Articles

Free to All Friends of IEPC!

Time & Date: 9:00 AM – 9:30 AM PT on the fourth Monday of each month. Membership in IEPC is not required to attend. Advance registration for the meeting is required. After registering, you will receive a confirmation email containing information on how to join the call! To receive a registration link, email admin@iepc.org.

Roneet Lev, MD FACEP
Executive Director, IEPC

“Doctors make bad patients,” my surgeon cautioned me as we discussed scheduling the removal of my thyroid amidst my busy professional and personal commitments. He emphasized the importance of taking my health seriously, a reminder I heeded with caution.

In the months leading up to my thyroidectomy, I juggled my medical responsibilities with my health concerns. Knowing that thyroid cancer progresses slowly, I postponed addressing it until after I had completed urgent obligations and arranged a three-month medical leave. Rather than clearing my schedule, I compiled a list of tasks I could manage while recuperating.
The reality of my diagnosis hit me during a hectic shift in the emergency department when my
surgeon called with concerning news about lymph nodes. The prospect of a more invasive
surgery loomed over me, threatening not only my physical well-being but also my self-image and
plans. My perception of medicine is colored by the cases I see in the emergency department,
often skewed toward adverse outcomes. Amidst the chaos of treating my own patients, my nurses gave me a hug and my colleague held down the fort, giving me the time and space to manage my own health and return to my patients.
One of the most significant hurdles I faced was reconciling my role as a knowledgeable
physician with my newfound status as a vulnerable patient. As a physician I found comfort and
control by studying the medical literature, guidelines, and preparing for possible symptoms or
complications. I wanted to be ahead of the situation. As a patient I learned I don’t have the
control of the future, I was forced to learn patience, and I failed at predicting my personal
reactions to treatment. There is a disconnect between medical knowledge and practical
application. I have been giving medical advice for years. Applying the advice, even simple
advice such as keeping your head elevated or following a diet required sage advice from
experienced patients rather than doctors.

Navigating the healthcare system proved to be another formidable obstacle, highlighting
disparities in access and efficiency. Despite my professional connections, I encountered delays in
scheduling crucial tests. It took me a month to schedule an MRI. I empathized with the struggles
of other patients. I treated a young man in the emergency department who, like me, faced long
delays in scheduling crucial. His request for an MRI to stage his cancer for a next day urology
appointment may seem non emergent, but I ordered it STAT, understanding that he tried and
failed to arrange it as an outpatient. The test underscored the life-or-death implications of
bureaucratic inefficiencies and highlighted the importance of proactive advocacy.

I was striving to be a good patient, but the doctor in me remains. I strove to better understand the radioactive iodine treatment I was to receive that could radiate and harm my vulnerable
granddaughters and pregnant daughter-in-law. The treatment requires a period of isolation
without a clearly defined time. I purchased a Geiger counter and graphed my radiation emissions
to follow the data on when it was safe to return to contact with my family.

My health scare gave me a forced and unplanned stop in my daily life. I grappled with questions
of mortality and purpose leading to healthy thoughts of reassessing my priorities. While I strive
for control, I learned to accept uncertainty and found solace in the support of loved ones and the
resilience of the human spirit.

Ultimately, my journey from doctor to patient taught me invaluable lessons about vulnerability,
resilience, and the power of human connection. While my professional expertise offered insights
into my diagnosis and treatment, it is my faith, community, and inner strength that carries me
through the darkest moments. As I embark on the road to recovery, I do so with a newfound
appreciation for the interconnectedness of humanity and the transformative power of empathy
and compassion.

Elena Lopez-Gusman
Executive Director, California ACEP |
American College of Emergency Physicians

The Legislature passed the first Medi-Cal rate increase for emergency physicians in 20 years. This was made possible by the renewal of the state’s Managed Care Organization Tax. This tax on managed care plans will provide an opportunity to raise funds, match them with federal dollars, and provide resources to invest in the state’s health care infrastructure, including the largest Medi-Cal rate increase in California history. The initial proposal included rate increases for primary care providers and mental health providers to 87% of Medicare, but did not include emergency physicians.

California ACEP staff and member physicians engaged in grassroots efforts to encourage the Governor and the legislature to include emergency physicians in the final language. Our advocacy efforts literally paid off!

Starting in 2025, $200 million will be devoted annually to reimbursement rates to emergency physicians. As you are painfully aware, your Medi-Cal reimbursement rates have not increased in 20 years, despite you caring for a disproportionate share of the Medi-Cal population. This increase will take our rates from somewhere between 55-60% of Medicare reimbursement to 80%.

Robert Chavez, MD
President, IEPC

Providence Little Company of Mary Medical Center Torrance

Here is my pearl for this month:

Check with your network Payors overseen by DMHC to see if they have given your rates their annual inflation rate updates.

