The Year that Was: Virginia Emergency Medicine in ‘24
If you ask members about the value VACEP offers, the response is consistent: Advocacy for the specialty, for emergency physicians, and for the patients and families under our care.
Every year brings successes and challenges to our mission of representing the professional interests of our physician members and promoting quality care, and 2024 was no different. Here’s a look at our year in and a glimpse at what’s to come.
January
At our annual EM Advocacy Day, VACEP members convened in Richmond to advocate for legislation requiring a physician to be physically present in every Virginia emergency department, addressing existing law that only mandates an on-call physician. The bill passed unanimously, and will become law on July 1, 2025.
We also were the only specialty physician group to oppose reduced training requirements for nurse practitioners seeking independent practice.
February
During our Annual Conference in Hot Springs, VACEP leaders and ACEP Board members discussed the year’s key legislative developments. VCU Health’s Jesse Spangler, M.D. succeeded Riverside’s Todd Parker, M.D. as VACEP president.
ACEP president Aisha Terry, MD (left) with VACEP board member Ashley Nicholson, MD at the Annual Conference.
Also at the Conference, the attendance of American College of Emergency Physicians president Aisha T. Terry, MD, MPH, FACEP marked the third straight year that the national president met directly with Virginia’s emergency medicine community. Her official remarks touched on boarding, workplace violence, and emergency physician “maldistribution.”
April
VACEP representatives participated in the ACEP Leadership and Advocacy Conference in Washington, D.C., meeting with lawmakers to address issues such as the boarding crisis, workplace violence, and Medicare reimbursements.
July
July is the month when many (but not all) bills that became law in the January General Assembly actually go into effect. Among those that impact emergency medicine:
Family Access in Emergency Departments: Family members can accompany patients under Emergency Custody Orders (ECO) or Temporary Detention Orders (TDO) in emergency departments. However, VACEP advocated for emergency physicians to retain the authority to restrict access if a family member's presence poses a medical, clinical, or safety risk, or interferes with patient care.
Nurse Practitioner Independent Practice: Another bill reduced the required supervised practice period for nurse practitioners seeking autonomous practice from five years (9,000 hours) to three years (3,600 hours). VACEP opposed this change, advocating for the existing five-year standard to ensure adequate training comparable to physician residency requirements.
As noted earlier, VACEP’s bill mandating 24/7 physician presence in emergency departments passed, but with a year’s delay enactment clause to July 1, 2025. Doing so gives hospitals time to comply with the new requirement. (Note: The law requires a physician in an ED, but not necessarily an emergency physician).
*Mason-Dixon Polling & Strategy, December 2023 survey
August
A judge dismissed VACEP's lawsuit against Virginia's Medicaid administrator, which sought to recover nearly three years of allegedly downcoded Medicaid reimbursements. See below for additional details.
September
VACEP issued guidance to emergency physicians on attestations for NPs seeking independent practice in emergency departments, outlining the six core competencies required for autonomous practice. We encourage all emergency physicians to review the attestations before signing off.
August
Our first “VACEP Presents” webinar provided guidance to the Commonwealth's ER docs, admitting psychiatrists, and Community Services Boards regarding the importance of proper emergency department documentation to avoid blanket testing on patients experiencing a psychiatric crisis. Get the state guidelines outlining this process and a replay of the event.
November
FBI analyst Jessica Young engaged with VACEP and emergency medical services to discuss counter-terrorism efforts and the role of medical providers in life-saving priorities. We weren’t able to record the session, but we do have resources that you can use, including a poster.
In 2025
Much more to come, but VACEP is monitoring developments in Virginia related to medical malpractice caps and scope of practice.
We will also continue our efforts to improve the Virginia Department of Health Professions (DHP) investigation process. Statewide, there's been an uptick in DHP in-person investigations based off patient complaints. The physician and provider community believe many of these stressful and time-consuming in-person visits can be avoided with a preliminary review.
This fall, VACEP leaders including president Jesse Spangler, MD, Board member Lauren Webb, MD and our government affairs lead Aimee Perron Seibert met with DHP director Arne Owens and chief deputy director James Jenkins Jr. to advocate for physicians who have been targeted with such investigations. We will have more to share soon, but if you have been impacted by these complaints, let us know.
A word on Downcoding
In 2023, VACEP scored a major victory in ending Virginia’s harmful “Downcoding Provision,” which automatically cut reimbursement on nearly 800 common ER diagnoses for Medicaid patients. Emergency medicine groups were later reimbursed for several months’ worth of claims from April to June 2023.
Though we attempted to continue this legal case in the hopes of fair reimbursement for several years’ worth of downcoded claims since the policy was enacted in July 2020, in August a judge ruled in favor of the Virginia Department of Medicare and Medicaid Services (DMAS), which oversaw this policy. While we believed our case was winnable and considered next steps including an appeal, we decided to wind it down due to the high financial risk.
Moving forward upholds our ability to continue our volunteer advocacy on several fronts: Protecting your physicians from medical malpractice, putting in place advanced provider scope of practice guardrails, ensuring public safety, keeping ED physicians and staff safe in the workplace, behavioral health, access to care, opioid death, and numerous other issues.
