Although it's still officially Summer, our Fall calendar has seen a flurry of activity affecting the practice of Emergency Medicine in our Commonwealth. Here's what we've been working on:
1. Boston Municipal Court Ruling on Section 12(a) Cases: Last week, the Appellate Division of Boston Municipal Court ruled that psychiatric patients held in an emergency department under Massachusetts General Laws Chapter 123, Section 12(a) may only be held for a maximum of three business days inclusive of the time they spend in the acute care hospital/emergency department and before the patient presents at the psychiatric hospital or unit. Under this reading, if a hospital has not been able to find a psychiatric hospital or unit to admit the patient, the hospital must release the patient, even if the patient is unstable, suicidal, or dangerous to others. While this ruling may ultimately help advance the conversation leading to a fix to the mental health boarding problem in our emergency departments, we advise that all EDs and emergency physicians consult with their hospital's legal department for interpretation of this ruling. We must continue to be our patients' advocates in their times of crisis and protect them from harm despite what a singular appellate court has decided.
2. E-prescribing Regulations from DPH: MACEP and other stakeholders submitted written comments to the original drafts of these new regulations and OUR VOICES WERE HEARD as they have amended sections that would have been onerous to our practices. Among the changes are:
- 1-year delay in implementation to Jan. 2021 (vs Jan. 2020)
- Full exemption of Schedule VI drugs (such as antibiotics) from all electronic prescribing requirements ( this includes phone-in prescriptions)
- Four additional exceptions, and increased flexibility for emergency scenarios ( the two-day electronic follow-up prescription requirement has been removed, as Schedule II oral prescriptions fall within the emergency situation exception in 721.070, which requires a seven-day written follow-up prescription.)
- Broader language for the annual waiver process.
3. Out of Network Billing: Massachusetts Health Policy Commission findings: MA HPC recently published their findings illustrating pricing variation for typical OON/surprise bills that may arise for patients from hospital-based physicians using data from Fair Health benchmarks which ranged from Medicare rates (lowest) to 80th percentile of charges (highest). The report also showed geographic variation with regard to certain benchmarked ED charges. What the report failed to disclose, however, was the cost of doing business 24/7/365 and why it may cost more to do so in certain regions of the state vs others. Expect more on this issue as the legislature readies health care reform legislation that will include OON language.
4. BORIM Regulation changes and FAQ: Unfortunately, the FAQ released in early September did little to clarify the language that was contained in the 7 pages of regulatory changes handed down in July. For our EM practices the most potentially confounding new reg has to do with written informed consent. Bottom Line: according to the new regulations, if you did something in your practice that required informed consent before, it now has to be in writing. In the case of "emergencies," the revised regulation states that every effort must me made to obtain written informed consent but that if the physician is unable to do so in the case of an emergency, the physician must document in the chart why he/she was unable to obtain consent and share with the patient at a later time. MACEP will continue to work with the BORIM and other stakeholders to further clarify and perhaps amend these current new regulations with the purpose of creating an environment of safety and efficiency in our emergency departments.
Please know that your MACEP representatives on our Board of Directors and Committees meet regularly in person and via online communications to create positive outcomes for ourselves and our patients in accordance with our organizations's mission statement.
MACEP celebrates its 50th anniversary this year and we are planning a celebration to be held on November 13 in Boston on Beacon Hill. Before the celebration, we will be organizing an Emergency Medicine Lobby Day where members will meeting with their senators and state representatives to help influence the voting on legislation we are supporting. Among our priority legislation on that day will be: H.910/S.588, An Act Relative to Mental Health Parity Implementation (Balser/Friedman) and H.932 An Act Relative to Out of Network Billing (Cassidy).
A message from the MACEP President
|We hope you are having a wonderful summer. Since our Annual Meeting in early May, we have been busy monitoring the debates both Federally and on Beacon Hill as they pertain to our practice of Emergency Medicine here in Massachusetts as well as digesting the recent updates from our own Board of Registration in Medicine. But more on that later…
MARK YOUR CALENDARS: MACEP celebrates its 50th anniversary this year and we are planning a proper celebration to be held on November 13 in Boston on Beacon Hill. Before the big party, we will be organizing a MACEP LOBBY DAY where we will assist you, our members, in lobbying your districts’ senators and state representatives to help influence the voting on legislation we are supporting. Among our priority legislation on that day will be :
H.910/S.588, An Act Relative to Mental Health Parity Implementation (Balser/Friedman)
Strengthens state reporting requirements and oversight of health insurers compliance with existing state and federal Parity laws.
H.932 An Act Relative to Out of Network Billing (Cassidy)
This bill provides a solution to out-of-network billing by prohibiting patients from receiving unavoidable out of network bills, or "surprise bills," and lays out a solution to ensure reasonable reimbursement between the health insurer and the clinician for the services provided. The bill lays out a formula to establish a “usual and customary” rate of reimbursement for the given medical service in the geographic area according to an independent database. The bill also establishes a mediation process and provides for additional patient protections regarding the enforcement of these provisions, as well as transparency requirements to prevent some instances of surprise billing.
Following a debriefing, we will convene at Carrie Nation Cocktail Club on 11 Beacon Street from 4:30 PM until 7 PM. We are hoping to see a big turnout of current members, past MACEP officers, counselors and board members. A special thank you to MACEP Past President Elijah Berg and LogixHeath for their support in helping make this celebration possible.
MASSACHUSETTS LEGISLATIVE UPDATE from Ronna Wallace, Legislative Consultant:
The summer recess is about to come to an end and we have a very busy fall ahead of us!
