Decision Favors ACEP in Lawsuit Against Federal Government

This message was issued by ACEP President Dr. Rebecca Parker on August 31, 2017

The federal court system took a step in the right direction Thursday when it was announced that the Centers for Medicare & Medicaid Services (CMS) needs to further explain a regulation that impedes emergency physicians from receiving reasonable payment for out-of-network services.

ACEP filed suit against the federal government in May 2016 in response to the Government’s refusal to address concerns ACEP set forth regarding a CMS regulation for out-of-network emergency physician payment, which outlines the “greatest of three” options. As written, ACEP believes this rule, which originated from the ACA in 2010, opens the door for insurers to use black box methods to determine physician payment without providing any means to verify the data. In November 2016, ACEP then filed a Motion for Summary Judgment asking the Court to rule in its favor on this issue.

On Thursday, the U.S. District Court for the District of Columbia partially granted ACEP’s Motion and denied the Government’s counter motion. More importantly, it remanded the matter back to the federal agencies for further explanation of the ruling, saying that comments had previously been submitted during the regulation’s development expressing “concerns … for example, that the methods it used to set payments were not transparent and could be manipulated by insurers. Many of these commenters proposed using a transparent database to set payments instead. The Departments all but ignored these comments and proposals.”

Since 2010, ACEP has had numerous meetings with federal officials, sent formal comments, and drafted guidance to voice the concerns of our 37,000 members that the “greatest of three” rule cannot be enforced and has the potential to be manipulated by insurers without a transparent database of usual and customary charges

This decision does not invalidate the rule; however, it forces the Government to respond to ACEP’s concerns in a substantive manner.

ACEP will always continue the fight to protect the specialty of emergency medicine that Americans have come to depend on.

More details about the lawsuit –
http://www.acepnow.com/article/acep-sue-federal-government-health-insurer-billing-practices/

Nation’s Emergency Physicians: Senate’s Alternative to Affordable Care Act Is a Huge Disappointment

This statement was issues from ACEP President Dr. Rebecca Parker on June 23, 2017:

The American College of Emergency Physicians (ACEP) today issued a statement deeply critical of the draft health care legislation introduced yesterday in the Senate, known as the Better Care Reconciliation Act, or BCRA. ACEP’s president, Dr. Rebecca Parker, said:

“Senators should vote ‘no’ on BCRA as it stands today. After holding out hope that the Senate would develop a bill more in line with our priorities, we are extremely disappointed that the Senate’s health care legislation is no better and actually worse than what was introduced in the House of Representatives, the American Health Care Act. The draft that was introduced yesterday makes sweeping changes to the health care system that directly contradict ACEP’s principles and endanger patient safety and patients’ lives. It is a step backwards from improving the health of the nation.

“Of immediate concern is the gutting of Medicaid coverage for millions of Americans who will likely be uninsured or underinsured as a result. The inevitable consequence of people losing their insurance is increases in patient loads and crowding at emergency departments, which are already seeing record numbers of patients. Similarly, when patients have insurance with astronomical deductibles, they delay regular care until a problem becomes so acute they end up in the emergency department. This new legislation will create burdens on ERs that are unsustainable and dangerous.

“In addition, the loss of guaranteed coverage for emergency care – which was one of the essential health benefits of the Affordable Care Act – is basically a gift to insurers, who historically have always chosen to deny coverage when given the option. Access to emergency medical care is critical to all Americans, as is insurance coverage for that care. In a recent poll, Americans overwhelmingly — 95 percent— wanted health insurance companies to cover emergency medical carei.

“We also have grave concerns that this bill does nothing to address the epidemic of opioid and drug dependence in the country, which led to a 99 percent increase in emergency department visits between 2005 and 2014.ii No members of the medical profession see the scourge of opioid addiction more than emergency physicians. The amount of money set aside by BCRA for treatment of the disease of addiction is no better than pocket change.

“Next week, Senators have an opportunity to offer amendments to address the numerous problems that currently exist in BCRA. We hope they are given ample opportunity to discuss and amend the gaping holes in this legislation. Our concerns, which are shared by virtually every other medical group, should serve as a wake-up call to all members of Congress. Without significant improvements, ACEP cannot support this bill and urges members to vote ‘no’ on BCRA.”

i http://newsroom.acep.org/2017-03-16-Public-Overwhelmingly-Wants-Insurance-Companies-To-Cover-Emergency-Care-and-To-Be-Transparent
ii https://www.hcup-us.ahrq.gov/reports/statbriefs/sb224-Patient-Characteristics-Opioid-Hospital-Stays-ED-Visits-by-State.pdf

ACEP Joins Coalition to Oppose Medical Merit Badges

March 30, 2017

The American College of Emergency Physicians is pleased to announce a historic collaboration involving nearly every major emergency medicine organization: The Coalition to Oppose Medical Merit Badges. Coalition members include the following organizations:

  • American Academy of Emergency Medicine (AAEM)
  • American Academy of Emergency Medicine/Resident and Student Association (AAEM/RSA)
  • American Board of Emergency Medicine (ABEM)
  • American College of Emergency Physicians (ACEP)
  • Association of Academic Chairs of Emergency Medicine (AACEM)
  • Council of Emergency Medicine Residency Directors (CORD)
  • Emergency Medicine Residents’ Association (EMRA)
  • Society for Academic Emergency Medicine (SAEM)

Board-certified emergency physicians who actively maintain their board certification should not be required to complete short-course certification in advanced resuscitation, trauma care, stroke care, cardiovascular care, or pediatric care in order to obtain or maintain medical staff privileges to work in an emergency department. Similarly, mandatory targeted continuing medical education (CME) requirements do not offer any meaningful value for the public or for the emergency physician who has achieved and maintained board certification. Such requirements are often promulgated by others who incompletely understand the foundation of knowledge and skills acquired by successfully completing an Accreditation Council for Graduate Medical Education–accredited emergency medicine residency program. These “merit badges” add no additional value for board-certified emergency physicians. Instead, they devalue the board certification process, failing to recognize the rigor of the ABEM Maintenance of Certification (MOC) program. In essence, medical merit badges set a lower bar than a diplomate’s education, training, and ongoing learning, as measured by initial board certification and maintenance of certification.

The Coalition finds no rational justification to require medical merit badges for board-certified emergency physicians who maintain their board certification. Our committed professional organizations provide the best opportunities for continuous professional development, and medical merit badges dismiss the quality of those educational efforts.

Opposing the requirements for medical merit badges will be a long and challenging struggle. It will take time to help administrators and regulatory bodies to better understand the rigorous standards to which we adhere as board-certified emergency physicians. In the coming months, we will develop our long-term strategy to create success and a pathway to recognize clinical excellence.

We welcome your thoughts and suggestions as to how we can best succeed. In the near future, we will ask for strong support and a loud and unified voice.

We will persist and we are up to the challenge—we are board-certified emergency physicians. Opposing medical merit badges is the right thing to do for our specialty. We will forever demonstrate a lifelong commitment to caring for anyone who is ill or injured, at any time, for any reason.

Sincerely,
Kevin G. Rodgers, MD
President, AAEM

Mary Haas, MD
President, AAEM/RSA

Michael L. Carius, MD
President, ABEM

John J. Rogers, MD
Chair of the Board, ACEP

Richard Zane, MD
President, AACEM

Saadia Akhtar, MD
President, CORD

Alicia Kurtz, MD
President, EMRA

Andra L. Blomkalns, MD
President, SAEM