EDPMA Membership Newsletter 
January 2019
January 2019 Articles:
  1. Registration is Open for the 2019 EDPMA Solutions Summit
  2. Trump Expresses Interest in Surprise Billing: It's Time to Review the EDPMA Webinar on the Issue
  3. EDPMA Board Nomination Materials Are Due Today (January 31st)
  4. Register Now for the Solutions Summit Golf Tournament in Scottsdale, AZ
  5. Reserve Your Exhibit Booth for EDPMA's Solutions Summit
  6. New Member Spotlight: Sierra Emergency Medical Group (SEMG)
  7. Join an EDPMA Committee!
  8. Urgent Matters Blog and More
  9. Payment Reform Summit 2019
  10. CMS Announcements:
    The MIPS 2018 Data Submission Period is Now Open 
    "Pathways to Success," an Overhaul of Medicare's ACO Program 
    New 2018 QPP Resources


Registration is Open for the 
2019 EDPMA Solutions Summit

The Emergency Department Practice Management Association (EDPMA) is Pleased to Invite You to the
2019 Solutions Summit!

REGISTRATION IS OPEN!

Join us at the Scottsdale Resort at McCormick Ranch, Scottsdale, AZ, April 28-May 1, 2019!

Come and join EDPMA for the 2019 Solutions Summit - the premier conference for those in the business of emergency medicine. The Summit offers in-depth educational sessions on the issues facing those managing an Emergency Department, emergency physician group, billing company, or other business that supports the Emergency Department. Learn solutions to the issues you face every day and network with both new and familiar business partners.

This Year:
  • Do you golf? Arrive early and play in EDPMA's Golf Tournament. Please join us on Saturday, April 27th, for a round of golf at the McCormick Ranch Golf Club located adjacent to the resort property. After the tournament, all attendees are invited to the Pre-Conference Reception for drinks, appetizers, and networking.
  • EDPMA Committee workshops will be held on Sunday, April 28th, and are open to all attendees (including nonmembers and Exhibitors). Enjoy a small group setting where you can discuss federal and state policy issues, balance billing, the prudent layperson standard, Medicaid waivers, quality payments, Medicare Administrative Contractors (MACs), and more.
  • Regular educational sessions begin on Monday, April 29, 2019. Session topics include leadership under pressure, contributions of women in Emergency Medicine, ED coding, Alternative Payment Models, and a musical. 
  • New this year, on Wednesday morning, May 1st, we will offer sessions that prepare you to advocate for the business of emergency medicine. Presenters will not only give great advice on being a federal and state advocate, but will make sure you can comfortably address the issues the emergency business faces today. Learn about the 2019 advocacy landscape, tips and tricks, latest on Out-of-Network Reimbursement, and more. A relaxing Resort Brunch will be served to help you wind down before heading home.
Information about the 2019 Solutions Summit is available here.

In order to register at the member rate, you must first log into the EDPMA website as a member. You can register online or download, print, and send us the registration form and payment. Don't miss out!! You have until February 15th to get the Early Bird Rate ($749 for members of EDPMA and $949 for nonmembers)!
If you have forgotten your member password, please email Paul Gerard at [email protected].

Learn more at www.edpma.org


Trump Expresses Interest in Surprise Billing: It's Time to Review the EDPMA Webinar on the Issue

Last week, President Trump held a round table with patients who raised concerns about surprise billing, drug prices, and more. Trump stated "Patients should know ... the real price and what's going on with the real prices of procedures. Because they don't know, they go in, they have a procedure, and then all of a sudden, they can't afford it. They had no idea it was so bad." He added, "The pricing is hurting patients, and we've stopped a lot of it, but we're going to stop all of it."

This announcement will likely add momentum to both federal and state legislative efforts to ban balance billing.  U.S. Congressman Lloyd Doggett (D-TX), the newly appointed Chair to the Health Subcommittee of the House Ways and Means Committee, along with 28 Democratic cosponsors, recently reintroduced his bill banning balance billing.  Many of the other 4 federal proposals we discussed last year are likely to be reintroduced in the next few months. We are hoping that many of the improvements EDPMA proposed will be incorporated into these bills before they are reintroduced. Many of the federal committees with jurisdiction over the issue are planning on holding hearings and passing legislation.  And, at the state level, over 30 bills have been introduced in 17 states in the month of January alone.

