EDPMA Membership Newsletter 
June 2019
June 2019 Articles:
  1. EDPMA's Telehealth Workshop Focuses on Emerging Technology
  2. Thank You to the Telehealth Workshop Sponsors
  3. Solutions Summit Pictures
  4. Don't Miss Out on Discounted Rates to Exhibit
  5. EDPMA's 2018 Annual Report
  6. The Acute Unscheduled Care Model: A Change To Prove Our Value
  7. Thank You to EDPMA's Corporate Supporters
  8. Thank You to the Solutions Summit Sponsors & Exhibitors
  9. New Member Spotlight: Southwestern Michigan Emergency Services, PC
  10. Join an EDPMA Committee!
  11. CMS News:
     - CMS Seeks on Patients over Paperwork Initiative
  12. Save the Date: 2020 Solutions Summit


EDPMA's Telehealth Workshop Focuses on 
Emerging Technology

EDPMA's "Integrating Telehealth into Your ED Practice" Workshop in Fort Worth, Texas, during the last week of May, was an amazing success. Around 50 participants heard from industry experts shared the latest advancements in telehealth in the emergency department (ED) and presented a glimpse of what to expect in the future.

On the first day, Dr. Jenn Raley gave an informative introduction with tips for setting up a telehealth program in an ED practice, including a live demo. Dr. Ethan Booker, David McKenzie, and Juli Forde  the discussed the latest on models for ED reimbursement in telehealth. Dr. Judd Hollander, who streamed live into the workshop from Philadelphia, and Becky Sanders presented on the barriers, resources, and models available  in rural and urban ED settings.

On the second day, Melissa Goldman gave a thorough review of the legal ramifications of properly licensing and credentialing a telehealth ED program, which included malpractice and liability examples from various states. Dr. Edward Barthell gave a lecture on creative telehealth models for different ED healthcare delivery systems. Finally, Dr. Alex Mohseni gave a thought-provoking presentation on what the future of telehealth would entail for emergency medicine and society.

EDPMA would like to offer special thanks to Drs. Dave Ernst and Jason Alder, along with Ed Gaines, Mark Owen, and Paul Hudson, for their time and effort in planning this workshop. The final agenda can be found here

Workshop photos are available here.


Thank You to the Telehealth Workshop Sponsors

The in-depth educational sessions offered at the Telehealth Workshop in Ft. Worth, TX, were phenomenal and only possible because of our generous sponsors. EDPMA would like to thank all sponsors for making this event such a great success. Thank you!


Evening Reception Sponsorship



Lunch Sponsorship


Breakfast Sponsorship



Break Sponsorships

 


Door Prize Sponsorship




Solutions Summit Pictures

If you have not been on EDPMA's Facebook page recently, you missed the pictures posted from this year's Solutions Summit in Scottsdale, AZ. If you haven't done so yet, please "like" EDPMA on Facebook. We hope to you all had as much fun as we did. EDPMA looks forward to seeing all of your in Nashville, TN, in 2020.

Don't Miss Out on Discounted Rates to Exhibit 

This year, members of EDPMA will receive a $200 discount when exhibiting at the 2020 Solutions Summit in Nashville, TN. In addition, you will receive an additional $200 discount if you purchase your booth by July 31, 2019. Plus, the earlier you register, the earlier you get to choose your booth location.

Exhibit Table Rates:
Before July 31, 2019
$2,000 member rate
$2,200 nonmember rate

After July 31 - standard rates
$2,200 member rate
$2,400 nonmember rate

A 2020 EDPMA Exhibitor Contract is available here. Please reach out to Megan Van Dam, [email protected], to select your booth. Don't delay and miss this opportunity. Reserve your booth now!

EDPMA's 2018 Annual Report

If you attended the Summit, you received a copy of the EDPMA's 2018 Annual Report. Here is a link to the report for those of you who do not have it. The report is chock full of information about your many member benefits: advocacy successes, educational sessions, networking opportunities, and more. We strongly encourage you to share this annual report with your senior management and colleagues in the ED industry to ensure they are aware of the value of your EDPMA membership.

