At its Nov. 3, 2016 meeting, the Medicare Payment Advisory Commission (MedPAC) further examined the role of stand-alone emergency departments (EDs) in urban and suburban areas, where access to care may not be much of a concern.  In its June 2016 report to Congress, the Commission suggested that stand-alone EDs might be a solution for isolated rural areas with concerns about access to care.  MedPAC Commissioners are revisiting stand-alone EDs again because the number of these facilities has continued to increase, such that a national association has formed. There are new academic studies on stand-alone EDs published this year.  And, contained within the “site-neutral” law  is a provision that exempts off-campus stand-alone EDs from the prohibition on off-campus facilities billing as hospital outpatient departments.

There was a general consensus among the Commissioners on the following points:

1. CMS could begin tracking off-campus EDs in Medicare claims data as administrators and researchers are largely unable to see what services are being conducted in facilities.
2. The Commission could consider examining incentives that encourage providers to serve patients in the ED setting.
3. The Commission could consider reexamining the off-campus emergency department exemption included in the site-neutral law.
   

Commissioners acknowledged that urgent care is filling a need for the health care community and that some of the freestanding EDs are performing in the manner of an urgent care center and getting paid more.  Commissioners agreed they should look at the exception for the site-neutral policy for stand-alone EDs, with overwhelming support to have a rural exception, as they provide a much-needed service in these areas.

Additionally, some Commissioners called for MedPAC to consider a recommendation to Congress or CMS that there be a moratorium on additional hospital freestanding ED
facilities.

UCAOA will continue to monitor MedPAC’s discussions.