2011 PR E SI DE NT -ELECT CANDIDATE WRITTEN QUESTIONS. Robert C. Solomon, MD, FACEP

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1 2011 PR E SI DE NT -ELECT CANDIDATE WRITTEN QUESTIONS Question #1: How would you capitalize on the development of the Emergency Medicine Action Fund and maintain the voice and broad involvement of all members? What would be one of the first uses you would contemplate for this fund? The idea of the Action Fund is to facilitate advocacy that goes beyond what can be accomplished through a PAC, while establishing a new revenue stream to fund these endeavors. So many of the external influences on the practice of our specialty come from government and quasi-governmental organizations (such as TJC) in the form of rules and regulations. Efforts to inform the processes through which such rules and regulations are developed, to shape them as they are fashioned, and (on the back end) to alter those we view as misdguided are both laborintensive and costly. At the most basic level, emergency physicians are individualists who prize the autonomy of the individual physician and seek to shield their clinical practice and the doctor-patient relationship from unwarranted and illconceived outside interference. We have no shortage of people telling us how to practice medicine. Unfortunately, those who are doing so often demonstrate a remarkable shortage of expertise, evidence, and good sense, not to mention a complete lack of awareness of the law of unintended consequences. There has been some concern expressed that EMAF will be controlled by groups and alliances that are focused on what is in the best economic interests of large practice groups and corporate structures. But the inclusion on its board of several membership organizations - including ACEP, EMRA, SAEM, AAEM, and AACEM - should serve to assure that a broad range of opinions and perspectives in emergency medicine will guide decisions about how the resources of the Action Fund are deployed. While so many of our efforts in advocacy have been directed at securing adequate funding for emergency care, the role of the Action Fund in the regulatory arena may be best established with early, narrowly-focused efforts with a strong likelihood of success. Getting CMS to recognize that micromanaging the practice of our specialty is a fool s errand would be a good start. Is there really anyone at that agency competent to craft an evidence-based clinical decision instrument suitable for use in determining which ED patients with nontraumatic headache should have CT scans? Yes, that is a rhetorical question. Question #2: What can ACEP do for emergency physicians as they face the development of Accountable Care Organizations, bundled payments, and potential employment by hospitals? What these trends have in common is that the drivers - chiefly third-party payers - are generally not thinking about the role of emergency medicine in the health care system when they press for the adoption of their favored models. The single most important thing ACEP can do in this arena, as in many others, is to position emergency medicine for visibility and to get all of the stakeholders to recognize the central role the specialty plays. The impetus for ACOs and bundled payments is the desire to gain control of the total cost of caring for patients - sort of a prix fixe rather than à la carte approach to paying for care. While this is an understandable goal, most of us think it is important to preserve independence in the practice of emergency medicine. This means that EPs should continue to have an array of options, including status as independent contractors, partners in or employees of physician groups, and hospital employees. Many policymakers clearly care little about such professional issues and think a system in which all doctors are employees of hospitals or health systems is the best model. While it is possible that our nation s health care system will eventually evolve to look like that, for the present ACEP should continue to advocate for choice in professional practice and for fair treatment of emergency physicians who must negotiate with hospitals and health systems for their share of bundled or global payments.

2 Question #3: What is a realistic goal for liability reform and how would you guide ACEP to attain it? Mary McCarthy, best-selling author and winner (1984) of the National Medal for Literature, said, If someone tells you he is going to make a realistic decision, you immediately understand that he has resolved to do something bad. So let us not worry so much about what is realistic and focus instead on what is best. The purpose of a medical tort system is to provide fair compensation to patients harmed by medical negligence. If you have read even a little about this subject, you know the current system is an abysmal failure. Most of the money goes to attorneys, administrative costs, and patients undeserving of compensation. Strong evidence shows there is poor correlation between the merits of claims and the likelihood of settlements or awards. It is possible to build a system that reliably identifies patients harmed by medical negligence and compensates them fairly, at the same time using the information gathered in a constructive approach to reducing the probability of future harm of a similar nature. Much can be done to reform the current system and improve the odds that it produces outcomes in accord with what is just and fair for all involved. But its rate of success in achieving such outcomes will continue to be low, and too little of the money will go to those who need it. The system must be replaced. An alternative structure must begin by identifying patients harmed by error (without waiting for them to file claims), assign cases for review by panels that include experts in medicine and economics, and use an analytical approach to discerning causes and building preventive solutions. Such a system could fairly compensate patients harmed by medical error and reduce the probability of future error. Money that currently enriches the trial bar would be redirected to help these patients - and improve safety for all patients. Is this realistic? We can construct that reality. There is opportunity under the Affordable Care Act for states to try new approaches to medical liability. Let us seize that opportunity.

