Emergency Department Practice Management Association
Return on Investment for Your 2017 Membership
I. Successful Advocacy
One EDPMA membership benefit is successful advocacy. Here is a list of what we successfully lobbied for in 2017:
A. Private Insurance (about 70% of ED revenue and 35% of ED claims)
B. Medicare (about 15% of ED revenue and 18% of ED claims)
- Congress passed legislation directing the Trump Administration to improve the federal minimum payment standard for out-of-network emergency care by clarifying the meaning of "usual, customary, and reasonable" and suggesting the Administration issue a FAQ tying the definition to an unbiased charge database,
- Nine state legislatures failed to pass legislation either banning balance billing for emergency services or establishing a problematic reimbursement formula. Despite over 100 bills, only one balance billing ban impacting emergency care was signed into law in 2017 (in Oregon) and we continue to work in that state to ensure appropriate out-of-network reimbursement, and
- A private payer (Aetna) modified its problematic down-coding policy.
C. Medicaid and Self Pay (about 15% of ED revenue and 47% of ED claims)
- The Centers for Medicare & Medicaid Services (CMS) did not finalize its proposal to incorporate updated malpractice premium data which would have cut Medicare reimbursement for emergency medicine by an estimated 1%,
- CMS continued to allow claims-based reporting,
- CMS delayed the requirement that professionals participate in the Appropriate Use Criteria program while they test it and consider concerns raised regarding emergency physicians,
- CMS dropped its proposal to report median time from ED Arrival to ED Departure for mental health patients on Hospital Compare,
- CMS removed three problematic ED quality measures from the hospital outpatient quality reporting program, and
- CMS provided greater flexibility for physicians to develop Alternative Payment Models under the Medicare program.
- Congress failed to pass various proposals repealing or replacing the Affordable Care Act which would have resulted in up to 32 million fewer people with health insurance and would have made it easier for insurers to further limit coverage for emergency care, and
- Two states modified their Medicaid waiver proposals to address our concerns about coverage of emergency care and the prudent layperson standard, and
- One state acknowledged its Medicaid policy violates the prudent layperson standard and needs to be changed.
Another important benefit, especially for our billing companies and supporting organizations, is high-level networking opportunities:
- EDPMA’s members handle over half of the emergency department visits in the nation.
- 80% of EDPMA’s Solutions Summit attendees are decision makers (C-Suite or Management)
- At the 2017 Solutions Summit, we held three evening networking receptions.
- We held two networking receptions and 4 refreshment breaks in the Solutions Summit Exhibit Hall.
- An exhibitor registration for the Summit provides access to educational sessions where networking takes place.
- We held a new member/new attendee breakfast which was attended by EDPMA leadership.
- We held two EDPMA workshops in 2017. Each workshop had sponsorship opportunities and an evening networking reception.
- EDPMA’s 7 committees provide members a chance to network on monthly conference calls and at the Solutions Summit Committee Day.
- EDPMA held a membership networking reception at the ACEP Scientific Assembly.
Members also benefit from our educational opportunities which focus on the business of emergency medicine:
- At the 2017 Solutions Summit, we offered two and a half days of educational sessions plus EDPMA’s Committee Day (which is open to all attendees). We had a special half-day focus on successful solutions.
- In 2017, EDPMA offered two workshops – one on balance billing and out-of-network reimbursement and another on collecting the hard dollars.
- In 2017, EDPMA offered 5 webinars (some were offered through our partnership with Urgent Matters).
- EDPMA’s committee meetings provide an opportunity to learn from the experts in the business of emergency medicine.
Contact: [email protected]