The Acute Unscheduled Care Model:
A Change To Prove Our Value  

Mahesh Polavarapu MD and Claudie Bolduc MD, MPH

"I'm sorry we didn't find the reason for your abdominal pain today, but your work-up in the ED did not reveal any acute life-threatening illness. I'm glad you feel better, please follow up with your primary care doctor or return for any worsening symptoms." Raise your hand if that sounds familiar, go ahead we'll wait. Now, what if we told you that only 17 percent of those patients are able to follow up with their PCP within 7 days, and it takes 30 days for 83% of patients to get into their PCP's office. That doesn't even include the nearly 20%, according to some government surveys, of Americans that don't have a PCP to begin with. What do you do with that, and more importantly, who is responsible for the care of these patients once they leave the ED? Well, If the ACEP proposal to CMS is approved, it just might be you.

The proposal, entitled Acute Unscheduled Care Model (AUCM): Enhancing Appropriate Admissions is meant to allow emergency physicians to participate in Alternative Payment Models (APMs) by accepting financial risk directly attributable to their discharge disposition decisions. Now that may sound unnerving, but it may actually be a blessing in disguise. Current value-based (aka cost-saving) payment models attempt to remove the ED physician from patient care by curbing visits to the ED that insurance providers, cough-cough, deem 'unnecessary'. This is done via coordinated outpatient care, which sounds great, but the outpatient setting is cracking and patients are continuously falling through these cracks. Pair that with the hot topic of balanced billing, and it seems that lately Emergency Physicians are being scapegoated for the rising costs of healthcare in America. This is where the AUCM (or 'awesome', see what we did there) proposal comes into play, attempting to place ED physicians back in the driver's seat and providing us with the chance to prove our value within the healthcare delivery system.

At its core, the proposal is elegantly simple. It focuses on rewarding emergency medicine providers while simultaneously decreasing cost of healthcare delivery in three ways. First, it aims to reduce hospital inpatient admissions and observation stays by providing a safer discharge option. Second, it empowers providers to coordinate, manage and avoid unnecessary post-discharge services on a case-by-case basis. Third, it attempts to avoid post-ED visit patient adverse events (repeat ED visits, inpatient events, observation stays and death) and their inherent costs. By doing so, it increases the 'value' of care provided by ED physicians. Essentially, the awesome proposal makes ED providers and their facility responsible, for lack of a better word, for a discharged patient 30 days from their initial encounter. We know what you're thinking...sounds good in theory, but HOW?

Keeping in mind that some details may change, the current proposal focuses on 4 chief complaints most ED physicians can approach in their sleep: chest pain, abdominal pain, syncope and altered mental status. Any patient checking into the ED with one of these 4 chief complaints will be eligible to enroll in the awesome payment model upfront. The final diagnosis in theory does not matter, although if your chest painer ends up being a STEMI, they would be pulled from awesome. In fact, no patients admitted to inpatient or observation status would qualify under the current proposal. But the nearly 60% of chest painers discharged with a diagnosis of anxiety, costochondritis, GERD, or our personal favorite "non-cardiac chest pain"(thanks for being specific doc), would fall into the model. Okay great, but what does that actually mean? Well, it means that instead of sending your patient out into the abyss, you would now have a tool set at your disposal to bubble wrap patients until they are back to their baseline. These tools, as proposed, include next-day telemedicine appointments, home visits by nurse practitioners/RNs, and other forms of transitional care; as well as care coordinators in the ED to help facilitate everything.

Now this clearly comes with an upfront financial investment. However, when this new cost is compared to the hospital's current benchmarks for the same episodes of care, the upside is projected through the reduction of admission, readmission and/or complication costs. The bottom line is if emergency physicians appropriately reduce unnecessary admissions, there will be a cost-savings, which by voluntarily participating in this awesome program, will be shared with ED providers. Phew, that's a lot of information and if it sounds like a bunch of words strung together, don't worry, we've included a diagram.



Now, you may be reading this and saying, "but wait, I went into Emergency Medicine so I wouldn't have to provide longitudinal care, and now you're saying I may have to?" If so, we urge you to reframe this thought process and recall that your purpose as a professional is to provide quality care. The proposed model does not, by any means, require you to establish life-long relationships with your patients. Neither does it mandate that you adjust a patient's insulin regimen 1 unit at a time until their HbA1c is just right (we got palpitations just writing that). What it does require, however, is for you to step up, be accountable and ensure that patients do not fall through the cracks when they leave the 4 walls of the department.

The beautiful thing about us is that we provide care to whoever, whenever, and wherever; not to whoever we prefer, whenever we choose fit, and whenever it's convenient. Traditionally, that care has been in the Emergency Department where we've served as a safety net for all, but now that safety net needs to expand beyond the ED. While that may seem like a tremendous burden, it actually provides our profession the opportunity to vastly increase our sphere of influence. We pride ourselves on being go-getters, community leaders, problem solvers and innovators and the awesome proposal offers us a chance to once again prove our value. Sounds, well...awesome, doesn't it?