So, this is a great time to review the recording of the webinar where Dr. Jeffery Bettinger and Mr. Ed Gaines discuss the EDPMA/ACEP Joint Task Force whitepaper and FAQs on the Minimum Benefits Standards for Out of Network ED Claims. The two-part webinar is available here and here and on EDPMA's Resources page.  The webinar has already been taped, so you can review these 2 tapes at your convenience.

EDPMA Board of Directors Nomination Materials
Are Due Today  (January 31st)
 
All nomination materials and dues payments must be received by the end of the day TODAY, January 31st. In  February 2019 , the Designated Company Contact for each member organization will have the opportunity to vote for the EDPMA Board Members who will serve on the Board from   2019-2021 . The EDPMA Board has a staggered membership with two-year terms. In 2019,  6  of the 19 Board Seats will be open. The organizations that currently hold these seats may run for reelection. 

The formal nominating materials are linked here.  They consist of the  Official Board Nomination Form ,  Candidate Statement and Questionnaire , and information about 
EDPMA Board Responsibilities .  We encourage you to think about nominating your organization, big or small. Please note, the member organization - not the individual - holds the seat on the Board . However, nominating materials also ask for information on the individual who will represent the organization on the Board.  When you fill out your Candidate Statement and Questionnaire, please type your answers to the questions into the form (only typed responses will  be accepted, please no hand writing).  The required forms needs to be received by EDPMA as a typed Microsoft Word documents and not as a PDF . 

Deadlines are strictly enforced. All nomination materials plus your 2019 dues must be submitted to  [email protected] by the end of the day today,  Thursday , January 31 , 2019.
 
The current Board is listed below. Board seats that will be open in the 2019 election are marked with an asterisk. 

Executive Committee: 
Brault: Andrea Brault, MD, MMM, FACEP, Chair
TeamHealth: Aron Goldfeld, JD, MBA, Vice Chair  
*Vituity: Bing Pao, MD, FACEP, Chair-Elect
Intermedix: Jackie Willett, CHBME, Treasurer 
BSA Healthcare: Jeffrey Bettinger, MD, FACEP, At Large 
Edelberg & Associates: Caral Edelberg, CPC, CPMA, CCS-P, CHC, CAC, At Large
*Emergency Care Specialists: Don Powell, DO, FACEP, At Large
*EPOWERdoc, Inc.: David Ernst, MD, FACEP, At Large  
*Zotec Partners: Ed Gaines, JD, At Large 

Other Board Members: 
Acute Care, Inc.: Paul Hudson, MBA, MHA, FACHE
*America's ER: Mark A. Feanny, MD
CIPROMS Medical Billing, Inc.: Andrea Halpern Bryan
Envision Healthcare: Bob Kneeley                      
Gottlieb: Shanna Howe 
Medical Coding Solutions: Mark E. Owen 
Reimbursement Technologies, Inc.: Gary Gelbart, MBA 
Schumacher Clinical Partners: Randy Pilgrim, MD, FACEP  
*St. Vincent Emergency Physicians: William Freudenthal, MD, FACEP 
US Acute Care Solutions:  L. Anthony Cirillo, MD, FACEP


Register Now for the Solutions Summit Golf
Tournament in Scottsdale, AZ 

Arrive early and join us for our Second EDPMA Solutions Summit Golf Tournament on Saturday, April 27, 2019. Whether or not you join us for golf, all registrants are invited to attend the Pre-Conference Reception as the afternoon winds down over the desert.
   
Golf Tournament:
The deadline to register for golf is April 1st .

Tournament Date: Saturday, April 27, 2019

Time: 1:00 PM Shotgun Start (different teams start from different holes) (arrive early!)

Format: 18-Hole Scramble - Each player on the team tees off on each hole. The best of the tee shots is selected and all players play their second shots from that spot. The best of the second shots is determined, and then all play their third shots from that spot, and so on until the ball is holed. Team scores for 18 holes will be compared for prizes.

