On Tuesday, Representatives Ami Bera, MD (D-CA) and Larry Bucshon, MD (R-IN), introduced legislation to help stop one of the most significant components of the impending Medicare cuts facing emergency physicians in January 2023. The bipartisan bill, the "Supporting Medicare Providers Act of 2022," (H.R. 8800) provides an additional 4.42% to the Medicare Physician Fee Schedule (PFS) conversion factor for 2023, and acknowledges the necessity of long-term physician payment reform to provide necessary stability and certainty in the Medicare physician payment system. Click here to quickly send a message to your legislators asking them to support H.R. 8800 and help prevent a substantial part of the impending Medicare cuts.

Without congressional action before the end of the year, emergency physicians and other health care providers will receive a more than 10 percent cut to Medicare payments on January 1, 2023, due to a combination of sequestration cuts, "PAYGO" sequestration cuts, and the PFS cuts due to Medicare's "budget neutrality" requirements. While Congress mitigated the vast majority of these cuts at the end of 2021, emergency physicians have already felt the impact of approximately a 2% cut this year, and the annual threat of significant Medicare payment cuts once again jeopardizes the health care safety net. 

As reported last week, the legislation follows a parallel effort launched by a bipartisan group of eight members of the House of Representatives who issued a request for information (RFI) to solicit feedback from stakeholders to help develop a comprehensive solution to challenges in the Medicare payment system. Led by Representatives Ami Bera, MD (D-CA), Larry Bucshon, MD (R-IN), Kim Schrier, MD (D-WA), Michael Burgess, MD (R-TX), Earl Blumenauer (D-OR), Brad Wenstrup, DPM, (R-OH), Brad Schneider (D-IL), and Marianette Miller-Meeks, MD, (R-IA), the RFI asks stakeholders to provide their input by October 31, 2022. ACEP is currently in the process of providing a response to this workgroup and will share the response when submitted in the coming weeks.

On Wednesday, the House of Representatives passed the "Improving Seniors' Timely Access to Care Act," (H.R. 3173), by voice vote. Introduced by Reps. Suzan DelBene (D-CA), Mike Kelly (R-PA), Ami Bera, MD (D-CA) and Larry Bucshon, MD (R-IN), this ACEP-supported legislation improves and streamlines the Medicare Advantage "prior authorization" process and is one of the most heavily cosponsored bills in the 117th Congress with 326 bipartisan cosponsors. It now awaits further action in the Senate.

The legislation would streamline the prior authorization (PA) process in Medicare Advantage (MA) and increase transparency by: 

• Giving providers greater access to criteria for PA determinations;
• Requiring MA plans to compile annually and publish publicly: (1) a list of services subject to PA; (2) rates of initial approvals and successful appeals; and (3) time delays resulting from PA;
• Adopting MA beneficiary protections via federal rule making to improve PA transparency, identifying services with high approval rates, providing continuity of care when changing coverage, and ensuring that PA programs adhere to evidence-based guidelines;
• Expanding use of electronic prior authorization in MA.

Prior to passage on the floor Wednesday morning, the House Energy and Commerce Health Subcommittee held a markup of five health care related bills, including H.R. 3173 (the House Ways and Means Committee previously marked up this bill in July). Also included in the markup was the "Improving Trauma Systems and Emergency Care Act" (H.R. 8163), ACEP-supported legislation to reauthorize and improve critical trauma readiness programs and improve coordination between emergency medical services and trauma care centers.

ACEP continues to monitor the progress of H.R. 3173 as the focus now shifts to the Senate. While it is unlikely to be considered as a standalone bill on the Senate floor, ACEP and the physician community, as well as a coalition of more than 450 endorsing organizations, continue working to ensure this important reform is included in any larger legislative vehicles Congress must consider prior to the end of the year.

On Thursday, the House Ways and Means Committee held a hearing entitled, "Preparing America's Health Care Infrastructure for the Climate Crisis." The hearing was also accompanied by a committee report analyzing responses from health systems, hospitals, dialysis companies, nursing homes, community health centers, and health care trade associations following a request for information sent earlier in 2022. 

The hearing featured an emergency physician witness, Paul Biddinger, MD, FACEP, Chief Preparedness and Continuity Officer, Massachusetts General Hospital Brigham and Director of the Center for Disaster Medicine at Mass General, who highlighted instances when climate-related events caused near-failures in the health care system and emphasized the need for increased data that describes the specific impacts of climate change. He also underscored the need for hospitals to utilize available data for climate projections under the Centers for Medicare & Medicaid Services (CMS) Emergency Preparedness rule, as well as strengthening current infrastructure in the most vulnerable areas. 

NEMPAC VIP Donor Reception (by invitation only)
Friday, September 30 from 6:00 - 8:00pm, The View Lounge, San Francisco Marriott Marquis

NEMPAC donors at the Sterling level or above ($600 for attendings/$60 for residents/fellows/medical students annually) are invited to celebrate NEMPAC's success while mingling with other donors and NEMPAC and ACEP leaders. 

