Highlights from ACEP’s Leadership and Advocacy Conference, the Surgeon General’s address to emergency physicians, a new poll by ACEP on drug shortages and emergency preparedness, and FDA letter on drug shortages, an ACEP member testifying on Capitol Hill about opioids and a preview of ACEP’s tele-town hall meeting on gun violence and injury prevention. This is the latest coming out of Washington that affects emergency physicians and patients.
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 They also have rescinded their modifier 25 policy which would have reduced payment when a E/M code was paired with a procedure code.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.