About the Authors
Mahesh and Claudie are two of the current EMRA EDPMA scholars. Mahesh is a PGY3 at Christiana Care Health System in Delaware and will be pursuing a fellowship in administration after graduation. Claudie is a PGY2 at UCLA. She has completed an administrative fellowship at Sutter Health and is a past board member of the Quebec Medical Association.


Thank You to EDPMA's Corporate Supporters

EDPMA would like to thank our year-long Corporate Supporters.  Your important contributions ensure that the association stays active on many fronts, advocating for and educating our membership.

Platinum Corporate Level
Gottlieb

Gold Corporate Level
ImagineSoftware
Zotec Partners

Silver Corporate Level
athenahealth, Inc.
Cascade Capital
Medlytix LLC
Pendrick Capital Partners
R1

Bronze Corporate Level
Academy for Continued Healthcare Learning (ACHL)
Vituity

We urge the rest of you to become Corporate Sponsors too!  Please contact Elizabeth Mundinger ([email protected]) or Paul Gerard ([email protected]) to learn more.

Thank You to the Solutions Summit
Sponsors & Exhibitors
 
The 2019 Solutions Summit was a huge success due to the generous support of all of our sponsors and exhibitors. Thank you!

Solutions Summit Sponsors:
Golf Tournament & Preconference Reception - Brault
Martin Gottlieb Advocacy Luncheon - Gottlieb
Conference Portfolio - Gryphon Healthcare
Mobile App - Brault
Hotel Key Cards - LogixHealth
Lanyards - Change Healthcare
Water Bottles - CIPROMS Medical Billing, Inc.
EMRA Resident Scholarship - St. Vincent Emergency Physicians Inc., US Acute Care Solutions, and Vituity
Golf Balls & Tees - Brault
Wednesday Morning Joe - Franklin Collection Services Inc.

Exhibitors:
Academy for Continued Healthcare Learning (ACHL)
American College of Emergency Physicians
ARMCO Partners, LLC
athenahealth, Inc.  
Automated Collection Services, Inc. (ACSI)
Aviacode Incorporated
Board of Certification in Emergency Medicine
Brault
Capio
Cascade Capital
Change Healthcare
CirrusMD
d2i
Data Media Associates, Inc.
DuvaSawko
EmOpti, Inc.
Envision Physician Services
EPOWERdoc, Inc.
Equian
Franklin Collection Service, Inc.
Gottlieb
Gryphon Healthcare
Huddy Healthcare Solutions, Inc.
ImagineSoftware
Innovative Healthcare Systems, Inc.
Integrated Care Physicians Inc.
LightSpeed Technology Group
LocumTenens.com
LogixHealth
MedData, Inc.
Medical Coding Solutions
Medlytix LLC.
MY Biomedical
Newsura Insurance Services, Inc.
Nicka & Associates, Inc.
Payor Logic (A ZOLL Company)
Pendrick Capital Partners
Pettigrew Medical Business Services
Phoenix Financial Services, LLC
Presidiohealth
PhyCon Incorporated
Physicians' Choice, LLC
Premium Asset Recovery Corporation (PARC)
ProScribe, LLC
Qventus, Inc.
R1
RelyMD
ScribeAmerica
SheppardMullin
Shift Administrators, LLC
Sycamore Physician Contracting
The Dental Box
The Sullivan Group
TransUnion Healthcare, Inc.
TruBridge
T-System, Inc.
USI Southwest
Zotec Partners
  
New Member Spotlight:  Southwestern Michigan Emergency Services, PC


Southwestern Michigan Emergency Services, PC (SWMES, PC) is the oldest emergency medicine group in the state of Michigan. Over the past 50 years, SWMES has grown to include over 40 Board-certified emergency medicine physicians and over 20 Advanced Practice Providers. SWMES provides emergency services to four hospitals in the southwestern part of Michigan, including one hospital providing Trauma Level 1 services. For more information on Southwestern Michigan Emergency Services, PC please click here .
 