NEMPAC "Give-A-Shift" Donor Lounge (by invitation only)
Saturday, October 1 - Monday, October 3, 8:00am - 4:00pm, Moscone Center, Lobby Level South, Room 104

ACEP members who have donated at the "Give-a-Shift" level ($1,200 for Attendings, $120 for Residents, $365 for Transitioning and Retired Members) in 2022 are invited to visit and enjoy this private lounge with complimentary beverages, hot buffet lunch, snacks, head and neck massage appointments, and business center amenities. NEMPAC Board members and staff will be available to discuss NEMPAC's mission and activities.

Click here to contribute to NEMPAC and secure your invitation. Donors who are currently eligible will receive an invitation via email. Questions about your donation status? Click here to email us.

Contributions or gifts to NEMPAC are voluntary and are not tax deductible for federal income tax purposes. The amount given or refusal to donate will not benefit or disadvantage you. By law, we may only use your contribution to support federal candidates if your contribution is made using a personal credit card or personal check. We are required to provide your employer name, your occupation, and to obtain an original signature of the ACEP member if contributing by credit card. NEMPAC encourages personal contributions. All non-personal contributions to NEMPAC will be used to defray costs of educational programs for NEMPAC and other activities permissible under federal law.

Saturday, October 1, 10:30am - 12:30pm
Moscone Center, Upper Mezzanine, 151

Back by popular demand, ACEP is pleased to offer Spokesperson Media Training, an exclusive interactive workshop reserved only for ACEP22 registrants. During this session, you'll hear from communication experts and get one-on-one guidance as you learn how to enhance your ability to communicate clearly and deliver key messages to the media and other stakeholders. Last minute walk-ins are welcome (space pending), but to guarantee your spot add it to your course schedule. 

Celebrate National Voter Registration Day by making sure you're ready for the 2022 Midterms: Click here and enter your address for voter resources and the list of candidates who will be on your ballot. 

In back-to-back weeks, ACEP has submitted responses to major annual Medicare proposed regulations: last week it was the Physician Fee Schedule (PFS), and this week, it's the Medicare Outpatient Prospective Payment System (OPPS). 

While the PFS is the most impactful reg that ACEP responds to each year, the policies within the OPPS reg also can significantly affect you as emergency physicians and your patients since they focus on the facility payments that hospitals receive for outpatient services (including emergency care).  

Read the Regs & Eggs blog for highlights of ACEP's response to the Calendar Year (CY) 2023 OPPS proposed reg, including an overview of our comments on rural emergency hospital policies and consolidation within health care. 

On Thursday, the Centers for Medicare & Medicaid Services (CMS) released data that highlights trends in the use of telehealth services between January 1, 2020 and March 31, 2022.  The data allows for analysis of telehealth utilization by quarter, state, and various demographic characteristics. Trends found in the data include:

• From 2020 to 2021, the percentage of Medicare users with a telehealth service dropped from 48% to 34%.
• White beneficiaries represented the lowest utilizations of telehealth service over every quarter (Q1 of 2020 to Q1 of 2022)
• Over every quarter, dual Medicare and Medicaid eligible beneficiaries utilized telehealth service more than Medicare only eligible beneficiaries.
• Medicare users aged 0-64 utilized telehealth on average 20% more than 65+ (~40% compared to ~20%).
• Urban Medicare users utilized telehealth more than rural users (~30% compared to ~20%)

The No Surprises Act includes provisions that enable patients to receive good faith cost estimates of scheduled services.  That way, patients have a better understanding of what the cost of services are before they receive them.  

The Departments of Health and Human Services, Labor, and Treasury (the Departments) have already issued regulations regarding good faith estimates for self-pay individuals or those that are uninsured. However, the Departments have yet to implement the requirement that patients with insurance receive good faith estimates.  Specifically, the No Surprises Act requires providers and facilities, upon an individual's scheduling of a service, or upon an individual's request, to inquire if the individual is insured.  If an individual is insured and wants the service to be covered by the insurer, providers and facilities must provide to the individual's health plan a good faith estimate of the expected charges for furnishing the scheduled service(s) along with the expected billing and diagnostic code(s) for the service(s).  Health plans, upon receiving the good faith estimate, must send a covered individual, through mail or electronic means, an advanced explanation of benefits (AEOB) in clear and understandable language.

The implementation of the AEOB requirement includes some complex operational issues, including enabling the transfer of cost data between providers and facilities and health plans.  To help develop regulations regarding the requirement, the Departments are requesting information from the public, through a formal Request for Information, on a range of issues to better inform future rulemaking. 

ACEP is reviewing the questions in the Request for Information and considering their applicability to emergency physicians.  In most cases, AEOBs would only be required for scheduled services, so they would not be necessary for unscheduled care delivered in emergency departments.