Location: McCormick Ranch Golf Club | Pine Golf Course 7505 E. McCormick Parkway, Scottsdale, AZ 85258

Transportation: The hotel is next to the golf course. The hotel provides on-property resort transportation services that depart from the main hotel/lobby area and drop golfers off at the Golf Pro Shop. The hotel is in walking distance to the Pine's Course-but you might get lost.

Eligibility: You must be a Summit Registrant (you can register for the entire conference or just register for Sunday sessions) and register for the tournament.

Team Requests: If you would like to be placed on the same team with another Summit registrant, please email [email protected].

Pricing: $150 per person

Club Rentals: $55 (plus tax)

Clothing Restrictions: Golf attire is required: collared shirts are required; Denim/jeans are allowed, but cut off jean shorts are prohibited. Golf shoes are available for rent, but sizes and availability are very limited.  Tennis shoes may be worn.
   
Pre-Conference Reception:
The Pre-Conference Reception will be held at the McCormick Ranch Golf Course immediately following the tournament. All Summit registrants are welcome; you do not have to play golf.

Date: Saturday, April 27, 2019

Time: 5:30 PM to 7:00 PM

Location: Upper Terrace Patio at the McCormick Ranch Golf Club 7505 E. McCormick Parkway, Scottsdale, AZ 85258

Transportation: The hotel is next to the golf course. The hotel provides on-property resort transportation services that depart from the main hotel/lobby area and drop golfers off at the Golf Pro Shop. The hotel is in walking distance to the Pine's Course-but you might get lost.

Pricing: Free for Summit registrants; $50 for guests who are not in the ED industry; guests in the ED business must, at minimum, register for Sunday sessions.

Contact Megan Van Dam at [email protected] if you are interested in sponsoring something for the golf event, like water bottles, golf contests, or food and beverages.

Contact [email protected], if you have questions about registration.


Reserve Your Exhibit Booth for EDPMA's
Solutions Summit  

Reserve your exhibit booth for the Emergency Department Practice Management Association's Solutions Summit in Scottsdale, AZ, from April 28-May 1, 2019!  EDPMA's Solutions Summit is the premier conference for those in the business of emergency medicine. Billing, coding, scribe, legal, staffing, computer software, and other consultants serving the emergency medicine community know that the Solutions Summit gives access to high-level decision makers in an intimate environment. And, unlike other conferences, an exhibitor pass provides access to educational sessions and events.

Once you have reserved and paid for your booth, you can select its location in the exhibit hall. So, the earlier you reserve, the better the space you can select. To reserve an exhibit booth, please fill out and return the attached Exhibitor Contract. To learn more about additional sponsorship opportunities, please check out our 2019 Sponsorship Prospectus.

 For more information, please contact Megan Van Dame at (703) 245-8061 or [email protected]  or visit www.edpma.org.
  
New Member Spotlight: 
Sierra Emergency
Medical Group (SEMG)
   
 
Sierra Emergency Medical Group (SEMG) is an independent, democratic group created in 1993 by a group of five emergency physicians working in the local community h ospital. Twenty-five years later, the group has grown to 17 physicians and two of the original founders remain with the group. SEMG staffs one hospital and two rapid care facilities and prides itself on the highest quality patient care. SEMG is headquartered in Sonora, Tuolumne County, CA, just outside of Yosemite National Park. To learn more about Sierra Emergency Medical Group, please click here.

Excerpts from a conversation with Kathryn Johnston, M.P.A., Practice Manager
 
Ms. Johnston joined SEMG in 2007 and manages all administrative functions including recruiting, hiring, scheduling, payroll, etc. Kathryn explained that, in 2007, the county hospital closed and very quickly, there was a doubling of demand for Sierra Emergency Medical Group's services as the local (remaining) hospital saw its needs expand. They asked SEMG to add a second rapid care facility and the group saw an expansion in the number of shifts, providers and para-professionals. Also, the hospital asked SEMG to add a hospitalist program which was created, developed and expanded over the next few years. Eventually, the hospital took over that program. In 2014, SEMG added a medical scribe program to support the documentation requirements in the emergency department.

When deciding to join EDPMA, Ms. Johnston took a close look at the promotiional materials and realized that the association and the Solutions Summit would be a worthwhile use of her time and the group's resources. Ms. Johnston said the networking opportunities with leaders of emergency medicine and her fellow practice managers helps her gain a better understanding of the issues facing the emer gency medicine industry.

