Dr. Mark Rosenberg on the ACEP Board of Directors was appointed to the HHS Pain Management and Best Practices Task Force by the Secretary of the Department of Health and Human Services.
ACEP also submitted comments to the Senate Finance Committee regarding efforts that Medicare and Medicaid can take to improve our current opioid situation. ACEP is also working to address areas of concern under CARA 2.0. While this legislation has benefits, there are also areas that are concerning such as limiting prescribing to 3 days for opioids without exception. While this may be okay for many patients, there may be some that would benefit from a few more days and physicians should be able to exercise their own judgement. You can view ACEP’s responses to the Senate Finance Committee here. ACEP Response – Senate Finance Committee – Opioid Request – 02162018
SB 870 was voted out of the Senate Local Government Committee, and HB1919 was heard in the House Feb 13th at noon in HR6. Under this act, emergency medical technicians and paramedics shall only perform medical procedures as directed by treatment protocols approved by the regional medical director or as authorized through direct communication with online medical control. Basically, these bills prevent EMS providers from being forced to draw blood for police in the field. This was particularly a problem when EMT’s where caught in the middle as this was likely outside of their scope of practice and not approved by their medical director.
Anthem has softened the review process. Not to the point where we feel it is acceptable yet but there has been some improvement. Anthem has offered that if the patient receives a CT scan or MRI or receives IV fluids or IV medications that the claim will not be denied. They also have rescinded their modifier 25 policy which would have reduced payment when a E/M code was paired with a procedure code. We are still pushing for language in the bill to state that a Board Certified EM physician must review the chart before it can be denied.
Regarding our bill, Senator Onder presented Senate bill 928 , and Representative Henderson presented HB2225, to their respective committees last week. The Senate bill has made it out of committee. The House bill will likely make it out of committee on the 27th. The House bill will be relatively clean coming out, while the senate bill will be modified, primarily with the balance billing issue that Senator Schupp wants to fix for consumers. That piece has been more of a topic of conversation among the interested parties than the rest of the bill over the last 5 days. The balance billing provision is a result of constituents complaining to the legislature about receiving bills from certain practitioners while in the hospital (most common is anesthesiology). The latest language would require insurers to pay the greater of Medicare, average in network rate or UCR. If the provider and insurer can not agree on the amount, then they can appeal to the department of insurance for a decision. The patient could not be billed the difference and the insurer would have to pay the provider directly.
I’m sure everyone is aware that after a brief shutdown, a short term continuing resolution to fund the government was passed. Included in that was a very large spending agreement, which included several items that ACEP has been advocating for on behalf of its members.
-Medicare Extenders packge
-Repeal of the Independent Payment Advisory Board
-Funding for the Children’s Health Insurance Program for 4 additional years
-Technical fixes for the Medicare Access and CHIP Reauthorization Act (MACRA)
-Additional funding to address the opioid epidemic
-Elimination of the ‘misvalued codes’ initiative which would have resulted in cuts to physician payments
-5 year extension of the Medicare ambulance add-on payments
SB 678 was heard in committee. This bill would move Missouri from a modified joint and several liability to only several liability. Currently if someone is found to be at least 51% responsible for being at fault, then they could be held responsible for 100% of the plaintiff’s recovery. This bill would make it so that you’d only be responsible for your part of the damages.
The media is starting to look into and report about Anthem’s policy regarding not paying for emergency department visits.
In this article, the New York Times describes a patient with severe pain that was diagnosed with a ruptured ovarian cyst in the emergency department and how Anthem declined to pay for the evaluation as ‘it was not an emergency.’ According to the article, Anthem told the patient, “We do not believe that a person with an average knowledge of health and medicine would think that this needed care right away.” Just as important after Anthem denied payment to another patient for what may have been angioedema, she was quoted as saying, “It would have to be terribly life-threatening if I were to go (to the ED),” Kurtz said. “I would probably have to be (unconscious) and someone would have to carry me out.”
This week, the Centers for Medicare & Medicaid Services (CMS) released the finalized regulations for three different CY 2018 Medicare payment rules that impact emergency physicians.
- Provides up to a 5% bonus on clinician’s final MIPS score based on patient acuity
- Increases low volume exemption
Medicare Physician Fee Schedule
- Did not finalize proposal that would have cut RVUs for Emergency Physicians
- Will review future RUC recommendations before considering this in future rulemaking
Outpatient Payment System
- Pulled back proposal to make ED throughput of psychiatric patients a reportable measure. The information will still be available on data.medicare.gov for research and officials but will not be on the website for the general public.