PACEP Advocacy Priorities

Balance Billing

It is important to take patients out of the middle of billing issues related to insurance networks. No one chooses where to have an emergency. No one should worry about going to an emergency department when facing a medical crisis.
Emergency physicians stand ready to care for anyone with any condition, 24/7, 365, regardless of their insurance.
Insurance companies are constructing narrow networks to maximize their profits by excluding physicians and restricting patient access.
PACEP is working with a multi-specialty coalition to ensure that patients have access to quality emergency care by resolving the issue of balance billing in an equitable manner.
PACEP worked with the same multi-specialty coalition to ensure that PAMED also prioritizes the proper resolution of the balance billing issue.
PACEP opposes any bill that sets a Medicare payment standard for emergency care. Such a standard is not reflective of the costs of providing quality emergency care, would set a state-mandated price cap on emergency services, would remove any negotiating power between emergency physicians and insurers, and would jeopardize the emergency care safety net in the state.
PACEP and its coalition partners support a payment standard that is transparent and market based. The FAIR Health Database meets this standard and should be the basis for any legislation on balance billing.

Read PACEP's Resources:
PACEP FAIR Health Database FAQs (compiled in conjunction with FAIR Health)
Article: A Solution to Surprise Medical Billing - When emergency physicians are caught between take-it-or-leave-it contracts and the EMTALA mandate.
NORC Report
Article: RAND

PACEP Working on the Issues That Impact Patients We Care For, On Every Level
The urgent need for Congress to act on a series of health care policy matters that are essential to maintaining access to health insurance coverage and care for Pennsylvania families. Read the letter to Pennsylvania Congressional Delegation.

Opioids

Emergency physicians are on the front-line of treating Pennsylvanians affected by opioid crisis.
Emergency physicians are innovative champions in developing solutions to the opioid crisis, including championing increased access to naloxone, developing warm handoff programs, initiating medication assisted therapy in the emergency department, and working with governmental stakeholders in writing guidelines on opioid prescriptions from the emergency department.
PACEP supports efforts to empower emergency physicians to provide quality care to patients with Opioid Use Disorder both in the emergency department and in other settings. These efforts include legislation and regulations to ease the administrative burdens, ensure reimbursement for treatment of patients with opioid use disorders, and improve access to substance abuse treatment and mental health services for patients upon discharge from the emergency department.
PACEP opposes legislation or regulations that are not reflective of the demands of emergency care or unsupported by evidence for effectiveness. This includes blanket bans on the use of opioids in the emergency department, onerous restrictions on emergency physicians’ judgements in prescribing opioids to discharged patients with acute medical conditions, and mandated inpatient therapy for patients with opioid use disorders.
PACEP will publicize the efforts of emergency physicians developing and implementing novel

Rewrite of Hospital and Emergency Department Regulations

The Pennsylvania Department of Health is currently re-writing regulations of hospitals and emergency departments for the first time in 25 years.
These regulations have the same authority as law in Pennsylvania and will affect how every emergency physician practices in the state.
PACEP believes these regulations should reflect the state-of-the-art care being provided by emergency physicians in emergency departments across Pennsylvania and recognize the advances in emergency medicine since the last time these regulations were revised.
PACEP therefore is working with the Department of Health to ensure these regulations are written in a manner that allows emergency physicians to provide effective care to patients throughout Pennsylvania.

Regulatory Activity

Affordable Health Care Act (AHCA)
As part of a collaborative effort to educate and advocate with the PA Congressional delegation on Medicaid expansion and Medicaid financing reform, PACEP signed a group letter asking legislators to vote no to the AHCA.

The current version of the legislation would allow states to apply for waivers to opt out of providing insurance coverage for essential benefits, including emergency care.

Independence Blue Cross (IBC) policy on modifier 25
Read PAMED’s letter of opposition to Daniel J. Hilferty, President and CEO of Independence Blue Cross on the recently announced policy on modifier 25, set to become effective August 1, 2017. This policy denies appropriate payment for evaluation and management (E&M) services when billed with modifier 25 by reducing reimbursement for those services by 50 percent. In addition to several other specialties, PACEP was a co-signatory on the letter.

Help Make A Difference

Please join our grassroots advocacy network, the “PACEP 911 Network.” By growing and developing our PACEP 911 Network, we will have a more effective voice in Harrisburg.

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