EDPMA Membership Newsletter 

March 2019

Congratulations to Members Who Will Serve on the  EDPMA Board from 2019-2021

Congratulations to the six members elected to serve on the EDPMA Board from May 2019 until May 2021: 

Vituity: Bing Pao, MD, FACEP, Chair-Elect

Emergency Care Specialists: Don Powell, DO, FACEP, Executive Committee 

EPOWERdoc, Inc.: David Ernst, MD, FACEP, Executive Committee

Zotec Partners: Ed Gaines, JD, Executive Committee  
Rev4ward, LLC.: Juli Forde

St. Vincent Emergency Physicians: William Freudenthal, MD, FACEP  

We would like to welcome one new member to the Board: Rev4ward, LLC., represented by Juli Forde. EDPMA would like to thank America's ER, represented by Dr. Mark Feanny, who is stepping down in May.   Thank you to those who ran for a seat, but didn't make it on.  We hope to see you run again next year when the other 13 seats will be open.

Registration Ends (Monday) April 1st for EDPMA's

Golf Tournament at Solutions Summit

Please join us at EDPMA's Solutions Summit Golf Tournament on The conference hotel is sold out for Saturday night, but EDPMA set aside rooms for those who are registered for the Golf Tournament! Please contact Megan Van Dam at (202) 802-9028 or   [email protected]  for assistance with your hotel reservation.

The tournament is at the McCormick Ranch Golf Club, Pine Golf Course, located adjacent to the Scottsdale Resort at McCormick Ranch (the conference hotel). The course is within walking distance, but transportation will be provided. Following the tournament, EDPMA is holding a Pre-Conference Reception on the Upper Terrace Patio of the Golf Club. This reception is open to all Summit registrants, not just golfers.

Time: 1:00 PM Shotgun Start (different teams start from different holes) ( arrive 30 minutes early!)

Pricing: $150 per person.

Guests of Summit Registrants: If you are in the emergency medicine business, you must be a conference registrant in order to play golf. However, you have the option to register for just Sunday sessions. If you are not in the emergency medicine business and are a guest of a registrant (such as a spouse or child), you need only pay the golf registration fee of $150 plus the $50 for a guest pass to the Pre-Conference Reception ( $200 total). If a non-industry guest of a Summit registrant would also like to attend the Opening Reception and Closing Reception, this would cost an additional $50 to attend both. (Guest passes to the evening receptions are $50 for one reception or $100 for all three.)

Golf tournament registrations are non-refundable.

Club Rentals: $55 (plus tax)

Sponsorships: You can sponsor a hole or a competition (closest to the hole; longest drive; etc.) for $1000 plus the cost of anything additional you would like to offer, such as a special award, drink, or snack.

Hotel Room Block Update:
You must be registered for the Summit and golf tournament to qualify for one of the Saturday-night rooms EDPMA has set aside for golfers. Once you are registered, Please contact Megan Van Dam at (202) 802-9028 or   [email protected]  for assistance with your hotel reservation.

More information about the Golf Tournament is available here.

Information about the 2019 Solutions Summit is available here.

If you have forgotten your member password, please email Paul Gerard at [email protected].

 

May 29th and 30th in Dallas/Fort Worth, TX

Register Here!

Location:  Holiday Inn DFW Airport South

Room Rate: We have a block of rooms at  $129/night

Session Topics Will Include :

Pricing:

Assessing the Risks and Rewards of CMS Rule to
Reduce E/M Documentation Burden by Eliminating Re-documentation for Chief Complaint and History

As part of the Patients Over Paperwork Initiative, the Centers for Medicare and Medicaid Services (CMS) at the beginning of 2019 implemented rules aimed at reducing the E/M documentation burden. The rules were focused on office and outpatient Evaluation & Management (E/M) visits. In response to a request for feedback on whether to extend the policies beyond the office and outpatient E/M codes set to the emergency department (ED) E/M code set, in the calendar year (CY) 2019 Medicare Physician Fee Schedule final rule, CMS stated, "[W]e are taking a step-wise approach and limiting our policy proposals this year to the office/outpatient E/M code set . . . We may consider expanding our efforts more broadly to additional sections of the E/M visit code set in future years." So, while the ED E/M itself is not included in new documentation requirements, many Emergency Medicine clinicians also practice in settings where the office/outpatient visit CPT codes (CPT 99201 - 99205; and CPT 99211 - 99215) are used.

For the office/outpatient E/M visit code sets (CPT 99201 - 99205; and CPT 99211 - 99215), beginning on January 1, 2019, CMS began accepting history elements documented elsewhere in the medical record, including if entered by ancillary staff or if personally performed by the beneficiary. According to a CMS FAQ , this applies to "the chief complaint (CC) and any other part of the history (History of Present Illness (HPI), Past Family Social History (PFSH), or Review of Systems (ROS)) for new and established office/outpatient E/M visits." The goal is to reduce the need to re-document elements in the record already stated by ancillary staff or beneficiary.

Previously, the billing clinician could reference the ROS and PFSH from others but had to personally document the CC and HPI. Under the new provisions, the billing clinician may review notes already documented in the chart, update or supplement as needed, indicate an acknowledgement of their review and verification of that information in the record and rely on all of that information for the CC, HPI, ROS and PFSH. In other words, the billing clinician can use a nurse's notes for the HPI and not re-document what has already been documented.

The intent appears to allow the clinician to focus on generating a more meaningful medical record without having to worry about previous documentation requirements that are founded on counting history elements. These element requirements still exist and must be fulfilled somewhere in the documentation; however, the clinician need not re-document what other members of the treatment team have already included, ideally resulting in less repetition, less time at the computer, and more time for the clinician to be patient-focused.

While the rationale driving the new policy seems well-intended, there remain questions about how the new rules will work in practice and whether it will result in real burden reduction.

Ideally, a well-written medical record is one that accurately captures the encounter, the cognitive work the clinician puts in toward caring for their patients including the background thought process and 'work intensity.' A well-written medical record accurately communicates a patient's condition and treatment to other clinicians, reduces the risk of malpractice, allows for accurate coding, and reflects the high quality work that clinicians perform daily.

We applaud CMS for their efforts to reduce the documentation burden, but the real world effect remains unknown. As CMS directly states in the CY 2019 MPFS final rule, "We note that this policy to simplify and reduce redundancy in documentation is optional for practitioners, and they may choose to continue the current process of entering, re-entering and bringing forward information." It is important for physicians to consider the potential impacts before taking advantage of the new flexibility being provided under these rules. Before embarking on new internal documentation policies, the full scope of impact should be considered. Consult with your revenue cycle team and medical malpractice experts to determine the best path for moving forward.

Written By: Dr. Jason Adler, Vice President of Practice Improvement, Brault and Juli Forde, Principal, Rev4ward, LLC.

  

• 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.

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