ACEP has been instrumental in supporting and influencing recent federal regulations. In addition to a lawsuit against the federal government and the successful influence of removing pain questions from patient satisfaction surveys, ACEP has been speaking out on the issues that matter most to you and your patients. Here are some recent updates:
Medicaid Managed Care Final Rule (CMS-2390-F)
• A long-awaited revision to Medicaid Managed Care regulations contained a win for psychiatric patients and ACEP members. Doctors will be able to transfer or admit Medicaid MCO enrollees ages 21 to 64 to private psychiatric hospitals, which should help reduce emergency department boarding, as 70 percent of Medicaid population is currently enrolled in managed care plans. The previous restriction had been in place since the beginning of the program, when states operated their own psychiatric hospitals. ACEP strongly supported this long-overdue change.
• The Centers for Medicare & Medicaid Services (CMS) will soon implement a new Congressionally mandated notice, the Medicare Outpatient Observation Notice (MOON) to beneficiaries, that lets them know when they are considered “observation” (outpatient status) in spite of being in an inpatient bed for two to three days. The language of the notice is not much of an improvement on CMS’s previous efforts; it is still confusing and doesn’t fix the underlying policy problem, which is that Medicare rules allow hospitals to reclassify patients from inpatient to outpatient during the course of a several-day stay, which severely penalizes beneficiaries who need skilled nursing care but do not qualify for Medicare coverage without a three-day inpatient stay. It should be noted that research shows that in hospitals with dedicated observation units and/or protocol-driven practices, the average length of stay before disposition by emergency physicians is 14 hours while the MOON notice is required to be given by the 36th hour of observation.
• CMS does not propose expanding diagnoses for the readmission penalty program, which ACEP is pleased to see, but has not moved to improve risk adjustment that incorporates patient socioeconomic factors, which research shows correlate with readmission rates.
• The final rule for IPPS FY 2017 will be released by Aug. 1 for an annual startup date of Oct. 1.
CMS Released Draft Regulations to Implement MACRA
• This 963-page rule describes in complex detail how CMS plans to implement new physician payment and reporting requirements under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). This law repealed the Sustained Growth Rate formula for Medicare physician reimbursement, ending more than a decade of last-minute fixes and potential payment cliffs.
• The proposed rule would implement changes through a unified framework known as the Quality Payment Program, which includes two paths, the Merit-Based Incentive Payment System (MIPS) or the Alternative Payment Model (APM), with proposed quality measures for each. Aside from a handful of preapproved primary care medical homes and other ACO-like models, most physician specialists—including emergency physicians—will begin to report quality and resource use data in 2017 under MIPS, while some groups will consider developing APMs over the next few years.
• ACEP has established an APM Task Force to help develop arrangements that will allow emergency physicians to participate in these new payment systems, although the practice of emergency medicine does not easily fit into any of the existing or proposed models. ACEP submitted formal comments on June 27, describing its myriad concerns with this very complex and burdensome draft regulation.
• ACEP expects the final rule to be published along with (or as part of) the annual Medicare Physician Fee Schedule for 2017, which is effective Jan. 1.
Tomar is ACEP’s federal affairs director.