Excerpts from a conversation with James S. De Moss, D.O., President
 
Dr. James De Moss is a Board-certified emergency medicine practicing physician. He has been President and CEO of SWMES for 12 years. SWMES places the highest priority on serving the community with the highest-quality patient care, staying up-to-date on emergency medicine practices, and maintaining a superior working environment. All of the board-certified physicians are part of the clinical teaching staff at Western Michigan University Homer Stryker M.D. School of Medicine (WMed). Since the mid-1970's, SWMES, through the Bronson Trauma and Emergency Center, has helped develop and support the Kalamazoo County EMS System, culminating in the development of the Kalamazoo County Advanced Life Support Corporation, which is responsible for overseeing the ALS system for Kalamazoo County.
 
Dr. De Moss heard about EDPMA through a member in the Michigan emergency medicine community. He was intrigued and did some of his own investigation. Jim quickly saw the value in joining EDPMA and in attending the 2019 Solutions Summit. Dr. De Moss brought three SWMES, PC colleagues, Recruiter, Alison S. Smith, Clinical Operations Coordinator, Kaitlin Craven and Systems ED Medical Director, Scott C. Gibson, MD to the Summit and commented that the conference "was very worthwhile, good connections, great networking and the topics were spot on." Dr. De Moss and his team particularly focused on the reimbursement and APM tracks.
 
Dr. De Moss said he sees many of the challenges and opportunities confronting emergency medicine with private payers changing the rules that have been understood previously and changes in fee for service vs. fee for value. Dr. De Moss is pleased that EDPMA included the alternate payment models (APM) as part of the Summit's agenda. In particular, Jim mentioned that the hospitals his teams serve have a large Medicaid population. And, the Affordable Care Act (ACA) was a positive force for their group. Before the ACA, the self-pay population was 18%-20% of their patients, now it has dropped to about 5%. Dr. De Moss also sees surprise billing as a key issue for emergency medicine. In general, Dr. De Moss is seeing the narrowing of networks by insurers and increases in self pay and higher deductibles. All of this is contributing to the current state of emergency medicine today.
 
Dr. De Moss is pleased to be a part of EDPMA, as it focuses on many of the issues that concern SWMES, PC at the both the state and Federal levels. Jim expects some members of his team will join one or two committees later this year. He knows that joining EDPMA Committees is a great way to get to know many of the experts in emergency medicine and to contribute to the discussion and planning.
 
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.  (Don't be shy: if you want, you can just listen in.)

Membership Committee Update: 
EDPMA would like to welcome one new member this month: 

Morgan Financial Group, Oklahoma City, OK

We look forward to working with you!

Special Edition - Thursday, June 6, 2019

CMS Seeks Public Input on Patients over Paperwork Initiative to Further Reduce Administrative, Regulatory Burden to Lower Healthcare Costs

On June 6, CMS issued a Request for Information (RFI) seeking new ideas from the public on how to continue the progress of the Patients over Paperwork initiative. Since launching in fall 2017, Patients over Paperwork has streamlined regulations to significantly cut the "red tape" that weighs down our healthcare system and takes clinicians away from their primary mission-caring for patients. As of January 2019, we estimate that through regulatory reform alone, the healthcare system will save an estimated 40 million hours and $5.7 billion through 2021. These estimated savings come from both final and proposed rules.

This RFI provides an opportunity to share new ideas not conveyed during the first Patients over Paperwork RFI in 2017 and continue the national conversation on improving healthcare delivery. We are especially seeking innovative ideas that broaden perspectives on potential solutions to relieve burden and ways to improve:
  • Reporting and documentation requirements
  • Coding and documentation requirements for Medicare or Medicaid payment
  • Prior authorization procedures
  • Policies and requirements for rural providers, clinicians, and beneficiaries
  • Policies and requirements for dually enrolled (i.e., Medicare and Medicaid) beneficiaries
  • Beneficiary enrollment and eligibility determination
  • CMS processes for issuing regulations and policies
Key Burden Reduction Milestones to Date:

We gathered feedback on burdensome requirements from medical and patient communities through other RFIs, listening sessions, and on-site meetings with frontline clinicians, healthcare staff, and patients and are working every day to reduce regulatory burden while safeguarding patient safety, quality, and program integrity. Achievements so far:
  • Simplified Documentation and Coding
  • Improved Quality and Operational Efficiency
  • Meaningful Measures
  • Changing CMS Culture

See the full text of this excerpted CMS Press Release (issued June 6). Submit comments by August 12.

Save the Date: 2020 Solutions Summit 



Don't miss Solutions Summit next year!  EDPMA looks forward to seeing all of you in Nashville, TN, May 3-6, 2020.