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Topics in Emergency Medicine
Weekly Update

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September 29, 2000

WEEKLY UPDATE for September 29, 2000

1) Balanced Budget Act "Giveback" Bill (H.R. 5259)
2) Patients' Bill of Rights
1) OIG Issues Final Compliance Program Guidance for Physicians
2) OIG Reports that Medicare Payments to Managed Care Organizations are Adequate


Ushering in the new fiscal year yesterday, a continuing resolution extended government funding until October 6. This leaves Congress with 4 working days to finish the remaining 11 appropriation bills needed before they can return home to campaign. Negotiations between Republicans and the White House have stalled, leaving the final adjournment date of the 106th Congress up in the air. Future short-term measures are expected to keep the government going until the passage of all FY 2001 appropriation bills. Most Members believe that it will take another 3 weeks to wrap up their work.

1) Balanced Budget Act "Giveback" Bill (H.R. 5259)

H.R. 5259, the "Beneficiary Improvement and Protection Act" (BIPA), the latest version of the Balanced Budget Act "giveback" bill, began its journey through the legislative process Tuesday. Most analysts believe that the final bill will allocate between $21-$30 billion among hospitals, skilled nursing facilities, HMO's, and home health agencies. It is unlikely physicians will be included among the providers receiving additional funds.

ACEP is working on a proposal developed by the Practice Expense Coalition and endorsed by the AMA to be incorporated into the House Ways & Means Committee version of BIPA. The provisions would place a 2-year moratorium on the HCFA practice expense transition. With the proposal, emergency physicians stand to gain about 3 percentage points each year over the current HCFA transition formula.

If this amendment is to move forward, it is important for ACEP members to contact Ways & Means Committee Members as well as their own elected officials in the House and Senate. The bill is due to mark up on Tuesday, October 3. The Senate is believed to be ready to proceed later in the week. Due to this short timeframe, a quick turnaround is needed. Perhaps the best way to get the Members attention is to fax your correspondence. You may also wish to contact your Member by telephone. Talking points and a suggested letter are available at:

2) Patients' Bill of Rights

House Speaker Dennis Hastert (R-IL), Reps. John Dingell (D-MI), Bill Thomas (R-CA) and Charlie Norwood (R-GA) continue their efforts to reach a compromise with Senate Republicans and the White House. Meanwhile, Sen. John McCain (R-AZ) has signaled his intention to attach the new version of the Norwood-Dingell patients' bill of rights on any legislation moving through the Senate. Sen. McCain believes he now has enough votes to pass the measure and is hoping to push the Senate into considering the bill. However, Senate Assistant Majority Leader Don Nickles (R-OK) renewed his opposition in passing the House version of Norwood-Dingell. Sen. Nickles asserted that he does not support any bill that would increase costs or increase the ranks of the uninsured. "I am willing to compromise but not to capitulate," he stated during a conference at the U.S. Chamber of Congress.

Dueling media ads on the patients' bill of rights are appearing all over the county. The insurance industry and business community recently increased media efforts to defeat the bill while the AMA has targeted its media campaign towards vulnerable Members up for re-election who have opposed the bill. Despite the dollars spent on behalf of the bill and the energy spent lobbying for it, the outlook remains 50:50 for a patients' bill of rights to be signed into law this year.


1) OIG Issues Final Compliance Program Guidance for Physicians

On September 25, the Office of Inspector General issued final compliance guidance for individual and small group physicians. The guidance was posted on the OIG's web site and will be published in the Federal Register within the next week or two. The OIG stressed that its guidance is voluntary and should be implemented "in a manner that fits with the practice's existing operations and resources."

The final guidance identifies four specific compliance risk areas for physicians: proper coding and billing; ensuring that services are reasonable and necessary; proper documentation; and avoiding improper inducements, kickbacks and self-referrals. The guidance includes an appendix of additional risk areas. These topics include reasonable and necessary services, including issues related to advance beneficiary notices; physician relationships with teaching hospitals, including the physician role in EMTALA and teaching physicians; and physician billing practices, including third party billing services.

