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Did you say EDPMA? What is it?
April 23, 2009
Emergency Department Practice Management Association (EDPMA) is a national trade association and advocacy group that represents independent Emergency Physicians and their billing organizations.
EDPMA was formed in 1997 by a group of like-minded ED staffing and billing companies who joined forces to work on federal advocacy issues. The legacy companies include The Schumacher Group, Team Health, and Medical Management Professionals. They originally united to battle for the ability of third party billing companies to accept assignment of Medicare (CMS) money for physician services (reassignment).
It took countless hours meeting with CMS and Congressional representatives, but in the end, they overturned the prohibition. Medicare reimbursement is one of the biggest streams of revenue for Emergency Physicians, and if third party billing companies could not act as an agent on behalf of the physician(s) billing operations would have been devastated.
Over the last 10+ years, EDPMA has grown from three member companies to approximately 89 members and affiliate member companies. EDPMA represents the majority of the nation’s largest emergency physician staffing organizations/practice and billing companies. EDPMA membership is based by the company/organization and not an individual level, which sets EDPMA apart from other professional organizations such as ACEP, OSMA, and HBMA.
Premier Health Care Services, Inc. (PHCS) joined EDPMA in 2001 and has been one of the primary leaders and financial resources for EDPMA. As a result of our long-term membership, Premier has been unanimously elected to the Board of Directors.
Dr. John Lyman initially served as the Board representative for PHCS. He also served a two-year term as Board Chairman until 2007. Currently, I serve as the Premier Board representative and Chairperson of the EDMPA Health Care Reform Task Force. Although a Board of Directors governs EDPMA, the majority of member activity and interaction takes place via Task Force meetings and conference calls. Premier resources, such as Dave Chauvin, Lisa Hohler, Cindy Springer, and Linda Dinkel, direct the Medicare Reimbursement, Documentation Guidelines, Health Care Reform, and Quality Initiatives Task Force leadership.
Due to the compact size of the nation’s heavyweights of independent emergency medicine practices, EDPMA can mobilize quickly to act upon CMS and Capitol Hill or state regulatory activities to circumvent negative consequences. For example, on March 13, 2009, a CMS Transmittal concerning Medicare Integrity updates stated “EFT payments may only be made to a banking institution located in the state where the practice location is located.” For companies that do interstate business such as Premier, we would have been required to establish a banking relationship in each state we do business in.
The new CMS “instructions” were issued with the intent of closer monitoring and integrity, which seems logical. However, the end result from a business perspective was negative. This ruling was not vetted with public comment, only an internal memo distributed to the “carrier” (i.e. Palmetto GBA). It was only by coincidence that EDPMA leadership saw the internal memo; they then alerted membership about the consequences. EDPMA hit the streets while others were still under layers of bureaucracy. On April 2nd CMS rescinded the new instructions.
EDPMA has had direct impact on other CMS policies, such as appropriate Pay for Performance and PQRI measures, what is or is not feasible for the specialty of Emergency Medicine, mitigating mandates that require use of electronic prescription and EMR. EDPMA members also engage in interstate negotiations and lobbying against prohibition of balance billing and artificially set UCR for out-of-network emergency services.
What is the value of EDPMA membership? It allows Premier to work collaboratively with other national leaders in Emergency Medicine business/practice management to overturn CMS/Federal/legislative proposals that encumber the practice of Emergency Medicine or the business and operations of our billing company (MBI). EDPMA allows the highest level of legislation to hear our concerns and for us to receive favorable action.
We cannot place a dollar value on the outcomes. Recent (and past) EDPMA action has prevented implementation of CMS proposals that would have negatively affected MBI operations and, in turn, significantly decreased Premier’s revenue.
Many connectors exist between EDPMA and ACEP, and the two organizations collaborate on many of the same initiatives, such as Fair Payment/Reimbursement, Managed Care class action settlement compliance, stabilization of Medicare Reimbursement, Balancing Billing Prohibition, limited liability for EMTALA related services, and the Access to Emergency Medical Services Act. EDPMA focuses on the independent emergency physician practice and advocating sound fiscal conscientiousness by our governmental agencies.
The mission of EDPMA is to advocate for emergency physician groups and their partners to enhance quality care through operational excellence and financial stability.
If you have any questions or want to become involved with EDPMA, please contact Beth Cesta at 937-312-3786. Or visit me at EDPMA Solutions Summit XII June 8th-10th at the Ritz Carlton, South Beach, Miami, FL.
For more information about EDPMA, contact:
Beth Cesta, CPC, CHCCAssistant Vice President Government and Payer Relations
e-mail: bcesta@phcsday.com
Premier Health Care Services, Inc.
332 Congress Park Drive
Dayton, OH 45459
1-800-726-3627
© 2010 Premier Health Care Services, Inc.