Introduction:
The Centers for Medicare & Medicaid Services (CMS) recently unveiled its proposed rule for the calendar year (CY) 2024 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) payment systems. While the proposed rule aims to enhance access to emergency medicine services and improve price transparency, it has raised significant concerns within the Emergency Department Practice Management Association (EDPMA) regarding potential reimbursement cuts for physicians providing care to Medicare beneficiaries.
Emergency Department Practice Management Association's Concerns:
The EDPMA, a leading organization representing emergency medicine practices, has urged Congress to intervene and prevent the reimbursement cuts outlined in CMS's proposed rule. According to CMS estimates, these proposals could result in a 3.25% reduction in reimbursements to emergency medicine in 2024. This reduction is attributed to a 2% cut to emergency medicine services and a 1.25% contraction in the Congressional conversion factor assistance.
EDPMA emphasizes the urgent need for Congress to stabilize the Medicare Physician Fee Schedule, as 2024 would mark the fourth consecutive year of contraction. Emergency medicine plays a vital role in our healthcare system, with the guarantee under the Emergency Medical Treatment and Labor Act (EMTALA) that every emergency patient be seen, regardless of insurance status or ability to pay. It is important to note that at least 8% of all emergency department (ED) visits are provided to uninsured patients, placing additional strain on emergency physicians who deliver non-reimbursed services.
The COVID-19 pandemic and the ongoing efforts of insurers to reduce payments for medically necessary services have exacerbated the financial challenges faced by emergency medicine practices. The volatility caused by the pandemic, coupled with these reimbursement cuts, has already forced several practices to close their doors. This trend not only diminishes access to care but also contributes to unnecessary consolidation, jeopardizing the stability of the emergency care system.
Call to Action:
EDPMA calls on Congress and policymakers to recognize the crucial role of emergency medicine and ensure fair reimbursement for the vital services provided to Medicare beneficiaries. By averting the proposed reimbursement cuts, policymakers can support the financial viability of emergency medicine practices, preserve access to care for the most vulnerable patients, and maintain the resilience of our healthcare safety net.
Conclusion:
While CMS's proposed rule for the CY 2024 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center payment systems aims to improve emergency medicine access and enhance price transparency, it has raised significant concerns within the EDPMA. The potential reimbursement cuts could have a detrimental impact on emergency medicine practices, hindering their ability to provide care to Medicare beneficiaries and exacerbating existing financial challenges. It is imperative that Congress and policymakers consider the concerns raised by the EDPMA and take necessary action to ensure fair reimbursement for emergency medicine services.
Please note that this blog post highlights the concerns of the EDPMA and summarizes the proposed rule. For a comprehensive understanding of the topic, readers are encouraged to refer to the official documents, consult healthcare professionals or legal experts, and consider multiple perspectives.
Sources:
- CMS Proposes Policies to Expand Behavioral Health Access and Further Efforts to Increase Hospital Price Transparency: https://www.cms.gov/newsroom/press-releases/cms-proposes-policies-expand-behavioral-health-access-and-further-efforts-increase-hospital-price
- CY 2024 Hospital Outpatient Prospective Payment System (OPPS) Policy Changes and Hospital Price Transparency Requirements: https://www.cms.gov/newsroom/fact-sheets/cy-2024-hospital-outpatient-prospective-payment-system-opps-policy-changes-hospital-price
- CMS Physician Payment Rule Advances Health Equity:https://www.cms.gov/newsroom/press-releases/cms-physician-payment-rule-advances-health-equity
- Calendar Year (CY) 2024 Medicare Physician Fee Schedule Proposed Rule: https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-medicare-physician-fee-schedule-proposed-rule-medicare-shared-savings-program
- CY 2024 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center: https://www.cms.gov/newsroom/fact-sheets/cy-2024-medicare-hospital-outpatient-prospective-payment-system-and-ambulatory-surgical-center
- Calendar Year (CY) 2024 Medicare Physician Fee Schedule Proposed Rule:https://www.cms.gov/newsroom/fact-sheets/calendar-year-cy-2024-medicare-physician-fee-schedule-proposed-rule
- Proposed Rule: Medicare Program; Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs: https://public-inspection.federalregister.gov/2023-14624.pdf
- EDPMA Statement on CY 2024 Medicare Physician Fee Schedule Proposed Rule: https://edpma.org/wp-content/uploads/2023/07/EDPMA-CY-2024-MPFS-Statement-FINAL-1.pdf