The OIG accepted many of ACEP's July 2000 comments in response to the draft compliance guidance. The compliance guidance is available on the OIG's web site at:

2) OIG Reports that Medicare Payments to Managed Care Organizations are Adequate

A report issued recently by the Office of Inspector General states that Medicare managed care organizations receive "more than an adequate amount" to care for Medicare beneficiaries. Although the managed care industry continues to argue that implementation of the Balanced Budget Act of 1997 has forced plans to reduce benefits and pull out of markets, the OIG found that both the BBA and the Balanced Budget Refinement Act of 1999 were beneficial to the industry. The report found that Medicare managed care plans will receive about 95.5 percent of fee-for-service payments in 2000, instead of the 90.5 percent they should receive. The OIG urged HCFA to modify its payment structure. The report is available on the OIG's web site at:


Jim Hoekstra, MD, FACEP (Rep. John Kasich, R-OH)
Charles Maddow, MD (Rep. Danny Davis, D-IL)
Brian Zink, MD, FACEP (Rep. Debbie Stabenow, D-MI)


Sunday, October 23, 2000 --- 6:00 pm to 7:30 pm in Room 407-409 Philadelphia Marriott

Established in 1980, the National Emergency Medical Political Action Committee (NEMPAC) is celebrating 20 years of political involvement on behalf of emergency medicine! Working in conjunction with the 911 Legislative Network, NEMPAC serves as a critical advocacy tool that helps to promote ACEP's legislative agenda. NEMPAC is the third largest medical specialty PAC raising and contributing over $400,000 to candidates for federal office in the 1997-1998 election cycle. In addition, one out of every four emergency physicians contributes to NEMPAC on an annual basis! We hope that all NEMPAC contributors will attend this reception and celebrate 20 years of political effectiveness!

Sunday, October 23, 2000 --- 7:30 pm to 9:30 pm in Room 414-415 Philadelphia Marriott

NEMPAC has experienced tremendous growth in 2000! We would like to show our appreciation to our generous NEMPAC donors by hosting a by invitation only dinner. Members contributing $250 or more will be invited to this event as a special thank you for encouraging this growth in NEMPAC and in emergency medicine's political clout in Washington.

School of Political Advocacy -- Featuring Michael Dunn
Monday, October 23, 2000 --- 1:00 pm to 4:00 pm in Salon 1 at the Philadelphia Marriott.

ACEP's School of Political Advocacy was established in 1998. This year we are taking a fresh look at advocacy and will have Michael Dunn, a dynamic national speaker discuss the fundamentals of becoming a successful "citizen lobbyist." The School offers you the fundamentals of grassroots lobbying, techniques on communicating with legislators in personal meetings and by mail, hosting a fundraiser in your home, and serving as an influential resource to your legislator.

Luncheon for New & Former Graduates of the School of Political Advocacy-- Featuring Tucker Carlson
Tuesday, October 24, 2000 --- 11:15 am to 12:30 pm in Salon D at the Philadelphia Marriott

Graduates of the School of Political Advocacy are invited to join other members of the 911 Legislative Network for a special luncheon. This event will feature political commentator Tucker Carlson who will provide insights into the current political landscape and the upcoming elections. Mr. Carlson is the political analyst for both ABC's Good Morning America and CNN. He appears weekly on CNN's Inside Politics and Late Edition with Wolf Blitzer. The Award for the "Outstanding 911 Member" will be announced.

Legislative and Regulatory Issues Briefing
Wednesday, October 25, 2000 --- 9:00 am to 11:00 am in Room 202 A&B at the Convention Center

The practice of medicine is dramatically affected by the legislation and regulations developed on the federal level. Learn the latest about ACEP's legislative and regulatory priorities and the issues that your Washington ACEP staff are working to implement, modify, or improve.

The Public Affairs Booth
Monday October 23 through Wednesday October 25 --- 9:30 am to 3:30 pm at the ACEP Resource Center in the Philadelphia Convention Center

Stop by the booth and see how ACEP is advocating for emergency physicians in the media, in Congress, and in the federal agencies. Sign up to join the 911 Legislative Network, ACEP's premier grassroots network, and learn how NEMPAC works to promote your practice. Collect materials to start your own public safety campaign in your emergency department and view Kaiser Family Foundation's HealthCast of ACEP's successful conference on Preserving America's Health Care Safety Net.

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