Virginia, national ACEP Councillors tackles key EM issues at 2025 Council meeting

Councillors at work before ACEP25 kicked off.

Each year in the days before the American College of Emergency Physicians’ annual Scientific Assembly, Virginia’s 10 ACEP Councillors and those from 52 other chartered chapters gather to vote on a series of Resolutions under consideration by the College. 

• What is a Resolution? In ACEP — and other medical specialty associations — a Resolution is a proposal that calls on the organization to adopt a position or take an action. Council members debate and vote on the Resolutions, and if adopted, they become official policy and guide the Board of Directors in its legislative and regulatory advocacy, education, and member services.

  At this month’s ACEP Council meeting in Salt Lake City, delegates reviewed 90 Resolutions spanning workforce, policy, and patient care.

Yet Resolutions do more than set internal policy. A glance at the list of them sheds light on the issues at the center of emergency medicine practice today — from training and workforce pressures, to Medicaid funding, EMTALA protections, new technologies like AI, and the role of vaccines and public health. In fact, several “emergency” Resolutions were added after the original list of 85 were published to address the turmoil at the Centers for Disease Control and Prevention and shifting federal guidance on vaccines.

Cox

“There was a feeling in the room that health care is under attack,” said Roanoke emergency physician Caroline Cox, MD, a VACEP Board member and longtime ACEP Councillor.

Because of the divided political climate and federal challenges to public health in 2025, EM’s major issues took center stage at Council perhaps more than past years, while less-acute concerns received less attention.

“We don’t have any wiggle room in our systems — so issues we are facing today like losing Medicaid support, EMTALA protections, or access to vaccines could have ripple effects that push already overburdened emergency departments past their limits,” Cox said. “That’s why the Council focused on the big things this year — preserving access, protecting physicians, and making sure ACEP has a strong voice in national policy.”

Cox shared highlights from the discussions at Council, pointing to the big-picture themes that dominated this year’s session: residency training length, Medicaid, EMTALA protections, and the role of technology in care delivery.

Diversity, equity, and inclusion (Resolutions 26 & 27)

Councillors discussed actions at the federal and state levels that threaten to undermine DEI initiatives critical to fostering inclusive, equitable, and culturally competent health care environments. Resolutions considered reaffirming ACEP’s commitment to the core principles of diversity, equity, and inclusion, recognizing their fundamental role in promoting patient-centered care, health equity, and a representative workforce.

The Council reaffirmed DEI’s importance, but stopped short of adopting language that might appear overtly political. Both measures were referred to the Board of Directors, since ACEP already has existing policy statements and leaders wanted to avoid undermining broader advocacy efforts.

Research funding limits (Resolution 30)

A proposal to restrict ACEP’s Emergency Medicine Foundation research grants primarily to ACEP members was defeated. Cox said members felt the foundation should remain open to any research that strengthens emergency medicine — whether led by physicians, epidemiologists, nurses, or others.

EM Residency program length (Resolution 36)

One of the most debated topics was the Accreditation Council for Graduate Medical Education (ACGME)’s proposal to extend all emergency medicine residencies to four years.

With 80% of programs currently three years — and concerns about cost, student debt, and recruitment — the Council reaffirmed support for both three- and four-year programs. ACEP does not control program length, but members wanted to send a clear signal that both models remain valid, Cox said.

Non-compete clauses (Resolution 43)

“Everybody agrees that we should not have non-competes,” Cox noted, as the clauses restrict an emergency physician’s mobility and fair employment. A Resolution passed with support for ACEP to develop resources physicians can use during contract negotiations, including a generic support letter and publicly affirming that such clauses are unfair, ethically problematic, and harmful.

Delegates also reaffirmed support for advocating no-fault medical liability reform, a long-standing ACEP priority.

Medicaid preservation (Resolutions 45 & 46)

Medicaid funding drew considerable attention, especially with potential cuts looming. “The thing about Medicaid is that it is a desperately needed safety net, but the Medicaid system itself is very flawed,” Cox said, “including very low payment rates, coverage gaps, and the dominance of managed Medicaid plans (United, Anthem, etc.) that put up a lot of roadblocks to care.”

The Council backed a combined Resolution that affirmed Medicaid’s role as a vital safety net while acknowledging its issues and without endorsing the current setup. The adopted language emphasized preserving and expanding Medicaid funding, reducing barriers to care, and protecting disproportionate share hospital payments.

EMTALA (Resolutions 48 & 49)

Calls to reform EMTALA — an unfunded federal mandate — were tempered by concerns that weakening or replacing it could jeopardize patient protections.

As introduced, the Resolution called for EMTALA reform to reduce barriers to care. The proposal was amended to stress that problems like boarding stem from capacity and liability issues — not EMTALA itself. As examples, Cox noted rural hospitals often struggle to find accepting facilities for specialty transfers, while urban centers are overwhelmed and at capacity.

Cox said physicians discussed ideas like strengthening payment for services at smaller hospitals and enacting medical liability reform, which would help more than altering EMTALA. ACEP will continue advocating for policies that ease transfers and strengthen specialty access. 

Artificial intelligence in insurance (Resolution 56)

Delegates voiced concern about insurers using AI to deny, downcode, or delay claims. The Council adopted language requiring that denials be reviewed by qualified, board-certified physicians in the relevant specialty, and prohibiting insurers from using AI as a blanket tool to cut payments.

Certificate of Need (Resolution 57)

A proposal to repeal certificate of need (known as CON) laws outright was softened. CON laws are state regulations that require health care providers to obtain government approval before opening or expanding certain medical facilities, adding hospital beds, or purchasing big-ticket equipment like MRI or CT scanners.

CON laws can be a double-edged sword, she notes.

• On one hand, repeal could improve patient access — for example, “it would help us all if we had more MRI scans so patients didn’t have to wait hours for them.”

• On the other hand, removing CON protections could allow specialty hospitals (like outpatient orthopedic centers) to take profitable cases, leaving community EDs underfunded.

Instead, the Council adopted language urging ACEP to work with other healthcare organizations to educate policymakers on how such laws affect access to emergency care, overcrowding, and capacity — and to advocate for removing barriers where they limit patient flow.

Telemedicine oversight (Resolution 60)

A proposal that would have allowed tele-emergency oversight of rural EDs staffed only by non-physician providers was not adopted. Delegates reaffirmed ACEP’s stance that an in-person, board-certified emergency physician remains the gold standard.

Bullying in schools (Resolution 63)

One proposal called for standardized screening for bullying in the emergency department and additional physician education on intervening with pediatric patients. Cox said the Resolution was defeated — not because emergency physicians don’t care, but because ED teams already ask patients a long list of screening questions (domestic violence, safety at home, travel history, falls, etc.), and there was strong reluctance to add yet another mandatory screen.

“We all want more resources for our pediatric mental health patients, but the truth is there’s not much we can do about school bullying from the ER,” Cox said.

Vaccines and CDC turmoil (Emergency Resolutions 89 & 90)

ACEP also introduced “Emergency Resolutions” focused on recent turmoil at the Centers for Disease Control and Prevention, along with shifting federal guidance on vaccines. Ultimately, ACEP joined with other groups to issue a statement warning that instability at the CDC endangers public health. The Council also reaffirmed support for scientific integrity in medicine and public health and in vaccine recommendations.

In conclusion: A focus on ‘the big things’

Cox said the meeting reflected a broader unease within the specialty: emergency medicine is being stretched by financial pressures, workforce challenges, and rising demand. The Council focused its energy on “the big things” — preserving access, protecting physicians, and making sure ACEP has a strong voice in shaping national policy.