NSA Impact
Presenter:
Mike Granovski, MD, CPC, FACEP
Key Elements of Successful Practices:
- Effective schedule management
- Positive practice environment
- Competitive physician compensation
No Surprises Act (NSA) Impact:
Groups with an out-of-network strategy suffered significant financial losses.
- Pre-NSA: Many groups recouped up to 5x Medicare (~$175/RVU -> up to $900-1000/pt, primarily from OON billing).
- Post-NSA: Payments reduced to 2x Medicare, leading to ~$473 loss per patient.
- Net impact: ~$24 per patient loss (at ~5% commercial payer mix).
- Broader Financial Challenges:
- Federal Reserve rate increases (0% → ~5%) exacerbate pressures.
- Groups under extreme pressure are primarily large PE backed groups.
- Opportunity for other groups as contracts with these organizations are lost.
Physician Autonomy & Systemic Operational Solutions
Presenter:
Alison Haddock, MD, FACEP
Theme:
Physician autonomy is the issue, not burnout.
ACEP working on Systemic Operational Solutions rather than “Physician Wellness.”
- ED Throughput/Boarding:
- Federal grants for boarding solutions
- Quality Measures and Medicare Compliance:
-
2 key quality measures
- Improved care for Medicare patients
- Enhanced flow through emergency departments
- Critical to tie these measures to Medicare Conditions of Participation, with financial incentives and compliance penalties for hospitals
- Reducing Preauthorization Requirements for SNFs (skilled nursing facilities)
- Smoothing operating room scheduling practices
- Insurer Accountability: ACEP is seeking examples of insurer misconduct to build cases for policy advocacy. Members are encouraged to email stories to reimbursement@acep.org
- Unionization and Physician Autonomy: Unionization benefits were discussed, with Oregon’s reported successes highlighted. Did not take a stand one way or the other on unionization … simply pointed out as option.
- Concerns of ED Corporatization: Particularly calling out private equity as factor reducing autonomy.
- Scope of Practice and ED Staffing Standards: ACEP is strongly advocating for the defense of physician scope of practice, emphasizing the necessity of a 24/7 physician presence in all emergency departments.
- The AMA aligns with ACEP on this standard.
- ED accreditation programs to ensure compliance with these staffing and support requirements.
