due to LGH’s affiliation with Penn Medicine. Likewise in the Harrisburg area, lawsuits for alleged injuries at Penn State Health or UPMC facilities could be heard in Allegheny County.

Emergency Physicians in practice 20 years ago will well remember the last medical liability crisis. The data indicates the Commonwealth is heading toward a similar situation. A month-by-month comparison of 2023 versus 2022 medical liability filings in Philadelphia County shows a doubling of cases.

In addition, the Pennsylvania Insurance Department set the 2024 MCARE assessment at 26%. This essentially doubles the 2022 assessment. The increase is a further sign of the looming medical liability insurance crisis and is the highest assessment rate in a decade.

PACEP is working with the Pennsylvania Orthopedic Society and others in the House of Medicine to advance remedial legislative to mitigate the Supreme Court’s adverse ruling. While venue reform is not a possible legislative solution (a state constitutional amendment is necessary), other measures, such as Certificate of Merit reform are possible. PACEP is pursuing such legislation.

PACEP is also pursuing a media strategy on this important issue. Please see former PACEP President Chadd Kraus’s PennLive op ed below:

Pennsylvania must act to avert another medical liability crisis | Opinion - pennlive.com

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