Ms. Johnston noted that there are many changes occurring in the emergency medicine arena and EDPMA's ongoing information, including the monthly Advocacy and Membership newsletters and action alerts, expands her knowledge and keeps her informed about legislative and regulatory issues at the State and Federal levels. Kathryn is well aware that, while it takes time and effort, it's important to look beyond her own group practice and understand the challenges faced by other emergency medicine physician groups and strategies they use to be successful. Kathryn has joined two EDPMA Committees -- Federal Health Policy and State Insurance and Regulatory. She finds that the Committees are another great forum to learn from emergency medicine experts about the latest concerns, especially payer challenges. Kathryn appreciates the willingness of members to share their challenges and jointly develop solutions so they  continue to provide excellent patient care, support their providers and get paid fairly.

Kathryn is planning to attend the 2019 Solutions Summit in Scottsdale, AZ (April 28-May 1). She expects to participate in Committee Day (April 28th) so she can hear directly from the Committee Chairs on the many important topics under discussion and network.
 
Join an EDPMA Committee! 
 
We encourage you to join an EDPMA committee.  The real work at EDPMA is done at the committee level. Committee members work together in a variety of ways including:
  • discussing the impact of the ACA, its possible repeal, and changes to Medicaid that impact ED practice groups,
  • organizing meetings with CMS officials on provider enrollment,
  • drafting letters to state-level policymakers on balance billing,
  • identifying speakers on ED best practices,
  • meeting with commercial payers about problematic downcoding policies,
  • developing a toolbox to help survive an audit,
  • preparing for Medicare reimbursement under the Merit-Based Incentive Payment System, and
  • building strong business relationships.
Experts work side-by-side with newcomers, new leaders shine, and everyone's contribution is greatly appreciated.  Many members report that insight shared on committee conference calls is one of the most important and unique benefits of their EDPMA membership. We invite you to join one of EDPMA's committees. Information about each committee is available here. 

Membership Committee Update:
EDPMA would like to welcome three new members this month:

Academic & Community Emergency Specialists, Uniontown, OH
Sound Physicians, Brentwood, TN
Southwestern Michigan Emergency Services, P.C., Kalamazoo, MI

We look forward to working with you! 

Urgent Matters Blog and More 

EDPMA is a member of the Urgent Matters Editorial Board and contributes webinars and other educational material to this important collaborative group.  As a member of EDPMA, you can access these resources for free.  You can access the blog, podcasts and more through the links below: 

Toolkit  



The Florida College of Emergency Physicians (FCEP) invites you to

Payment Reform Summit 2019

Cost-Effective Care in a Risk-Based World

February 7-8, 2019 
Emergency Medicine Learning & Resource Center (EMLRC)
Orlando, FL  

Presented by


Learn how to be a part of the solution to payment reform at this two-day conference, where leaders in emergency medicine and healthcare delivery will discuss new payment risk models, coordination of patient care, government regulations and more. CME: Earn up to 13.50 AMA PRA Category 1 Credits and 6.0 nursing contact hours.

The program's faculty is comprised of top experts in topics like healthcare policy, patient care and coordinated care. Presentations and panels include:


Ten Years of the Affordable Care Act: Where Are We Now and Where Are We Going?
Presented by Laura Wooster, MPH
ACEP Associate Executive Director for Public Affairs
This lecture will provide up-to-the-minute Affordable Care Act rules and regulations, including HHS, CMS and commercial insurers.
ED Systems Working with Hospitals-Running the Whole Show
Presented by Michael Zappa, MD, FACEP
The speaker will walk attendees through his emergency department business case model, which has transformed patient care, efficiency and financial success.
CMS: Potential Changes That Could Affect Emergency Medicine
Presented by Adam Krushinskie, MPA
ACEP Reimbursement Manager
A review of the CMS rulemaking process will lay the foundation for this talk. Future rules and their potential to impact emergency medicine will be thoroughly discusses.





The MIPS 2018 Data Submission Period 
is Now Open 

MIPS Eligible Clinicians Can Start Submitting Data for 2018 through April 2

The Centers for Medicare & Medicaid Services (CMS) has officially opened the data submission period for Merit-based Incentive Payment System (MIPS) eligible clinicians who participated in Year 2 (2018) of the Quality Payment Program. With the exceptions noted in the paragraph below, data can be submitted and updated any time from January 2, 2019 to April 2, 2019.

