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Ed Gaines Profile picture
@EdGainesIII
May 18 • 3 tweets • 2 min read Twitter logo Read on Twitter
1/ If you are hospital based & admin. doesn’t think “Medicaid redetermination” is a potential issue, especially if your state has expanded Medicaid, then show him/her this article—this redetermination.. 250K FL residents kicked off Medicaid; more expected tampabay.com/news/health/20…
2/ process for most states began April 1, 2023. 80% of the 250K covered lives in FL lost coverage b/c they did not respond to the communications from Medicaid officials—that seems like an opportunity to mitigate lost coverage—@ahahospitals have an enormous stake in mitigation. ImageImage
3/ N.B.—FL has not expanded #Medicaid so if your state has expanded the extent of the impact could be >.

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More from @EdGainesIII

Ed Gaines Profile picture
Feb 22
1/ What’s the urgency re: #NoSurprisesAct dispute resolutions decisions (IDRs) returning immediately you ask? 1st, amicus briefs are important but they’re but 1 tool in the tool box. “We” need to do more, to wit: for EM docs the decline in post #NSA reimbursements is >32% so….
2/ IDR is the main remedy to the EM Docs who have (willingly) the #EMTALA & moral duty to provide care regardless of the in network status; 2. @EDPMA survey data on the +30% decline in pre vs post NSA reimbursements is 10s of 1000s of claims. 2 paraphrase the movie “Patton”, how
3/will we all answer the question “where were you & what do you do when independent physician groups’ independence suffered an accelerate decline?” To borrow a line from Netflix doc “Full Swing” (attributed to Tiger) “ Don’t get bitter, get better” @ACEPNow @ACRRAN @ASALifeline
Read 4 tweets
Ed Gaines Profile picture
Oct 20, 2022
1/Big congrats 2 the Physicians Advocacy Institute, American College of Emergency Physicians, American College of Radiology, American Society of Anesthesiologists, American Hospital Association, American Medical Association, and The Emergency Department Practice Management....
2/ Association for filing w/in a very short timeline (@EPDMA found out last Friday that 10/19/22 was the deadline for amicus briefs--FUN weekend!) "friends of the court" (amicus curiae) briefs in support of @texmed @AdamCorley Motions for Summary Judgment to have the Aug. 2022...
3/ NSA final rule vacated, just as the court had previously ruled in Feb. 2022 with the Q4 2021 final rule--with @AmerMedicalAssn PAI coming in with over 30 state & federal medical societies joining to oppose yet another ill fated attempt by HHS to set the QPA as a benchmark....
Read 4 tweets
Ed Gaines Profile picture
Sep 14, 2022
1/ Here's a call to action for the bill to address the Medicare fee schedule cuts--Tell Congress: Fix Medicare Reimbursement!
Clinicians are working harder than ever to recover from the pandemic—but continually facing cut after cut, and inflation is on the rise......
2/Insurers, who posted record-breaking pandemic profits, continue to raise premiums and lower reimbursement rates to clinicians. Additionally, across-the-board, sequestration cuts of -2%, just hit our clinicians in the first half of 2022.
January 1, 2023, approximately.....
3/ -10% plus, in Medicare cuts will impact hospital-based clinicians. We need Congress to enact new legislation to STOP THE CUTS!
•-4.42% - Medicare conversion factor (CF) cuts were proposed by CMS’ 2023 Medicare Physician Fee Schedule (MPFS).
•-4% - Pay-As-You-Go (PAYGO) ...
Read 4 tweets
Ed Gaines Profile picture
Sep 14, 2022
1/ Good news on CMS fee schedule--Reps. Ami Bera (D-CA) and Larry Bucshon (R-IN) introduced legislation Tuesday (Sept. 13) to mitigate CMS’ proposed physician fee schedule cuts for 2023, which doctors have decried since the rule was released, by increasing the conversion .....
2/ factor 4.42%effectively putting the cuts on hold for a year. Congress has stepped in the past few years to help mitigate physician fee schedule cuts, and stakeholders have urged lawmakers to do so again prior to 2023. The lawmakers, who recently spearheaded .....
3/ a bipartisan request for feedback on how to revamp the flawed Medicare Access and CHIP Reauthorization Act, also include in their newly introduced Supporting Medicare Providers Act a sense of Congress that HHS, the House and Senate should administratively and legislatively ...
Read 4 tweets
Ed Gaines Profile picture
Aug 20, 2022
1/ Random musings on the #NoSurprisesAct final rule issued 8/19/22--sorry for the trade speak in advance but otherwise this string would be 50+--the "qualifying payment amount" serves 2 purposes--determine Pt cost sharing & as a factor in IDR; QPA by definition repeated in the...
2/ rule is the median allowed amount determined by health plans for same or similar svs. as of 1/1/19--adjusted for inflation; now my doc friend who used to be an actuary says the CPI on the QPA should be +20%--then how would over 90% of the claims surveyed by @ACEPNow & @EDPMA..
3/reflect that the QPA=the allowed amount in '22? Because the health plans are making up the QPA as they know their calculations are non-transparent to anyone--except if CMS audits & stakeholders have repeatedly requested same; but perhaps we are making progress; see the......
Read 10 tweets
Ed Gaines Profile picture
Jul 26, 2022
1/PSA--this just in--@CIGNA is engaging in systemic, multi-state actions & demanding immediate physician group contract reductions in the range of -30 to -50% (I have seen the emails in that range, see below for redacted copy); actions have been confirmed in #NC, #FL #TN &......
2/ other states; @CIGNA is specifically referencing the #NoSurprisesAct as their justification for demanding immediate reductions or threatened unilateral termination, a 'la @BlueCrossNC (they tend to follow herd behavior) (as reported here but repeated again below)--redacted....
3/ client named email is below, received Mon. 7/25/22--I have seen or discussed w/ EM and anesthesia groups so far--likely more is coming & industry colleagues have shared term letters--also redacted and posted below--once again, time for a strong advocacy response from.....
Read 7 tweets

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