A letter to Congressional leadership is circulating with an aim to obtain signatures from several hundred smaller and independent groups from various impacted specialties, providing maximal visual impact and local connections related to surprise billing.  The turn-around is very quick with a planned deadline to sign on by mid-day on Thursday, December 5.

Please share notice of this effort with as many smaller and independent groups as possible. The more sign on, the more compelling in its impact. Each specialty is defining "smaller group" for themselves, since there's such variation on relative group sizes across specialties. For EM, ACEP is requesting groups that serve 10 hospitals or less to sign-on, which is consistent with the EM smaller group letter that went to the Hill in early September.

Download, review and sign your group to the letter at bit.ly/SmallIndGrpLetter.

ACEP is requesting additional action on Out of Network Billing/Surprise Billing. Several Congressional champions (Reps Morelle, Shala, Roe, and Taylor) are circulating a bipartisan letter in the House to leadership to collect Congressional signatures. Anything members can do to encourage more Congressional offices to sign on would be a big help. The turn-around time is pretty tight--signatures are due Dec 5. Please see the letter below, and if you have good relationships with any House offices, please encourage them to sign on.

To sign on, please contact:

Maria Oparil, Legislative Assistant
Office of Congressman Joseph D. Morelle (NY-25)
1317 Longworth House Office Building
202-225-3615 | maria.oparil@mail.house.gov

The Honorable Nancy Pelosi
Speaker of the House
H-232, U.S. Capitol
Washington, DC 20515

The Honorable Kevin McCarthy
House Minority Leader
H-204, U.S. Capitol
Washington, DC 20515              

Dear Speaker Pelosi and Leader McCarthy,

Thank you for your leadership on addressing the unfortunate practice of "surprise billing," which leaves patients with unexpected charges after they receive emergency or out-of-network medical care. Many of our own constituents have been left helpless in disputes between health care providers and insurance plans, saddled with untenable out-of-pocket costs after receiving potentially life-saving care.

As you know, ongoing bipartisan, bicameral negotiations continue with the goal of addressing this critical issue in a larger legislative package before the end of this year. We are supportive of these efforts, and unequivocally believe Congress should complete legislation that will hold patients harmless in unplanned out of network care. However, we also believe it is critical that this legislation includes a balanced independent dispute resolution system between providers and insurers. We are committed to ensuring that our local doctors, hospitals, and communities are not disproportionately impacted by an approach that fails to include true measures of accountability.  

Patients, doctors, and hospitals are relying on us to address this issue without harming the quality of our health care system or hurting our local economies. A benchmarked, one-size-fits-all, approach would hinder network adequacy and access to care, particularly in rural and underserved areas. In contrast, instituting a neutral, independent review process after direct negotiations between the parties can lower health care costs without massive disruptions to the health care market. 

An accessible and meaningful appeals process would also ensure that the playing field is not tilted toward health insurance companies at the expense of our local hospitals or doctors, especially those who are already in-network, while still ensuring that the patient is out of the middle and not financially responsible for a surprise medical bill.

We look forward to working with you to end the practice of surprise billing through balanced legislation. This is a tremendous opportunity to ensure that no American family is faced with an unaffordable bill for unexpected out-of-network care ever again, without threatening the quality of care they receive from physicians and hospitals across the nation or increasing the cost of care for anyone.

Thank you again for your work to address this pressing issue-we are confident we can achieve a fair result to protect patients, providers, and insurers.

Sincerely,

Joseph D. Morelle
Donna Shalala
Phil Roe
Van Taylor

Lisa Maurer, MD
WACEP Legislative Chair

Wisconsin is one of many states that has received federal approval to change our Medicaid program, called a waiver project, in some substantial ways that will affect our patients in the emergency department. 

There are several characteristics of the changes that will affect our patients.  Namely, there will be a new work requirement for some Medicaid enrollees in order to maintain their eligibility for coverage, new Medicaid coverage for inpatient substance use disorder treatment, and some mandatory screening for substance abuse disorders.  Most impactful for our patients and workflow, the waiver also contains a new potential for copayment for Medicaid patients for ED visits.  As these new laws are implemented in Spring of 2020, it is our responsibility as advocates for our patients to ensure that we maintain protections under the Prudent Layperson Standard. 

This waiver project starts a new $8 copay for ED patients who receive care in the ED for non-emergencies as of February 2020.  This is not a new concept, whereby fourteen other states already charge copays to Medicaid enrollees who receive non-emergent care in the ED.  A minority of states have even gotten federal approval to charge more than the historic maximum of $8 copayment.  The real risk to emergency patients lies in the variance among the states in how they define a “non-emergency,” and what direction Wisconsin moves in this regard.  Scarily, some states’ Medicaid departments chose to define non-emergency based on final diagnosis.  Choosing to define non-emergency in this way is a clear violation of the Prudent Layperson (PLP) Standard as defined by federal law, which protects patients who present with symptoms concerning for emergency, even though ultimately, they might not be diagnosed with a life- or limb-threatening condition. 