Please note, CMS Web Interface users need to report their Quality performance category data between January 22 and March 22, 2019. Also, for clinicians who reported Quality measures via Medicare Part B claims throughout the 2018 performance year, we'll receive your quality data from claims processed by your Medicare Administrative Contractor, and claims for services furnished during 2018 must be processed within 60 days after the end of the 2018 performance period.

How to Submit Your 2018 MIPS Data

Clinicians will follow the steps outlined below to submit their data:
  1. Go to the Quality Payment Program website
  2. Log-in using your QPP access credentials (see below for directions)
  3. Submit your MIPS data for Year 2 (2018)
How to Log In to the Quality Payment Program Data Submission System

To log in and submit data, clinicians will need to use the new HCQIS Authorization Roles and Profile (HARP) system. Previously, clinicians received their credentials through the Enterprise Identity Management (EIDM) system. Clinicians are encouraged to log in early to familiarize themselves with the system.
  • Previous EIDM Accounts: For all clinicians who previously had an EIDM account, you were automatically transitioned to HARP, and will use your existing EIDM user ID and password to sign in to the QPP website.
  • New Clinicians: For all clinicians who didn't have an EIDM account, you'll need to enroll with HARP. For a step-by-step guide to signing up for a HARP account, refer to the QPP Access User Guide.
Note: Clinicians who are not sure if they are eligible to participate in the Quality Payment Program can check their eligibility status using the QPP Participation Status Tool.

For More Information

To learn more about how to submit data, please review the 2018 MIPS Data Submission FAQs and other resources available in the QPP Resource Library.

Questions?

If you have questions about how to submit your 2018 MIPS data, contact:

*The Quality Payment Program by phone: 1-866-288-8292/TTY: 1-877-715-6222, or email: [email protected]
*Your local technical assistance organization


CMS BLOG
https://www.cms.gov/blog/pathways-success-overhaul-medicares-aco-program

December 21, 2018
By: Seema Verma, Administrator, Centers for Medicare & Medicaid Services

 " Pathways to Success," an Overhaul of Medicare's ACO Program

Today the Trump Administration announced our overhaul of the program for Accountable Care Organizations, or "ACOs," in Medicare. ACOs serve a large number of Medicare beneficiaries - over 10.4 million individuals in Fee-for-Service Medicare (of the 38 million total Fee-for-Service beneficiaries) receive care from providers participating in a Medicare ACO. Before getting into the specifics of our new policy, let's take a step back and put today's announcement in a broader context.

The Trump Administration has put a high priority on accelerating a value-based transformation of America's healthcare system - which is the move from paying for the volume of services to paying for outcomes and health. CMS is hard at work to move to a value-based system, not just because we want to, but because the American healthcare system is on an unsustainable trajectory, with one in five dollars spent in our economy projected to be spent on healthcare by 2026. Therefore, it is incumbent on our agency to not just pay for healthcare services as they are billed but rather to ensure that patients are getting value for the care that is provided. To this end, we are developing and testing new payment models to transform our payment system, and today's changes to Medicare's ACO program are a critical component of that transformation.

ACOs are groups of healthcare providers that take responsibility for the total cost and quality of care for their patients. In exchange for this, ACOs are able to receive a portion of the savings that they achieve as long as they meet quality standards. The program for ACOs in Medicare has been in operation for six years, and from these years of experience, CMS has gleaned key insights about what works and what doesn't within the program.

CMS issues waivers to ACOs of specific fraud and abuse laws in order to provide the regulatory relief needed to innovate, including waivers of provisions of the Stark Law and the Federal Anti-Kickback Statute. In exchange for this flexibility, today's rule ensures that ACOs have strong incentives to provide high-quality care and generate savings. Most Medicare ACOs do not currently face financial consequences when costs increase, but a review of the data on ACO performance shows that over time those ACOs that take accountability for costs perform better than those that do not.

