September 18, 2023

Emergency Care Improvement Act (SB 1964)

The Emergency Care Improvement Act is the continuing effort of the FEC industry to be included in CMS recognition. We have been trying to get this or a form of this legislation passed for several years. A form of it was introduced by Senator Dr Bill Cassidy of Louisiana (S. 3531) for several years, but this year it has been introduced by Congressman Jodie Arrington and co-sponsored by multiple other congressmen. Senator Ted Cruz has suggested that he will introduce it in the senate, but hasn't yet.

It simply adds to the Affordable Care Act that states "Emergency care is that care provided in the four walls of a hospital designated for emergency medicine" the phrase "or in a state licensed facility licensed to practice emergency medicine." It also has additional wordage that Billing Code levels 1 and 2 will only be charged professional fee. This is to reassure the government entities and individuals that FECs will not be charging Emergency care prices to urgent care patients, as levels 1 and 2 billing code are more or less urgent care type patients. This was one of the major criticisms of CMS and others of FECs. Looking at actual rosters of patients seen by most FECs, billing code levels 1 and 2 are only about 4-10% of FECs volume. One of the questions asked and discussed is whether this stipulation in the bill will allow the hybrid FEC/Urgent care combo facilities to operate without the required separate areas for each function without the firewall and separate entrance. It also stipulates that it will be retroactive to May 11, 2023, when the CMS emergency pandemic waiver ended for FECs. Of note is that most of the FECs that have been taking CMS in the past waiver period, have continued to see Medicare, and Tricare (which requires a Medicare number to be reimbursed for Tricare) because the patients in their areas have become so dependent on this life-saving care that the effects of pulling this away from them could have bad results.  Additionally, our military needs to be focusing on the mission at hand and not worrying whether their sick child back home can find Emergency care. Our elderly are our most vulnerable part of our population, least able to tolerate the decreased access and long wait times of going to the more distant and more crowded hospital based Emergency departments.

Of note is that a FEC in the states they are licensed now will not be required to accept CMS patients if this bill passes. This is an option they can opt into. In my own personal experience, our volumes of private insured patients have gone up in our sites that have started taking and still take CMS patients and we hear from the populations that we serve that, the fact that we provide care for the elderly of their families and the military heroes in their communities prompts the rest of the family and friends of the military to use us as well. If you think of the typical family of today, by the time a typical person reaches Medicare age, they will have 2 to four children with their spouses and their children on private insurance that will far overcompensate for the lesser reimbursement and higher acuity of the typical Medicare patient with their privately insured higher reimbursing visit volume.  

The other important factor in getting permanent CMS acceptance is that if further ingrains our industry in the health care system and allows us to take EMS traffic to better be able to go out and serve those more rural communities, which will be helpful in allowing our industry to further innovate and provide care in a much more comprehensive manner mentioned in the article of FECs potential.

Please help by asking senators and congressmen to help pass the Emergency Care Improvement Act as soon as possible so that we can better serve our communities.  

[ Feedback → ]