Advocacy Successes

EDPMA amplifies your voice to influence legislative and regulatory decision makers to actively support the delivery of high-quality, cost-effective care in the emergency department.

EDPMA 2024 Advocacy By The Numbers (YTD)

While numbers may capture our activity, our advocacy efforts and focus capture so much more. Your membership equips EDPMA with the firepower to drive change to protect your business and your patients.

5 Letters to Support State Advocacy Priorities in Florida, Illinois, Arizona (x2) and Connecticut
3 Grassroots Campaigns to reverse the MPFS cut (twice!) and to support legislative priorities in Florida.

2 Letters to the Tri-Departments to urge enforcement and ensure effective dates are practical, reasonable and fair and to address health plans changing the patient cost-sharing amounts after the IDRE payment determination and hold health plans accountable for violating the patient protections in the No Surprises Act.

1 meeting with the Center for Consumer Information and Insurance Oversight (CIIO) on the No Surprises Act Independent Dispute Resolution (IDR) process.

1 Endorsement to members of Congress to support the reauthorization of the Dr. Lorna Breen Health Care Provider Protection Act

1 Letter to Congress supporting permanent telehealth policy flexibilities.

1 Letter to comment on Equity of Emergency Care Capacity and Quality eCQM proposed measures

EDPMA 2023 Advocacy By The Numbers

While numbers may capture our activity, our advocacy efforts and focus capture so much more. Your membership equips EDPMA with the firepower to drive change to protect your business and your patients.

 50 Meetings with members of Congress and staffers on EDPMA Lobby Day and the Doc Caucus 

 25 Member Alerts plus immediate updates on the IDR process 

 18 Letters to Congress on issues including fixing the flawed No Surprises Act, prevention of proposed Medicare Physician Fee Schedule cut, extending telehealth codes, rural health and reauthorization of the Pandemic, All Hazards Preparedness Act (PAHPA) and the No Fees For EFTs Act

 14 Letters and Meetings with CMS/CCIIO bringing attention to and recommending solutions for the unlawful and detrimental implementation of the No Surprises Act and opposition of the G2211 code 

  4 Coalitions and Letters to support state advocacy efforts in Indiana, Texas, California, and Washington. 

  4 Amicus Briefs to successfully supporting litigation led by the Texas Medical Association and to protect access to courts to pursue OON billing disputes in the Haller lawsuit. 

   3 Congressional Events on NSA with questions and information submitted by EDPMA 

   3 New Advocacy Resources in the EDPMA Toolbox 

   3 Grassroots Campaigns on Medicare Physician Fee Schedule Reform, to increase Medi-Cal rates and to urge the Energy & Commerce Committee to convene an insurer oversight hearing. 

2023 Advocacy Wins and Progress 

The Departments added 40 days to file batched disputes when the federal IDR portal opened (after being closed for 4+ months). EDPMA was the only organization in the specialty who made this request.

CMS finalized permanent split (or shared) E/M Policy as requested by EDPMA 

EDPMA successfully pushed back on proposed statutory expansion of Qualified Payment Amount (QPA) in the Primary Care and Health Workforce Expansion Act  

EDPMA filed an amicus brief to support the fourth lawsuit led by the Texas Medical Association. The court struck down two actions by CMS that did not comply with the No Surprises Act including the sudden 600%  increase of the administrative fees for out-of-network disputes in the overly restrictive batching requirements, and provisions related to the methodology for calculating the QPA.  

EDPMA No Surprises Act ongoing advocacy and specific requests acknowledged and evident in recent Federal IDR Operations proposals 

EDPMA successfully encouraged the continued inclusion of emergency department E/M and critical care service codes on the list of approved Medicare Telehealth Services for CY 2024 

CMS acknowledged EDPMA requests for the availability of more emergency medicine-focused measure reporting opportunities in the MIPS program 

EDPMA successfully pushed back on the CMS proposal to remove the hospital outpatient measure OP-22: Left Without Being Seen (LWBS), which CMS had proposed to eliminate for CY 2024 reporting period/2026 payment determination 

EDPMA Advocates Using Data

Based on your experiences, input, and concerns, EDPMA commissioned a study in 2022 looking at out-of-network payments before and after the implementation of the NSA. EDPMA’s study reveals:

  • 91% of claims surveyed did NOT include an identified QPA as required by law.
  • Post-NSA Out-of-Network payments decreased 92% of the time (compared to Pre-NSA rates) resulting in an average revenue decrease of 32% per ER visit.
  • The IDR volumes are driven by artificially low QPAs, payer intransigence, failure of Open Negotiation, health plan termination of in-network agreements, and CMS’ refusal to implement common-sense recommendations.
  • When reported, the QPA consistently equals the allowed amount for provider payments. This means that health plans are regularly using a problematic QPA amount when the NSA clearly indicates that the QPA should not be the sole payment standard.

In conclusion, the Emergency Department staffing is in jeopardy.

EDPMA is committed to a viable and sustainable No Surprises Act implementation. We continue to offer solutions, input, and data to the Tri-Departments to promote:

  • Rapid and effective enforcement of NSA provisions.
  • Required use of RARC codes for claims processed under no surprise billing regulations.
  • The creation of specific RARC codes to identify if claims were processed under either federal or state regulations.
  • Accurate QPA calculation.
  • Continued Congressional Involvement.
  • Sustain patient protections under EMTALA.

EDPMA 2023 Advocacy Priorities

EDPMA continues to advocate on our members behalf for the following:

  • Recommending solutions to the flawed implementation of the No Surprises Act.
  • The creation of the I-Tact Task Force which focuses on NSA Compliance, IDR and IDRE Non-Compliance, and Legislative and Regulatory Fixes.
  • Medicare Physician Fee Schedule
  • Down Coding Policies
  • Preservation of patient access to care.

2021 Advocacy Successes

2020 Advocacy Successes