Proposed new rule boosts ED payments

Under a proposed rule from the Centers for Medicare & Medicaid Services (CMS), the nation’s EDs will see payment rate increases of between 3.2% and 5% for services provided.

Currently, the ambulatory patient classification (APC) rate for low-level emergency visits is $74.70; under the proposed new rule, the rate will be $77.92, or a 4.3% increase. For midlevel emergency visits, the current rate of $130.77 will rise to $137.36, or a 5% increase. For high-level emergency visits, the rate will go from $226.30 to $233.76, or a 3.2% increase. The proposed changes would take effect Jan. 1, 2005.

EDs will reap additional benefits, says Charlotte Yeh, MD, FACEP, Boston regional administrator for CMS. "Under these new proposed Medicare rules, first-time physicals for new beneficiaries are covered and hospital payments increased for routine screening exams," she notes.

"This is an extraordinarily healthy step forward; preventing illness and keeping people healthy will always result in fewer people using our overburdened emergency departments [for primary care services]," Yeh adds.

To qualify for payment by Medicare, the physical must be performed within six months of the beneficiary’s enrollment in the program.

The proposed payment rate update and other policy changes in the annual outpatient prospective payment system rule will increase projected Medicare payments to hospitals for outpatient services to $24.2 billion compared to projected payments of $22.7 billion in 2004 — a 6.6% increase in total payments.

The proposed rule introduces changes that were required by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, signed into law Dec. 8, 2003.

The proposed rule was published in the Aug. 16, 2004, Federal Register. Comments on the proposed rule will be accepted until Oct. 8, 2004, and a final rule is scheduled to be published by Nov. 1, 2004.

For more information, visit the CMS web site at: www.cms.hhs.gov.