Ryan Thompson, MD, FACEP
WACEP President’s Message, August 2020
I recently started work on an addition for my house, and after digging a giant hole, my contractor discovered that the sandy dirt under my foundation had largely eroded away in the 90 years since the house had been built. This was an unwelcome (and expensive!) discovery, but even more concerning is that I suddenly had to worry about my house collapsing – a possibility I had never even considered in my 5 years of living there. How could something as seemingly small as sand have such a major impact on the stability of my home?!
Just like the sand under my home, Medicare reimbursement is probably something most emergency physicians rarely think about. However, since we see such a large number of Medicare patients, those payments do serve as the foundation for the financial solvency of many of our practices. And also like that sand, those payments are at threat of bringing down the whole house if they erode away.
ACEP had actually made great headway on increasing CMS payments for emergency E/M codes in this year’s CMS reimbursement fee schedule update. They were able to secure an increase of about 12.7% for level 3 charts, and an increase of about 5.25% for level 4 and 5 charts. This is good news! However, as always, the devil is in the details. In order to promote primary care, CMS increased payments for all outpatient office codes. However, CMS has a mandate to remain budget neutral, so they have proposed a rule slashing all other physician reimbursements by 9%. Factoring in the increase in ED codes, emergency physicians are facing a 6% decrease in reimbursement in 2021, taking a veritable firehose to the sand that supports many small practice groups.
However, we don’t have to stand idly by and watch this happen. If Congress waives the budget neutrality requirement, we will actually see an increase of about 3%. And in the midst of facing down a pandemic, now is not the time to start shortchanging the nation’s physicians. Reach out to your legislators and let them know that emergency physicians need relief right now, not belt tightening. A cut of this scale could force smaller groups out of business all around the nation, and Wisconsin has a high percentage of small independent groups.
If Congress fails to stop this erosion of the foundations of Emergency Medicine, the long-term damage will be far more expensive and difficult to fix than is apparent at first glance. Just ask my contractor!