Medical Economics

By Daniel Brennan, MD, FACEP Medical Economics Committee Co-Chair

State and federal legislative sessions are always a perilous time for EM medical economics, and 2020 was no exception. FCEP had some high priority items at Emergency Medicine Days 0n January 27-29. As of press deadline, it appears emergency medicine received another reprieve from the ill-advised attempt to repeal personal injury protection (PIP) coverage (HB 771) that provides a setaside for emergency physician care. This proposal for the third straight year would have replaced a no-fault system for a tort driven system, with no clear mechanism for emergency medical payments likely at artificially low reimbursement rates. Estimates range, but a 5% overall revenue reduction could have been the result for most practices. This was FCEP’s #1 priority: avoid repeal, or secure equivalent EM payments if eliminated, and will likely be again next year. In terms of scope of practice, FCEP supported FMA’s argument against independent practice of ARNPs/ PAs, which was a priority of House Speaker Oliva. The measure (HB 607) passed in both houses and was signed by Governor DeSantis within three hours. More applicable to EM, expanded practice for pharmacists to diagnose and treat strep and flu (HB 389) steamrolled through the house, stalled, and then passed in the Senate, and was also immediately signed into law. In the era of COVID-19, doesn’t it sound like a great idea to allow pharmacists to reassure that “flu-negative” patient? On the federal level, interest in “fixing” surprise billing remains perilously popular, without much consideration as to how allowing insurers to unilaterally price set would devastate access to care. ACEP and EDPMA continue to advocate vigorously, but we all must pay attention as this could drastically reduce practice revenue (estimates of 30% have been quoted), while effects on compensation would be larger given fixed overhead costs. Please take action when our professional society representatives sound the alarm. FCEP’s EM Reimbursement and Innovation Summit on February 27- 28 again hosted a nationally expert faculty and covered an array of subjects, including federal balance billing legislation, independent dispute resolution, payor challenges, Medicare payment / MIPS / alternative payment models, proposed regulatory and documentation changes, telehealth and more. Forward-looking In the era of COVID-19, doesn’t it sound like a great idea to allow pharmacists to reassure that “flu-negative” patient? “

group leaders would be well served by attending this excellent summit.

And now for some more upbeat payment notes:

1. The efforts of the RUC (RVU Update Committee) allowed a re-evaluation and increase in EM RVUs: overall, a 1% or so increase to 2020 MCR reimbursement for EM. (Unfortunately, a much larger primary care re-evaluation for 2021 may trigger budget neutrality, and EM is posed to be one of the biggest losers as a specialty without the advantage of any office-based codes, to the tune of potentially a 7% reduction unless some reprieve is granted).

2. FCEP’s outreach with AHCA was rewarded when AHCA agreed that Medicaid Managed Advantage (MMA) plans should be paying EM providers Medicare rates for pediatric patient care as of Oct. 1, 2019. This should result in a significant boost to Medicaid revenues for most practices seeing substantial numbers of pediatric MMA patients.

3. Emergency medicine had a favorable dispute resolution ruling via MAXIMUS, which ordered a payor (Humana) to pay an EM providers’ charges in an out-of-network claim dispute. ■

LEGAL MATTERS IN EMERGENCY MEDICINE ESSENTIAL A GUIDE FOR MEDICS

Membership & Professional Development

By Rene Mack, MD MPD Committee Co-Chair

You are likely reading this in April 2020. Compared to your experiences up to the release of the January 2020 edition, there have been many significant changes over the past few weeks and with more likely to come. With the gravity of battling a viral pandemic, COVID-19, it is understandable that the annual tradition of Match Day would have mattered most to those in its immediate orbit.

For those to whom Match Day 2020 played a role, congratulations! Congratulations especially to the Class of 2020 medical students (and residents) who matched into emergency medicine! We look forward to your contributions to our specialty and will share with you the tools needed to succeed and flourish within your new profession.

In years past, Match Day was filled with a sense of anxious excited tension, which was heightened by it taking place in a banquet room, auditorium or similar large space. Surrounded by your equally anxious and uncertain classmates, maybe even your family and friends, you opened the envelope that would shape your future. The rush of emotion, along with the shouts and cheers of celebration as you announce your Match location, is almost overwhelming. Match Day is the culmination of the many years of dedication and sacrifice you have made for your chosen profession and specialty. It is a Rite of Passage on the journey of medicine.

Unfortunately, the Class of 2020 did not have this experience. Due to the current pandemic of COVID-19, on Match Day 2020, our nation was in a state of social distancing to help curb the spread of the viral infection. Groups of no more than 10 persons and maintaining at least 6 feet of separation was the national guideline. Instead, the Class of 2020 opened an email/envelope with their Match results either individually or with a small group of family, friends and other classmates. Some schools were able to host smaller scale celebrations that adhered to the guidelines but overall, due to social distancing, the Class of 2020 was not able to partake in this tradition that we all hold so dear.

The changes associated with Match Day are only a few of the innumerable parts of our lives and experiences that have changed drastically in a very short period of time. We will all be affected by the rapid social changes enacted. As a practicing emergency physician, I can anticipate a few of the decisions we will need to make throughout the COVID-19 pandemic. The toll of our actions and experiences as we work on the front lines to overcome this pandemic will be difficult to predict, but will likely be high. As we welcome the Class of 2020 into our ranks, let us also show them the importance of self-preservation. Let us share with and remind each other of the tools necessary to have a long and healthy career. Maybe on your next shift you can share these techniques with your partner, so that we can continue the fight, together.

Take care of yourselves, and each other. ■

Daunting Diagnosis: Q

By Karen Estrine, DO, FACEP, FAAEM Editor-in-Chief

A 34 year-old female presents to the ED with worsening left upper extremity pain and weakness. She has a past medical history of neurofibromatosis 1. On exam, she has decreased use of her left deltoid,

biceps, triceps, and wrist flexion and extension. She endorses paresthesias. What do you see on her left shoulder radiograph?