American College of Emergency Physicians s2

1 PLEASE NOTE: THIS RESOLUTION WILL BE DEBATED AT THE 2017 COUNCIL MEETING. RESOLUTIONS ARE NOT 2 OFFICIAL UNTIL ADOPTED BY THE COUNCIL AND THE BOARD OF DIRECTORS (AS APPLICABLE). 1

2 3 4 RESOLUTION: 35(17) 5 6 SUBMITTED BY: Undersea & Hyperbaric Medicine Section 7 8 SUBJECT: Legislation Requiring Hyperbaric Medicine Facility Accreditation for Federal Payment 9 10 PURPOSE: Work with the Undersea and Hyperbaric Medical Society and ACEP’s Undersea and Hyperbaric Medicine Section to 11 advocate that CMS require hyperbaric facilities be accredited to receive federal payment. 12 13 FISCAL IMPACT: Budgeted staff and consultant resources to convey ACEP’s position to CMS and relevant regulators. 14 15 WHEREAS, Undersea and hyperbaric medicine is recognized by the American Board of Medical Specialties as a 16 subspecialty of emergency medicine; and 17 WHEREAS, Fewer and fewer (now less than 50 of more than 1,400) hyperbaric centers are offering 24/7 emergency care for 18 all approved indications; and 19 20 WHEREAS, Many hyperbaric centers that do not offer 24/7 emergency care are receiving profits through non-emergent (and 21 sometimes non-indicated) treatments, which pulls patients and revenue from those centers struggling to offer 24/7 emergency 22 availability to their patient populations; and 23 24 WHEREAS, It appears that CMS considers hyperbaric medicine to be overutilized and/or abused, which is evidenced by the 25 identification of hyperbaric medicine as the number one priority on the 2017 OIG work plan; and 26 27 WHEREAS, It is unlikely that emergency applications of hyperbaric medicine are wasteful or overutilized; and 28 29 WHEREAS, Other medical societies, such as the American Academy of Sleep Medicine (AASM), have decreased waste 30 and/or overutilization, as well as improved patient care, by requiring sleep center accreditation for federal payment; and 31 32 WHEREAS, While the Undersea & Hyperbaric Medical Society (UHMS) has an existing accreditation system, it is 33 underutilized (only 205 of more than 1,400 hyperbaric medicine centers are accredited), likely due in part to lack of incentives; and 34 35 WHEREAS, Under a current proposal by the UHMS, supported by the ACEP Undersea & Hyperbaric Medicine Section, 36 facility accreditation requirements would be bolstered to mandate (i) board-certified medical directors, (ii) expanded training 37 requirements for all providers, and (iii) 24/7 emergency availability (or create partnerships with other 24/7 facilities); and 38 39 WHEREAS, If accreditation was required for federal payment, there would be a subsequent increase in demand for 40 fellowship training and board certification in Undersea & Hyperbaric Medicine; and 41 42 WHEREAS, If federal payment was contingent on facility accreditation and training demand thus increased, the UHMS, the 43 Council of [Undersea & Hyperbaric Medicine] Fellowship Directors (COFD), and ACEP could work to create new fellowship 44 opportunities and improve training programs to help decrease non-indicated applications of undersea and hyperbaric medicine; and 45 46 WHEREAS, The UHMS plans to utilize funds collected through the accreditation program to support fellowship training and 47 hyperbaric medicine research to advance the aforementioned objectives; therefore be it 48 49 RESOLVED, That ACEP work with the Undersea & Hyperbaric Medical Society and the ACEP Undersea & Hyperbaric 50 Medicine Section to petition and advocate for CMS to require that hyperbaric facilities be accredited to receive federal payment. 51 52 Resolution 35(17) Legislation Requiring Hyperbaric Medicine Facility Accreditation for Federal Payment Page 2 53 Background 54 55 The resolution directs ACEP to work with the Undersea & Hyperbaric Medical Society (UHMS) and ACEP’s Undersea & 56 Hyperbaric Medicine Section to ask CMS to require that hyperbaric facilities be accredited to receive federal payment. 