A. In late 2023 applying to 2024, DMHC finalized regulations adding annual inflation rate adjustments to the interim payment methodology required by California’s out of network billing and payment law AB 72, 2016.
B. This law requires payors to reimburse at a default reimbursement rate, with an opportunity for physicians to challenge the rate through California IDR Process.
C. The current DMHC default reimbursement rate is based on the greater of the payor’s average contracted rate of 125% of Medicare for the same or similar services in the geographic region where the services are rendered.
D. This law amended reqwuirement went into effect on 1/1/2024. As a result, you could potentially receive a 6% increase in reimbursement (3% inflation per year over the last 2 years.)
E. Ask your RCM company to look and see if any of your rates are affected by this adjustment to existing law.
F. Ask your RCM company to reach out to the payors covered to see if they have increased your rates.

You may or may not receive a reply, but it never hurts to ask. If you get a chance, please take a moment to thank CMA for this potential rate increase. It was made possible through their state advocacy efforts.

Robert Chavez, MD
President, IEPC

Providence Little Company of Mary Medical Center Torrance

Here is my pearl for this month. With regards to out of network payers, the No Surprise Act mandates annual Consumer Price Index-Urban (CPI-U) annual updates to the Qualified Payment Amount (QPA). Each year since the NSA statute was signed into law, the IRS has published an annual inflation update to the QPA payers are obligated to present when a group has an IDR claim against them. The statute states the QPA’s CPI-U adjustment is a cumulative increase from the “median allowed amount as of 1/1/2019.” The 2022 adjustment from 2019 was +6.485%. The 2022 adjustment from 2019 was 6.485%+7.685%=+14.6695%. The 2024 adjustment, in addition to the previous two adjustments, is calculated at a total of +20.89%. Therefore, when engaging in the IDR process, be sure to ask your OON health plans if they have made the mandated adjustments. If they do not respond or have not made the adjustments, then consider filing a complaint at FederalIDRQuestions@cms.hhs.gov. In addition, I asked my in-network payers if they had increased their QPA and would this lead to a higher reimbursement based on my current rates? The response to this question was mixed, but it was definitely worth asking.

Sandra Schneider, MD FACEP

Director of EM Practice at ACEP, the American College of Emergency Physicians

Boarding, perhaps one of the biggest threats to our patients and our own burnout, is a major focus of ACEP. ACEP has done a lot to try to ‘fix’ boarding, but little has happened, and the pandemic, with the staff shortages that followed, has made a horrible situation ever worse. It is clear that movement on the boarding issue will require state and national changes to reimbursement and regulation. ACEP efforts included:

• A letter to the President of the United States, asking for a national summit.
• A task force, comprised of individuals with a thorough understanding of EM and government.
• Based on their discussions, a summit was held in DC involving many govermental agencies.
• AHRQ then took the issue of boarding as a patient safety issue as a topic for one of their systematic reviews.
• Finally, HHS has asked AHRQ to convene a national summit on boarding. https://www.acep.org/news/acep-newsroom-articles/green-light-for-acep-ledrequest-to-form-national-boarding-task-force

ACEP has passed a lot of policies focused on our workplace and on the practice of EM. Now we are putting those policies into action. In the next few months, ACEP will launch an ED Accredidation Program, based on ACEP policies, where hospitals that meet our standards can receive recognition https://www.acep.org/edap. This should help the public determine which ED to visit, as well as help with the recruitment/retention of employees. There are 3 levels based upon staffing, with level 1 requiring direct oversight of all NPs/PAs by a board-certified emergency physician. There are some options for Critical Access and Rural Emergency Hospitals.

In addition to the ED Accredidation Program, there will be a similar distinction, a Blue Ribbon, for employers who abide by all of ACEP policies, such as billing transparency, due process, etc.

This will hopefully encourage employers to create a better workspace and provide visible information for job-seeking physicians.

Along those same lines, ACEP is providing transparency through Open Book https://www.openbook.acep.org. This is a summary of EDs in the US, with information on which group staffs the site, ED volume and a list of the ACEP policies that are followed by that employer (self-assessed). This is tied to Ivy Clinicians which offers a job board.

Finally, there are a lot of meetings:

• First is this March, ACEP Accelerate. We are trying something new by gathering several different smaller meetings into the same venue. This helps with room rates as well as increasing marketing. https://www.acep.org/accelerate
• Leadership and Advocacy is early this year in April. https://www.acep.org/lac This is our time to talk with our legislators and let them know what is happening in our EDs and what will help our patients.
• And of course, ACEP 24 in Las Vegas! https://www.acep.org/sa. There are a number of new features this year. First Research Forum (abstracts are open now and due in April) will be close to the exhibit hall, so you can browse the abstracts more easily https://www.acep.org/education/meetings/research. We have created more focused advanced classes, along with the traditional review courses. There are more meet ups and small group areas, designed to focus conversation and increase networking. And of course it is Vegas!

Free to All Friends of IEPC!

Time & Date: 9:00 AM – 9:30 AM PT on the fourth Monday of each month. Membership in IEPC is not required to attend. Advance registration for the meeting is required. After registering, you will receive a confirmation email containing information on how to join the call! To receive a registration link, email admin@iepc.org.