On Monday, September 26, 2022 EDPMA sent a letter to Reps. Bera and Bucshon thanking them for introducing HR 8800, Supporting Medicare Providers Act of 2022, and in support of the bill. The letter can be found here.

On Tuesday, September 13, 2022, EDPMA submitted comments to CMS on 2023 Hospital Outpatient Prospective Payment System (OPPS) and Rural Emergency Hospitals (REH) proposed rule. The letter focused on REH provisions. The letter can be found here.

On Monday, September 12, EDPMA sent a letter to congressional committee leaders requesting that Congress act before the end of the year to mitigate expected Medicare Physician Fee Schedule (MPFS) cuts in calendar year 2023. EDPMA is asking Congress to address the short-term issue of stabilizing Medicare reimbursement in 2023 by increasing the Medicare CF in 2023 by at least 4.5 percent, waiving the 4 percent PAYGO cut, and providing an inflationary update based on the Medicare Economic Index (MEI). EDPMA is also urging Congress to work towards a long-term solution to provide an annual inflationary update to provide greater stability for physicians participating in the Medicare program and their patients. The letter can be found here.

On Tuesday, September 6, EDPMA submitted a comment letter on the 2023 Medicare Physician Fee Schedule (MPFS) proposed rule. The letter can be found here.

On Thursday, August 25, 2022, EDPMA filed a comment letter with CMS on the Conditions of Participation for Rural Emergency Hospitals (REH) and Critical Access Hospital conditions of participation updates. The letter can be found here.

On Friday, August 19, 2022, The U.S. Departments of Labor, Health and Human Services, and the Treasury this afternoon released a final rule further implementing provision of the No Surprises Act.

This rule addresses the IDR components of the legislation and responds to the federal court ruling from earlier this year regarding the approach that arbiters must take when making a payment determination in federal IDR.

NOTE: this is separate from the proposed rule which has cleared OMB and we are expecting soon, which will focus on the Advanced EOB provisions of the NSA as well as “Other Provisions.”

Additional resources:

• Link to final rule
• Link to DOL press release
• Link to DOL fact sheet

Stay tuned for additional information and analysis.

#EDPMAHasYourBack

The Emergency Department Practice Management Association (EDPMA) is concerned about health plans’ systemic and drastic reductions in emergency medicine physician reimbursement and threats to physician group contracts under their misinterpretation of the No Surprises Act. To read the full letter click HERE.

On July 27 EDPMA joined medical societies urging Congress to pass legislation that provides at least a 4.5% CF adjustment for 2023 and waives the 4% statutory PAYGO requirement. We also ask for legislation to provide a one-year inflationary update based on the Medicare Economic Index. These important policy changes will undoubtedly provide our members with crucial short-term fiscal stability while simultaneously laying the foundation for necessary long-term payment reforms.  The letter can be found here.

This afternoon, the Centers for Medicare and Medicaid Services released the calendar year (CY) 2023 Hospital Outpatient Prospective Payment System (OPPS) proposed rule.  While physician payments under the Medicare Physician Fee Schedule continue to be cut due to statutory budget neutrality provisions, CMS proposes to increase hospital outpatient payments by 2.7%. 

Also included in this proposed rule are several new provisions for Rural Emergency Hospitals (REHs). Congressionally-created in the Consolidated Appropriations Act, 2021, REH is the new enrollment designation for hospitals that “were CAHs [critical access hospitals] or rural hospitals with not more than 50 beds, participating in Medicare, as of the date of enactment” (December 27, 2020) and wish to convert to and enroll in Medicare as an REH. REHs must provide emergency and observation care. As you will recall, we recently announced a proposed rule directed at the Conditions of Participation (CoPs) for REHs.  The provisions included here in the CY 2023 OPPS proposed rule are directed at REH enrollment, payment, and quality reporting.  A CMS fact sheet on REHs is available here.  CMS notes that it will finalize the REH CoPs with the enrollment, payment, and quality reporting provisions later this Fall. 

For those interested in more details, CMS also issued a related press release and fact sheet.   

EDPMA will continue to review all of the provisions of the rule and provide additional details.  EDPMA plans to file comments on the proposed rule by the September 13, 2022 deadline.
#EDPMAHasYourBack

McLean, Virginia – The Emergency Department Practice Management Association (EDPMA) is concerned that payers are denying payments to emergency medicine physicians for essential and lifesaving care they provide to patients. EDPMA believes that emergency physicians should be able to deliver high-quality, cost effective care in the emergency department and that payers should reimburse highly-trained emergency physicians based on a patient’s presenting symptoms.

However, many payers prioritize profits over patient care with the systemic practice to unnecessarily delay, deny, or reduce payments. EDPMA believes this is wrong and advocates on the regulatory, federal, and state levels to combat this practice on behalf of its members.

EDPMA also supports the efforts of our member organizations to advocate on behalf of their emergency physicians, such as Fremont Emergency Services’ litigation to hold UnitedHealthcare accountable for its policy to withhold payment to ER doctors after services have been rendered. In this vein, we support our colleague’s efforts to advocate for emergency physicians and patients by any means necessary, including litigation.

“EDPMA continues to hold payers accountable for systemic practices that do not acknowledge or compensate for medical decision making in the emergency department,” says Don Powell, DO, FACEP, EDPMA Chair of the Board. “We strongly believe that emergency physicians should be fairly reimbursed for the delivery of emergency care, and payers should do their part to not undermine the emergency medical health care delivery system or the overall health of our healthcare system. EDPMA is in the business of emergency medicine and will continue to advocate for its members and patients.”

About EDPMA
The Emergency Department Practice Management Association (EDPMA) is the nation’s largest professional physician trade association focused on the delivery of high-quality, cost-effective care in the emergency department. EDPMA’s membership includes emergency medicine physician groups of all sizes, as well as billing, coding, and other professional support organizations that assist healthcare providers in our nation’s emergency departments. Together, EDPMA’s members deliver (or directly support) health care for about half of the 146 million patients that visit U.S. emergency
departments each year. Visit https://edpma.currentmediagroup.net.

Contact:
Cathey Wise
703.506.3282 (direct) l 817.905.3310 (cell)
[email protected]