The collective opposition from ACEP, the Emergency Department Practice Management Association (EDPMA), and the new Physicians for Fair Coverage against further health plan consolidation, flexing their market power, and “lose-lose” health plan OON proposals will have to make the difference in several areas: 1) drafting model OON legislation with minimum benefit standards tied to fair health; 2) establishing or supporting existing multispecialty physician coalitions to enact that legislation, including local fund-raising to support government relations (GR) and public relations (PR) initiatives; and 3) developing and launching PR and GR strategies to oppose health plans’ messaging and enact that proposed legislation.
Explore This IssueACEP Now: Vol 35 – No 11 – November 2016
Mr. Gaines is chief compliance officer, emergency medicine division, at Zotec Partners, LLC, based in Greensboro, North Carolina. He is also chair of the ACEP/EDPMA Joint Task Force on Reimbursement Issues, which cover both OON and Medicaid issues.
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- Avg. unsubsidized indy mkt rate hikes: 256.6% (46 states). ACASignups.Net website. Accessed Sept. 14, 2016.
- Final rules for grandfathered plans, preexisting condition exclusions, lifetime and annual limits, rescissions, dependent coverage, appeals, and patient protections under the Affordable Care Act. Federal Register. Nov. 18, 2015:72191-72294.