May 18, 2023

“Eggs Over (Not) Easy”: My Last Regs and Eggs at ACEP

After five years at ACEP, four of which were spent writing this weekly breakfast blog (around 190 posts!), I have decided to pursue another opportunity. Beginning in June, I will start a new position as a Health Policy Director at McDermott+Consulting, a Washington, DC-based health policy and lobbying consulting firm.

It’s been a pleasure and truly an honor to have had the chance to advocate on behalf of you all—the emergency physicians who serve as the safety net of our health care system. And together we have shared some highs and lows of our ongoing advocacy efforts.

We have celebrated the victories, such as:

  • The “Awesome” AUCM Model: Having the first, and only, emergency medicine-focused alternative payment model (the Acute Unscheduled Care Model or AUCM) considered and endorsed by an independent commission that recommended it to the federal government for implementation—and as that model is being considered for implementation, getting an emergency medicine MIPS Value Pathway (MVP) and a cost measure approved that was based on the AUCM.
  • Eating and Drinking in the ED: Getting clarification from the Occupational Safety and Health Administration (OSHA) that you are free to eat and drink in the emergency department (ED).
  • TJC Violence Standard: Working with The Joint Commission (TJC) on a new workplace violence standard that was implemented in 2022.
  • Emergency Medicine Code Values: Securing increases to the codes that you typically bill in both 2020 and 2021 and maintaining those increases in 2022 and 2023.
  • Emergency Medicine Telehealth: Getting the ED evaluation and management codes on the approved Medicare Telehealth List through the end of 2023 (at least).
  • Barriers to Buprenorphine Prescribing: Although significant barriers remain, getting the X-waiver removed and securing important changes to the “Three Day Rule.”
  • No Surprises Act Minor Victories: In the face of numerous challenges with the No Surprises Act implementation (more on that below), getting small victories throughout: 1) pushing for strong language supporting the Prudent Layperson Standard that was included in the first interim final reg; 2) securing a regulatory definition of downcoding and required information from plans on downcoded claims; 3) having ghost rates eliminated from the Qualifying Payment Amount (QPA) calculation; and 4) allowing the Independent Dispute Resolution (IDR) timeline to continue even when payors don’t participate in the process.

We have also commiserated together on our defeats and ongoing struggles:

  • Medicare Cuts: The annual song and dance that we go through to prevent you all from receiving significant cuts to Medicare reimbursement.
  • No Surprises Act Implementation: The disastrous implementation of this law and all the challenges you face (with new ones every day) to receive an adequate payment for out-of-network services.
  • Bad Payor Behavior: Denials and downcoding by Medicaid Managed care plans and other private health plans.

While these challenges (and others) that we continue to face may seem daunting, I do feel like with the power of our collective advocacy, with ACEP members yourselves advocating on behalf of your specialty and your patients every day, there is light at the end of the tunnel—and we soon will make progress on the issues that have weighed us down for years.

And don’t worry, you haven’t seen the last of me! I’m still going to be knee-deep in health care regs, devouring them for breakfast, lunch, and dinner. So, if you need me, I’m just an email away (and I may continue blogging in my new position)!

Finally, if you ever feel nostalgic and want some regs with your eggs (even if they are a little past due), then you can check out all the previous blog posts here, or find them by topic area:

One last thing. I have to give a shout-out to my colleague, Ryan McBride. I was soliciting titles for this last blog post from ACEP, and some of the suggestions Ryan came up with included:

  • The Life and Death of Regs & Eggs
  • The Brief Wonderful Life of Regs & Eggs
  • Remains Of the Regs
  • May I Take Your Plate?
  • April? No, May Is the Cruelest Month
  • Do Not Comment Gently into That Good Night: The End of Regs & Eggs
  • So We Beat On, Regs Against the Comment…
  • It’s Over, But Never Easy

Don’t quit your day job, Ryan!

Until we meet again, this is Jeffrey saying, enjoy reading regs with your eggs!

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