3 CANDIDATE DATA SHEET Past and Present Professional Position(s) Attending Physician (Academic) and Core Faculty, EM Residency, Allegheny General Hospital, Pittsburgh, PA Previous hospital affiliations: Weirton Medical Center; East Liverpool City Hospital; Ohio Valley Medical Center; East Ohio Regional Hospital; Trinity Health System; Sewickley Valley Hospital; Southwest Regional Medical Center Education University of Pittsburgh School of Medicine; The Western Pennsylvania Hospital Certifications ABEM: certified 1989, recertified 1998, 2007 Professional Societies ACEP (member since 1985); Pennsylvania chapter; SAEM National ACEP Activities List your most significant accomplishments Board of Directors, present. Councillor, Council Steering Committee, Council Reference Committees (total six, one as chair). Council Meritorious Service Award, Bylaws Committee, , chair Ethics Committee, , chair, Finance Committee, Federal Government Affairs Committee. Liaison to American Heart Association s Emergency Cardiovascular Care Committee/ACLS Subcommittee, Medical Editor-in-Chief, AC E P News, present. EMF Board of Trustees, present, chair ACEP Chapter Activities List your most significant accomplishments Note: now a member of Pennsylvania Chapter, but until very recently was in WV Chapter. In WV chapter, served on Board of Directors from Councillor, Served in all chapter offices, including president, Editor of chapter EPIC, Excellence in Emergency Medicine Award, Practice Profile Total hours devoted to emergency medicine practice per year: 2000 Total Hours/Year Individual % breakdown the following areas of practice. Total = 100%. Direct Patient Care 70 % Research 0 % Teaching 30 % Administration 0 % Other: 0 %

4 Candidate Data Sheet Page 2 Describe current emergency medicine practice. (e.g. type of employment, type of facility, single or multi-hospital group, etc.) My current practice setting is Allegheny General Hospital, a 661-bed tertiary care academic medical center in Pittsburgh, Pennsylvania, with an annual ED volume of 50,000. It is a Level I trauma center with a PGY 1-3 EM residency (ten residents/year) and a PGY 1-5 dual EM/IM residency (two residents/year). I am a hospital employee. My 26-year career in EM spans EDs with volumes ranging from 15,000-50,000 in settings that have incuded urban, suburban, and rural. About half of those years have been at teaching hospitals. Six of those years were spent as an ED medical director. Expert Witness Experience If you have served as a paid expert witness in a medical liability or malpractice case in the last ten years, provide the approximate number of plaintiff and defense cases in which you have provided expert witness testimony. Defense Expert Cases Plaintiff Expert Cases Prior to my election to the ACEP Board of Directors, I served as a defense expert in a small number of medical liability cases (no more than a dozen). I have never been asked to serve as an expert for a plaintiff.

5 CANDIDATE DISCLOSURE STATEMENT 1. Employment L ist current employers with addresses, position held and type of organization. Employer: Allegheny General Hospital Address: 320 East North Avenue Pittsburgh, PA Position Held: Attending Physician (Academic), Core Faculty (EM) Type of Organization: Tertiary Care Academic Medical Center 2. Board of Directors Positions Held List organizations and addresses for which you have served as a board member. I nclude type of organization and duration of term on the board. Organization: ACEP (2006-present); WV Chapter ACEP ( ) Address: Type of Organization: Duration on the Board: I hereby state that I or members of my immediate family have the following affiliations and/or interests that might possibly contribute to a conflict of interest. Full disclosure of doubtful situations is provided to permit an impartial and objective determination. If YES, Please Describe Below: 3. Describe any outside relationships that you hold with regard to any person or entity from which ACEP obtains goods and services, or which provides services that compete with ACEP where such relationship involves: a) holding a position of responsibility; b) a an equity interest (other than a less than 1% interest in a publicly traded company); or c) any gifts, favors, gratuities, lodging, dining, or entertainment valued at more than $ Describe any financial interests or positions of responsibility in entities providing goods or services in support of the practice of emergency medicine (e.g., physician practice management company, billing company, physician placement company, book publisher, medical supply company, malpractice insurance company), other than owning less than a 1% interest in a publicly traded company.

6 Candidate Disclosure Statement Page 2 5. Describe any other interest that may create a conflict with the fiduciary duty to the membership of ACEP or that may create the appearance of a conflict of interest. 6. Do you believe that any of your positions, ownership interests, or activities, whether listed above or otherwise, would constitute a conflict of interest with ACEP? NO I certify that the above is true and accurate to the best of my knowledge: Signature: Signature on file with ACEP Date: July 20, 2011