Thankfully, the Wisconsin Department of Medicaid has chosen to define emergency (and therefore non-emergency) based on the PLP.  What’s more, this definition of non-emergency is as determined by the physician caring for the patient.  Hence, our judgement is paramount, as it should be, as we are the ones who have the best sense of the patient’s concerns at the time of presentation.  Of note, in Wisconsin, this copayment will be applied to the facility charges, not the professional fee charged by the physician.  Therefore, each hospital system will need to determine what the workflow will be to assess for non-emergency and then somehow alert the registration staff so they can apply the copay to the patient’s cost-sharing responsibilities.  In other states that have implemented a copay for non-emergent services in the ED, actual utilization of the copay by the hospitals has been low.

In the coming months, DHS will be rolling out pre-implementation outreach and communication activities about the program.  Thank you in advance for making sure the implementation of this copay makes sense for emergency physicians and our patients at your hospital.

Your Medicare reimbursements will be cut unless Congress acts before the end of the year. Help us urge Congress to take action to improve MACRA and to stop the upcoming cuts to ensure Medicare patients continue to have access to high quality emergency care. Click here to learn more and send a message to Congress today.

Recently, CMS released its final 2020 Medicare Physician Fee Schedule (PFS) rule that includes changes that will affect Medicare physician payments and MIPS starting Jan. 1. ACEP's Regs & Eggs blog breaks down the final rule, emphasizing policies that apply to EM.

November 20, Wisconsin Health News

Gov. Tony Evers signed into law three health-related bills Tuesday. The measures will:

• Allow pharmacists with appropriate training to administer vaccines to young children. 
• Make technical changes so that EMS providers can apply for a Medicare pilot program. 
• Create a grant program to update 911 service infrastructure. Grants could go to staff training, equipment updates and consolidation of public safety answering points.

Evers said in a statement that the measures will help "promote safer and healthier communities in Wisconsin."

ACEP has developed new resources specifically to benefit small groups.  A new Small Group Advisory Group is a team of seasoned small group members who have volunteered to support the small group practice model by sharing their expertise with other small group members who are looking for guidance or wanting to tap into the experience of others as they face various challenges unique to small groups. If your small group is dealing with an issue that you’d like to ask the advisory group about, just send us an email at smallgroups@acep.org.

ACEP has also developed an online community for small group members to share ideas and discuss issues. To joint that group and see the other small group resources available, go to www.acep.org/smallgroups.

ACEP’s new first responder training program, Until Help Arrives, was officially unveiled during ACEP19 in Denver with a series of events to highlight how emergency physicians can positively impact their communities by conducting training sessions to teach the public basic life-saving skills. Learn more.

New ACEP member benefit now available

ACEP members care for their patients 24-7-365… but are you are taking care of yourself?  At ACEP19 in Denver, ACEP launched the ACEP Wellness & Assistance Program., a service available to all members that provides access to three confidential counseling or wellness coaching sessions, free of charge.

Call 1-800-873-7138 to register and receive support whenever, however iyou need it.

• Counseling is available 24 hours a day, 7 days a week
• Sessions can cover stress, anxiety, depression, family issues, drug and alcohol abuse, relationships, death, grief, and more
• The service is strictly confidential and can be scheduled face-to-face, over the phone, via text, or through online messaging 
• Wellness coaching sessions are 30-minute phone calls to help reach your personal wellness goals which can include weight loss, nutrition, healthy habits, stress, caffeine reduction, injury recovery, relationships, sleep, smoking cessation, and more

Members may choose three free sessions in any combination of counseling and wellness coaching, up to the session limit.

An additional resource is available at a nominal fee of $15/year that will help members manage legal and financial issues through ACEP’s partner, Mines & Associates. Participants will have unlimited access to an extensive online resource library and unlimited 30-minute in-person consultations for each individual legal or financial matter and a 25% discount on legal and financial services within the Mines network. 

During Tuesday’s Public Hearing for the Assembly Committee on Health, emergency physician and vice-chair of the Medical Examining Board Tim Westlake, MD, testified against Assembly Bill 526 on behalf of the Wisconsin Medical Society.

This bill is one of nine bills produced by the Speaker’s Task Force on Suicide Prevention. The first draft of the bill would require two credits of CME every two years on the topic of suicide prevention for all physicians, psychologists, social workers and several other professions. The Wisconsin Medical Society raised concerns to the Speaker’s office, the chair of the Speaker’s Task Force and the bill author, and an amendment was offered by Rep. Tony Kurtz (R – Wonewoc) that would only require the two hours once upon the next renewal.

The Wisconsin Medical Society opposes the legislation (even with the amendment) for the following reasons:

• Suicide prevention and mental health treatment are already part of best practices for physicians.
• Physicians are the best judges of what education they need to serve their patients, and the CME requirement is another example of government interference and regulation in medicine.
• The recent Opioid CME requirement was successfully created through the action of the Medical Examining Board, not through legislation.
• Physicians already take significantly more education than is required under state law to maintain Board certification.

Doctor Westlake stressed that all physicians care deeply about preventing suicide, mentioning that he treated four suicidal patients in the ER the night before. He then pointed out that a requirement of CME is unlikely to impact patient care. “A responsible physician will make sure they are up to date on all aspects of their practice,” Westlake said, “but requiring CME won’t change behavior. You can’t legislate responsibility.”