The Joint Committees will continue public hearings on all bills before them. We work closely with the Joint Committees on Health Care Financing, Financial Services, Public Health and Mental Health, Substance Use and Recovery. We appreciate the collaborative relationship we have built up with these Committees, Chairs and staffs over the years and work hard to maintain them with frequent communication and sharing of resources and priorities.
Also coming up in the fall will be a revisiting of health care reform and cost containment legislation. Governor Charlie Baker is expected to release a comprehensive health care bill in September or early October. That will kick off House action on the issue, beginning with a public hearing on that bill followed by the release of the House bill that will eventually go before the full House for passage. The Senate will follow suit sometime in late 2019/early 2020. This is of top importance to MACEP and our members as Out of Network billing will be included in those bills. You will remember in the last session, those bills ultimately died in Conference Committee. This session, we’ve started early and have been meeting with House and Senate leaders, sharing our thoughts on the importance of taking patients out of the middle of disputes between providers and insurers, holding patients harmless for additional costs, and ensuring fair reimbursement for out of network providers. If previous bills filed by Governor Baker are any indication, his health care bill this year will also include mental health and substance abuse provisions, a priority of both the Governor and MACEP.
FEDERAL LEGISLATIVE UPDATE: ACEP’s leaders have been working continuously on Out of Network Billing, a.k.a. Balanced Billing, for well over a year, advocating to keep our patients out of the middle of this and for Independent Dispute Resolution (IDR) for Emergency Physicians. During this congressional summer recess, which will end September 9th, ACEP is asking us to write/call/meet with our senators and representatives. Please ask your representative to support H.R. 3502, the Ruiz-Roe proposal, which levels patient deductibles and supports a ”baseball style” IDR process and and our Senators Warren and Markey to support the Cassidy workgroup proposal S. 1531, which does the same.
• Download and use the materials in the August Recess toolkit on surprise billing, including guidance on how to schedule in-district meetings, talking points, and meeting leave behinds.
• Send an email to your legislators during the recess period then share your communications on social media. We have prepared sample emails that you can customize to your U.S. Senators and Representative. Some of you will be thanking your House member for co-sponsoring H.R. 3502. This is also important so please take action today.
• Join the 911 Grassroots Advocacy Network for the latest updates and alerts on this issue. You will need your ACEP member log-in credentials.
ACEP COUNCIL UPDATE: In late October, a delegation of 10 consisting of most of our current MACEP Executive Committee and the other elected councillors will be attending the annual ACEP Council Meeting in Denver, Colorado. The ACEP Council is in charge of electing the ACEP Board of Directors the Council officers, and the ACEP President-elect. The Council also debates and votes upon forty to fifty resolutions which are put forward by individuals and/or ACEP chapters, giving guidance and acting as a sounding board for the Board of Directors as they consider policies that affect the College. The debates on the floor can get lively and I anticipate that this year it will be no different. I expect some action from the Council on the gun violence epidemic this year.
BORIM UPDATE: As most of you are aware, the Massachusetts Board of Registration in Medicine (BORIM) approved revisions to their regulations earlier this month that may greatly affect our practices. I attended the MMS Interspecialty meeting last week and it became apparent that these new regulations have shaken up the whole house of medicine in Massachusetts.
The new regulations significantly expand requirements for informed consent, including specificallyrequiring written consent before many diagnostic, therapeutic, or invasive procedures and medical interventions or treatments. We are deeply concerned about how this could affect the practice of EM. Please know that we are actively working with both BORIM and the Massachusetts Medical Society to gain clarification on the new regulations and advocate for a process which is non-disruptive to the care we give to our patients. Stay tuned for more info."
In closing, I would like to recognize the talented and smart people that MACEP has supporting me this year:
Immediate Past President: Scott G. Weiner, MD, MPH, FACEP, FAAEM is an Associate Professor of Emergency Medicine at Harvard Medical School and the Director of the Division of Health Policy and Public Health in the Department of Emergency Medicine at Brigham and Women’s Hospital in Boston. He is also the Director of B-CORE: The Brigham Comprehensive Opioid Response and Education Program, a hospital-wide, multi-disciplinary project with the goal of reducing opioid-related morbidity and mortality.
President Elect: Jesse Rideout, MD, MPH, FACEP, is an emergency physician at Tufts Medical Center in Boston and an Assistant Professor of emergency medicine at Tufts University School of Medicine. He is the Director of the Tufts Clinical Skills and Simulation Center and the Director of Simulation Education for Tufts University. He is the past Chair of the MACEP Education Committee.
Secretary: Kathleen Kerrigan, MD, FACEP is an Assistant Professor at UMMS-Baystate, Assistant Program Director for Emergency Medicine Residency at UMMS-Baystate and Director of Simulation for Department of Emergency Medicine. She also maintains her board certification for Ob/Gyn.
Treasurer: James J. Sullivan, Jr. MD is currently Associate Director, Emergency Medicine Residency and Associate Medical Director, Emergency Medical Services and LifeFlight at UMass Memorial Healthcare -Leominster. Completed a surgery intern year at the National Naval Medical Center, Bethesda MD in 1996, and have deployed with Navy and Marine medical units to Iraq in 2005 and Afghanistan in 2011.
Member At Large : Joseph C. Tennyson, MD , FACEP, is an Associate Medical Director, UMass Memorial EMS and LifeFlight and an Associate Professor, University of Massachusetts Medical School. His clinical interests include Air Medicine,. Emergency Medical Service, Emergency Medicine Administration.
Thank you and see you on November 13 on Beacon Hill.
Brian P Sutton, MD, FACEP