Act Now! Two Important Legislative Updates from the Government and National Affairs Committee
Act Now — Holding Providers Harmless from Medicare Cuts During COVID-19 Act (H.R. 8702/S. 5007)
Dear AAEM Members,
There is a critically important bill for our specialty currently on the floor for consideration. This bill which is described below in the AMA update will prevent the currently scheduled dramatic Medicare schedule and payment cuts that will dramatically reduce emergency physician's income starting January 1, 2021. It certainly doesn't seem right to cut our pay now in the context of the risk each and every emergency physician is exposing to on a daily basis. This is a call to action to please call your representative and senator and explain what you do and why this bill is so important to you. Educate your family and friends and have them do the same. If you belong to your state's medical association please call them and have them assist in the lobbying as well.
Thanks for your efforts and what you do every day. Stay well and have a great holiday season.
Sincerely,
Lisa A. Moreno, MD MS MSCR FAAEM FIFEM — President, AAEM
Kevin Beier, MD FAAEM — Co-Chair, Government and National Affairs Committee
The above link is a form provided by Physicians Grassroots Network.
Contact Your Congressional Members about the No Surprises Act (H.R. 3630)
Dear AAEM Members,
Another critical bill effecting the future of emergency medicine and physicians is being slipped in at the end of this year. This is a balanced billing bill that has the potential to dramatically push down reimbursement in emergency medicine. Please consider contacting your congressional members today regarding this critical issue to our specialty. There is very limited time to wait so please call or email today. Also let your family and friends know of the importance of this issue as it will impact them as well if the bill becomes law. Please consider the below template letter, with your personalized changes, to send to your selected congressional members. Thanks for all you do.
Sincerely,
Lisa A. Moreno, MD MS MSCR FAAEM FIFEM — President, AAEM
Kevin Beier, MD FAAEM — Co-Chair, Government and National Affairs Committee
*Look up and email Representatives in both residential and place of employment zip codes.
Dear Senator [Name] (or Representative [Name]):
As an emergency physician who takes care of the neediest and most seriously ill and injured patients in our nation, even through the current epidemic, I support the effort to take patients out of the middle of disputes between insurance companies and out-of-network physicians and hospitals. However, that can and should be done without giving the insurance industry absolute power to dictate terms to physicians and hospitals. And the No Surprises Act, as currently written, does just that. If this bill is passed into law as is, it will destroy the private practice of emergency medicine by driving small, independent emergency physician groups out of business — while also leading to even more hospital closures.
Insurers know that emergency physicians and hospitals are required by federal law (EMTALA, the Emergency Medical Treatment and Active Labor Act of 1986) to take care of everyone who comes to the emergency department, regardless of insurance status, insurance network, or ability to pay. That gives them little incentive to negotiate in good faith and offer fair contracts to get us into their networks. Our only leverage is the threat to stay out-of-network and bill the insurer — not the patient, the insurer — at the higher "usual and customary" rate rather than the discounted in-network rate. The No Surprises Act as currently written would eliminate that possibility, thus giving insurers the power to pay whatever they choose to out-of-network physicians and hospitals, while driving down in-network rates at the same time.
The deadly problem with the current bill lies in the Independent Dispute Resolution process. As the House Ways and Means Committee summary [Ways and Means Surprise Billing Summary_02 06 20 (final).pdf (house.gov)] says:
During mediation, the parties will present best and final offers along with any supporting information to the mediator, who will also consider the median contracted rate specific to the plan, and for similar providers, services, and geographic areas. Independent entities are prohibited from considering usual and customary charges or billed charges, and other guardrails ensure a fair and reasonable process.
That makes the insurer's median in-network rate the benchmark for setting out-of-network rates, erasing any difference between what insurers must pay in-network and out-of-network physicians, while both driving down contracted in-network rates and giving insurers no reason to bring physicians into network with reasonable contract offers. To add insult to injury, the bill prohibits mediators from using a database on charges and payments that isn't controlled by the insurance industry, such as FAIR Health (About Us | FAIR Health), in deciding on fair compensation.
Since emergency physician groups lose money seeing Medicaid patients and those who are completely uninsured, and approximately break even on Medicare patients, we depend on the minority of emergency department patients with commercial insurance to keep us in business, and to fund the huge charity burden carried by America's emergency departments. If we can no longer count on private insurers to fund the nation's medical safety net, either government will have to take over that responsibility or that safety net will unravel as emergency physician groups go out of business and emergency departments close.
Sincerely,
[Your Name]