57 58 Under current policy, accreditation is not required by CMS for federal payments to be made to hyperbaric centers. According to 59 UHMS, there are currently 203 accredited hyperbaric centers in the United States. 60 61 There is recent precedent for requiring accreditation for federal payment that is relevant to this resolution. In 2017, Local Coverage 62 Determination (LCD) L36839 was issued by Wisconsin Physicians Services, a Medicare Administrative Contractor (MAC), that 63 required sleep centers and staff credentials to be accredited by the American Academy of Sleep Medicine (AASM), The Joint 64 Commission (TJC), or the Accreditation Commission for Health Care (ACHC). WPS indicated that this LCD was simply a 65 clarification of existing policy, though some facilities were caught off guard by this revision, particularly those who were accredited 66 by TJC, but had not specifically requested the ambulatory care accreditation. 67 68 It is worth noting that requiring accreditation may create additional burdens for facilities, both in terms of costs and the delays 69 associated with the accreditation timeline, which can take as long as six months to complete. Additionally, the process for 70 implementing this policy is worth considering as well. The MAC process of issuing Local Coverage Determinations has been 71 subject to criticism from a wide variety of stakeholders, primarily due to a lack of transparency of how determinations are made and 72 inconsistency in payment policies throughout the country. MACs have recently received more scrutiny from federal lawmakers as 73 well, and the lessons learned from the WPS decision may be helpful for determining the most appropriate strategy for securing the 74 changes sought by this resolution. 75 76 ACEP Strategic Plan Reference 77 78 Goal 1 – Reform and Improve the Delivery System for Acute Care 79 Objective B – Promote quality and patient safety, including continued development and refinement of quality measures and 80 resources 81 Objective C – Pursue strategies for fair payment and practice sustainability to ensure patient access to care 82 83 Fiscal Impact 84 85 Budgeted staff and consultant resources to convey ACEP’s position to CMS and relevant regulators. 86 87 Prior Council Action 88 89 Resolution 20(16) Support & Advocacy for 24/7 Hyperbaric Medicine Availability adopted. Directed ACEP to work with Undersea 90 and Hyperbaric Medical Society and the Divers Alert Network to support and advocate for improved 24/7 emergency hyperbaric 91 medicine availability across the US to provide appropriate and timely care to patients in need. 92 93 Resolution 33(10) Support of Subspecialty Certification and Fellowships in Undersea and Hyperbaric Medicine adopted. Called for 94 ACEP to support ABEM subspecialty certification in Undersea and Hyperbaric medicine (UHM) for physicians board certified in 95 emergency medicine and promotion and development of ACGME accredited fellowship program sin UHM. 96 97 Prior Board Action 98 99 Resolution 20(16) Support & Advocacy for 24/7 Hyperbaric Medicine Availability adopted. 100 101 Resolution 33(10) Support of Subspecialty Certification and Fellowships in Undersea and Hyperbaric Medicine adopted. 102 103 October 2004, reviewed ACEPs liaison relationships with outside organizations. Members of the UHM Section were active 104 members in the UHMS and the current liaison personally funded travel for liaison activities. The Board approved discontinuing 105 funding for the liaison relationship. 106 107 November 1987, established an official liaison relationship with UHMS and the American College of Undersea and Hyperbaric 108 Medicine. Resolution 35(17) Legislation Requiring Hyperbaric Medicine Facility Accreditation for Federal Payment Page 3 109 110 111 Background Information Prepared by: Ryan McBride, MPP 112 Senior Congressional Lobbyist 113 114 Reviewed by: James Cusick, MD, FACEP, Speaker 115 John McManus, MD, FACEP, Vice Speaker 116 Dean Wilkerson, JD, MBA, CAE, Council Secretary and Executive Director