The Emergency Department Practice Management Association (EDPMA) is pleased to announce Cathey Wise, CAE as its new executive director. Wise will lead the EDPMA’s professional team to meet the organization’s mission to advocate for emergency department physician groups and their business partners to enhance quality patient care through operational excellence and financial stability.

“As the leader in the business of emergency medicine, EDPMA looks to Wise to guide and strengthen its advocacy efforts to ensure fair payment to emergency medicine physicians and their business partners,” says EDPMA Board Chair, Don Powell, DO. “We are confident her skills and experience will help EDPMA to continue to thrive in membership and member value, education and resources, revenue, and advocacy.”

Wise comes with an extensive background in emergency medicine and non-profit management. She most recently served as Executive Director of the Emergency Medicine Residents’ Association (EMRA). She helped increase EMRA’s membership by 63 percent, member-centric events by 240%, and non-dues revenue by triple digits.

“I’m beyond thrilled to have this opportunity to be part of an organization that is so important when it comes the care that patients receive—both when they are facing a crisis that has brought them to the emergency room—and in managing what can be very complex billing scenarios after,” commented Wise. “Likewise, I’m also excited to work to ensure that policies enable and support emergency department providers in operating successful businesses.”

Wise will meet with EDPMA members in person at the organization’s annual meeting, Solutions Summit 2022—Quality Connections: Ready, Set, Grow!, taking place April 24-27 at the Omni Amelia Island Resort in Florida. EDPMA members and stakeholders will convene to learn, engage, and network with the leaders in emergency medicine. The event will also kick-off the celebration of EDPMA’s 25-year anniversary.

WASHINGTON – On February 23, 2022, the U.S. District Court for the Eastern District of Texas granted the Motion for Summary Judgment filed by the Plaintiffs – the Texas Medical Association and Dr. Adam Corley – regarding their lawsuit challenging the federal government’s interim final rule implementing the independent dispute resolution process for reimbursement disputes between physicians and insurers.

The Memorandum Opinion and Order states “the Court concludes that the Rule conflicts with the Act and must be set aside under the Administrative Procedure Act (“APA”). … In sum, the Court holds that (1) Plaintiffs have standing to challenge Defendents’ September 2021 interim final rule implementing the No Surprises Act, (2) the Rule conflicts with the unambiguous terms of the Act, (3) the Departments improperly bypassed notice and comment in implementing the challenged portions of the Rule, and (4) vacatur and remand is the proper remedy.”

The Emergency Department Practice Management Association (EDPMA), an organization representing the practice of Emergency Medicine, filed an amicus brief, along with Texas ACEP and Virginia ACEP, in support of the Texas Medical Association’s and Dr. Adam Corley’s Motion for Summary Judgment.  Throughout the legislative process, stakeholders agreed that patients should be removed from billing disputes and held only to their in-network cost-sharing amounts.  EDPMA strongly supports the patient protections.

The Motion for Summary Judgment did not challenge these protections.  The focus of the Motion and the court’s order is the process for resolving reimbursement disputes between insurance plans and physicians.  Early legislative proposals that relied on a benchmark set at the plan’s typical in-network rate were rejected in favor of a compromise that considered evidence submitted by both the plans and the physicians. The statute clearly provides that the arbiter “shall consider” eight factors before deciding appropriate payment. The interim final rule would have inappropriately prohibited the arbiter from considering seven of those required factors except in special circumstances.

“EDPMA is thrilled that the Court has vacated and remanded the problematic Rule.  Congress was clear when it passed the landmark No Surprises Act last year: protect patients from unavoidable and unexpected costs without jeopardizing patient access to care,” said Don Powell, D.O., Board Chair of EDPMA. “The Rule would have allowed insurers to manipulate payment standards with little or no transparency on the health plan’s calculation of ‘median in-network’ rates. This would have harmed not just commercially insured patients, but the rural, medically vulnerable and indigent populations who rely on our nation’s emergency departments as an important safety net.

“With the COVID-19 pandemic, and the latest wave of new variants, emergency department safety net resources have been stretched to the breaking point. We see the Rule would have led to dire effects on the overall viability of our emergency medical care system. We urged the Administration to amend the Rule to be consistent with the language of the statute and Congressional intent — and now the Court has forced them to do so.”

On October 1, 2021, EDPMA and others blasted the Interim Final Rule that contradicts both the intent and language of the No Surprises Act (NSA) in a windfall for profitable commercial insurers which threatens patient access to care.  Early versions of the NSA — which could not pass due to lack of Congressional support — tied out-of-network reimbursement to the plan’s in-network rate.  In order to garner enough Congressional support to pass the bill, the bill was amended to include a list of factors the arbiter may consider and a list of factors the arbiter may not consider.  The rule released on September 30th directs arbiters to ignore these lists and simply choose the payment amount that is closest to the plan’s in-network rate in most cases.  Moreover, the rules provide that the plan’s in-network rate (also known as the Qualifying Payment Amount (QPA)) should not reflect any bonus payments or other related compensation earned by providers.

On September 13, 2021, EDPMA commented on the Proposed 2022 Medicare Physician Fee Schedule. Read the full letter below.

 9/13/21 EDPMA Comment Letter on Proposed 2022 Medicare Physician Fee Schedule.

On August 31, 2021, EDPMA and ACEP urged Cigna not to implement its policy of down coding based on diagnosis because it violates the Prudent Layperson Standard and coding standards. See the letter below

  8/30/21 EDPMA Letter to Cigna re: Down Coding

On July 1, the Department of Health and Human Services (HHS) officially opened the Reporting Portal for entities who received one or more Provider Relief Fund payments exceeding, in the aggregate, $10,000 from April 10, 2020 to June 30, 2020.  Those entities will have until September 30, 2021 to complete the reporting process. Any unused funds from the period of availability must be returned by October 30, 2021. If no report is submitted by the deadline, then all funds are considered unused.  HHS has detailed a series of steps for completing the reporting process, which include (1) registering in the Provider Relief Fund Reporting Portal; (2) reading the Reporting Requirements Notice, which was revised on June 30, 2021; (3) watching the reporting technical assistance webinar, and then (4) submitting your information through the Reporting Portal.  All of these steps and key information related to the Reporting Portal can be found here.  Attached is a resource guide to help with the process and answer additional questions as you navigate your reporting requirements.