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.

38 meetings with Senate and House offices advocating for enforcement of the No Surprises Act, Medicare Physician Fee Schedule reform and reauthorization of the Dr. Lorna Breen Provider Protection Act. 

13 Letters to Support State Advocacy Priorities in Florida, Illinois (x 2), Arizona (x2) , Connecticut (x2), Colorado, Georgia, Indiana, Iowa, Nebraska, Texas and Missouri.

6 Grassroots Campaigns to reverse the MPFS cut (x2) and to support legislative priorities in Florida, Connecticut , Colorado and Ohio.

3 Meetings with the Department of Health and Human Services and the Center for Consumer Information and Insurance Oversight (CIIO) on the No Surprises Act Independent Dispute Resolution (IDR) process and the Change Healthcare cyberattack. EDPMA also many times with CCIIO and  the Department of Labor on the impact of the disruption of the Change Healthcare cyberattack.  EDPMA held additional meetings with CCIIO urging them to include clarifications on the IDR cooling process in the next FAQs.

3 Member Alerts regarding the Change Healthcare cyberattack (x2) and a members-only “Ask The Expert” Town Hall.

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.

2 Endorsements to members of Congress to support the reauthorization of the Dr. Lorna Breen Health Care Provider Protection Act and the Improving Seniors’ Timely Access to Care Act.

1 Letter to the Department of Health and Human Services, one letter to the Departments and one note to 736 Capitol Hill staffers advocating for emergency medicine practices in wake of the Change Healthcare cyberattack.

1 Town Hall: The Impact of the Change Healthcare Cyberattack.

1 Letter to Congress supporting permanent telehealth policy flexibilities.

1 Response to a Request for Information (RFI) on the Consolidation in Health Care Markets from the Department of Justice, Department of Health and Human Services and the Federal Trade Commission.

(1) Letter to the Senate Medicare Physician Fee Schedule Work Group and (1) response to the Senate Finance Committee White Paper “Bolstering Chronic Care through Physician Payment: Current Challenges and Policy Options in Medicare Part B.

1 Meeting With Congressional Staff to discuss the impact of Electronic Fund Transfer and Virtual Credit Card fees have on emergency medicine practices.

1 Meeting with the Iowa Department of Health and Human Services.

1 Amicus Brief to support the TMA III appeal focused on QPA methodology and insurer disclosure requirements.

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

EDPMA 2024 Advocacy Successes

EDPMA advocated for its members in wake of the disruption caused by the Change Healthcare cyberattack:

  • Opportunities to increase practice cash flow like providing flexibilities for the Medicare Advanced and Accelerated Payments Program (Advocated for by EDPMA and granted);
  • Investigatory efforts to quantify the full impact of the cyberattack (Advocated for by EDPMA and granted);
  • Provide flexibilities for Merit-Based Incentive Payments System (MIPS) reporting deadlines (Advocated for by EDPMA and granted);
  • Increase outreach to physician practices, hospitals, and revenue cycle management entities (Advocated for by EDPMA and granted).

EDPMA’s vigorous advocacy to CMS and CCIIO to provide flexibilities for members affected by the Change Healthcare cyberattack and related outages paid off. CMS announced IDR 120-calendar-day open negotiation flexibility for entities affected by the Change Healthcare outage.

EDPMA advocated to the Center for Consumer Information and Insurance Oversight (CCIIO) to reach out to Independent Dispute Resolution Entities (IDREs) regarding IDREs rejection of batches on disputes held together in the same 90-day cooling off period. CCIIO confirmed they communicated with IDREs “to clarify the items and services delivered during the same 90-day cooling off period that meet all applicable batching requirements may be included in the same batch. “

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 the No Surprises Act 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.