March 13, 2019

Councillor’s Corner

Summarizing the latest advocacy and policy news
By John Corker, MD, YPS Councillor, and Ben Karfunkle, MD, YPS Alternate Councillor
It’s been a busy month on the policy front for ACEP.  Most prominently, we recently offered Congress our proposal on the foundational elements necessary for a meaningful solution to the out-of-network billing impasse between insurance companies and our patients. The framework was based on – but more specific than – a proposal recently offered by the American Medical Association (AMA) supported by more than 100 state and specialty societies. Naturally, Congress has been receiving varying caricatures of this crisis from insurance companies, ERISA (self-insured corporations), hospitals and physicians, and has responded by calling for data. 
While ACEP gathers data on insurance denials and narrow networks, ACEP President Vidor Friedman recently met with the Senate Health, Education, Labor and Pensions (HELP) committee to discuss the issue and our DC staff continues to liaise with members of the House Energy and Commerce, Ways and Means, and Education and Labor committees, all of which have jurisdiction over this issue.  Speaking to those inside the meetings, it appears that the Department of Health and Human Services (HHS) understands our stance and remains skeptical of insurers. 
However, emboldened by a recent USC/Brookings Health Policy report, the White House appears to be seeking the highest savings for insurance companies and the government by promoting a one-size-fits-all solution of bundled payments for the publicly insured; a proposal ACEP strongly opposes. 
The ACEP 911 Advocacy Network continues to leverage its considerable grassroots resources to support our efforts by targeting friendly members of committees with jurisdiction on this issue. We expect specific legislation to be proposed either in the House (Rep. Cassidy’s R-LA work group) or by Senator Alexander’s R-TN HELP committee within the next month. Whichever specific framework is proposed will help ACEP focus our “asks” for our upcoming Leadership and Advocacy Conference (LAC) to be held in Washington, DC, May 5-8. Don’t miss out on this important opportunity!
In other news, the ACEP-supported bill HR 8 on firearm background checks easily passed the House last month but is not realistically expected to make its way through the Senate and to be signed by the POTUS. Discussion on funding for firearm safety research has been equally contentious, even within our own membership, as ACEP continues to receive mixed feedback on our advocacy in support of funding for this important research.
MedPAC recently met with ACEP to discuss ED utilization and coding trends.  It likely surprises no one here that they found ED utilization increasing and that there has been a shift to higher-level codes.  They acknowledged that some ED patients (about 2 percent) would have been more appropriately served at an Urgent Care Center (UCC), and that Medicare would have saved approximately $2 billion on these 500,000 visits if they’d chosen UCCs instead.  However, consensus remains opposed to insurer policies like Anthem’s that have retroactively denied claims, citing physicians’ common need for a comprehensive work-up before determining a patient’s complaints to be non-emergent. Many policy options were discussed surrounding patient education – including a 24-hour nurse help line – but there was no consensus on their perceived utility. The latter shift in coding appears to be driven primarily by hospital facility codes rather than physicians’ professional codes, and there was consensus that CMS should finally trial/implement ACEP’s proposed coding guidelines that have been previously cast aside.  Note: MedPAC can only make recommendations to Congress. None of their policies or proposals constitute law.
Finally, the Centers for Medicare and Medicaid Services (CMS) recently released a five-year VOLUNTARY model to pay ambulance services for transporting Medicare patients to “appropriate alternative” sites of care, where previously only transport to the emergency department was reimbursed. Under this model, there would be two alternatives (Primary Care office, and Urgent Care center), reimbursed at different rates, and adjudicated by the transporting crew. Concerns remain over appropriate medical coding for these transports, and of course EMTALA-related concerns for crews owned and operated by hospitals. ACEP has yet to formally opine on the proposal.
That’s it for this month’s Councilor’s Corner. Stay in touch, reach out any time with questions, and we’ll look forward to seeing you all in DC May 5-8 for LAC19!