Today's final rule drives towards greater savings and quality for Medicare's ACO program. The rule is projected to achieve $2.9 billion in savings over ten years. The final policy is responsive to feedback about the need for incentives to bring healthcare providers into the ACO program, while ensuring the transition to value protects taxpayers and includes patients.

One key element of today's rule is a reduction in the amount of time that an ACO can remain in the program without taking accountability for healthcare spending. The allowed period of time is decreasing from six years to, at most, three years for new "low-revenue" or physician-led ACOs, two years for all other new ACOs, and one year for existing one-sided ACOs. We are setting the shared savings rate at 40 percent for ACOs not assuming risk for healthcare costs and 50 percent for ACOs at all levels of risk, to strengthen the on-ramp to the program while rewarding ACOs that take on greater risk with higher shared savings rates.

Smaller, physician-led or "low revenue" ACOs - many of which are in rural areas - have shown greater success in controlling costs than hospital-led ACOs, which is an example of why CMS is focused on promoting competition in healthcare marketplaces and ensuring that patients have choices of where to obtain care. We have heard that establishing a physician-led ACO can provide practices with a means of remaining independent from consolidated hospital systems. Today's rule bolsters the option for physicians to form ACOs while ensuring that all ACOs are generating savings for patients and taxpayers.

Today's rule also increases flexibility for certain performance-based risk ACOs to encourage innovation and expand access to high-quality services that are convenient for patients, including telehealth services provided at a patient's place of residence. This is part of our holistic review of policies aimed at driving innovation and efficiency and to ensure regulations are not hindering the development of new ways of delivering care.

In all that we do at CMS, we aim to put patients first and ensure that they have the information they need to make decisions about their care. To this end, today's rule requires ACOs to provide beneficiaries in an ACO with a written notice in person or electronically through email or a patient portal that they are participating in this new approach to care delivery, and it must also explain what participating in an ACO means for their care.

Pathways to Success also allows risk-based ACOs to offer new incentive payments to beneficiaries for taking steps to achieve good health such as obtaining primary care services and necessary follow-up care. This way patients are aligned with providers on the drive to value.

Finally, to ensure rigorous financial benchmarking for ACOs, we are incorporating regional spending factors in establishing an ACO's target spending during all agreement periods, providing a more accurate point of comparison for evaluating ACO performance. Our changes to the benchmarking process for ACOs also promote greater alignment between the ACO program and Medicare Advantage.

In connection with the program redesign announced today, and to ensure providers have time to review and assess the new options, CMS is offering an ACO application cycle for a special one-time new agreement period start date of July 1, 2019. We are encouraged that 90 percent of eligible ACOs with participation agreements expiring on December 31, 2018 elected to extend their agreements for six months, so now they will have the option to renew their agreement under the new policies and continue to participate in the program uninterrupted.

In addition to the final rule for Pathways to Success, CMS is also releasing the financial and quality results for the second performance year of the Next Generation ACO Model. The Next Generation model test provides ACOs with additional flexibilities in exchange for the greatest level of risk sharing offered across all ACO programs in Medicare.

The Next Generation ACO Model actuarial results show that net savings to the Medicare Trust Funds from the model in 2017 were more than $164 million across 44 ACOs. The Model is also showing strong performance on quality metrics.

As you can see, the Trump Administration is absolutely committed to the value-based transformation of America's healthcare system. Today's final rule for Medicare's ACOs accelerates that transformation while promoting patient engagement and ensuring high-quality care. This is a positive step forward for our healthcare system, one that we hope to continue building on in the future.

###

Get CMS news at cms.gov/newsroom, sign up for CMS news via email and follow CMS on Twitter CMS Administrator @SeemaCMS, @CMSgov, and @CMSgovPress.


New 2018 QPP Resources

We wanted to alert you to some new 2018 Quality Payment Program (QPP) guidance materials that CMS recently posted to the QPP Resource Library. On Monday, they posted a 2018 MIPS 101 User Guide, which you might have already seen. Today, they posted a 2018 QPP User Access Guide, which appears to have updated instructions for logging onto the QPP portal to submit and view 2018 MIPS data. All of these materials are attached. Let us know if you have any questions.

Resources:
  1. 2018 MIPS 101 User Guide
  2. Before You Begin
  3. Register for a HARP Account
  4. Connect to an Organization
  5. Security Officials Manage Access