Surprise Billing Legislation in House of Representatives

[southerndoc]

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We have some serious legislation that is pending that will have a large impact on surprise billing. Emergency physicians will likely see a significant cut in their pay -- as much as 50% -- if legislation passes with intended financial goals.

The purpose of the legislation is straight forward. Nobody wants patients hit with huge out-of-network bills that insurers -- who are contracted to cover their members -- do not pay. A provider may not be in-network because of an insurance company's negotiated payments being too low, billing processes being too burdensome, etc. Right now, insurers that are in-network usually get reduced rates.

There is pending legislation (HR 861) that would require hospitals to disclose being out-of-network status for its services, which includes physician services such as anesthesia and emergency medicine. This is currently in the House Ways and Means Committee. A panel of the House Education and Labor's Subcommittee on Health, Employment, Labor, and Pensions recently held a hearing examining surprise billing. They concluded that patients should not be held responsible for the dispute.

Discussion was made on what to make insurers responsible for paying out-of-network providers. New York has legislation that requires out-of-network insurers to reimburse based on the FAIR Health Database, which is an aggregation of claims data. The Subcommittee's panel recommended out-of-network reimbursement at 125% of the Medicare rate, which has several problems. It's incredibly low compared to most current in-network rates and would give incentives for insurers to not renew their contracts with providers. They could low ball negotiations so that providers would be forced to take extremely low reimbursements. Also, Medicare is uncertain in the future. Future reimbursements may be even lower, which would mean private insurers would pay less.

This would have devastating consequences on emergency medicine. Most providers would not tolerate a 50% pay cut given the litiginous risk associated with EMTALA-mandated care. It would be one thing if the federal government granted sovereign immunity, but they will not do this anytime soon.

The Medicare formula has not made its way into HR 861 as an amendment as of yet, and there has been no new legislation introduced. Keep your eyes on this. The 125% formula is currently in play in Colorado, and we just recently defeated it in Georgia (150% of Medicare reimbursement).

For those emergency physicians not involved in politics, you may want to reconsider. PM me if you want additional info on how to get involved.

 

[gamerEMdoc]

I'm DEFINITELY worried about balance billing legislation, but here's what I want to know. If I bill for $1-2 million dollars in physician fees every year, and this legislation takes a 30% cut to that, lets say its 1.5 million down to 1 million, the hospital is STILL profiting 600k off my work if I make 400k. Yes, their profit margins go down, but they are still making money based on my billed for services compared to my salary, right? This is going to destroy hospitals, and yes that will get passed down to all employees I guess. But I just don't know how big of a salary hit this will lead to because in the end, they are still making money off our care even at the lower reimbursement rate. So in the marketplace, if they don't want to pay me say 400k and ONLY make 600k a year in profit off me, I'd imagine some other struggling hospital would be happy to take on that bargain.

Maybe this is too simplistic of a view of our reimbursement for our professional fees I guess. Maybe I'm way off on the average amount of profession fees I think are billed under most EM docs care. Medical economics is definitely NOT my strong point. I just think we are vastly underpaid for what the hospitals/CMGs bill for in terms of our professional fees to begin with (not even considering the rest of the ED bill, which doesn't exist without us either).

 

[gamerEMdoc]

Also, a lot of this is thanks to CMGs. Hospitals that accept a certain insurance can contract their ED out to a CMG that doesn't participate in that insurance network. Patients go to that "in network" hospital only to find out that their ED bill is "out of network" thanks to the bill from the CMG. This balance billing issue needs to, if anything, be putting pressure on CMGs to be forced to participate in the plans that their hospitals they are contracting with participate in. It is absurd you can go to a hospital that is "in network" only to get an out of network bill that was never disclosed to you and has been a major player in why this problem exists.

 

[Booze Aldrin]

It's incredibly low compared to most current in-network rates and would give incentives for insurers to not renew their contracts with providers. They could low ball negotiations so that providers would be forced to take extremely low reimbursements.

To say insurers could low ball negotiations if this bill passed is a huge understatement lol. If it goes through, 125% of medicare would instantly and overnight become the new maximum reimbursement across the country. Negotiations would only occur if insurers believed they could force providers to accept a rate that is less than 125% of medicare. Nobody would be making more than 125% of medicare, because why would insurers possibly sign an in-network contract that's >125% of medicare if they can just go paperless and pay 125% across the board with zero effort. 😱

 

[southerndoc]

To say insurers could low ball negotiations if this bill passed is a huge understatement lol. If it goes through, 125% of medicare would instantly and overnight become the new maximum reimbursement across the country. Negotiations would only occur if insurers believed they could force providers to accept a rate that is less than 125% of medicare. Nobody would be making more than 125% of medicare, because why would insurers possibly sign an in-network contract that's >125% of medicare if they can just go paperless and pay 125% across the board with zero effort. 😱

Insurers would be required to continue their current contracts, but once it's time to renew I doubt very seriously they would pay more than 125% of the Medicare rate. Medicare + 125% would be the new standard reimbursement.

Long term, this will be even worse as CMS consolidates Levels 2-5 into one level to "reduce documentation burden." An E&M Level 5 today is likely to be reimbursed at the new rate of 75% of current rate if the new E&M coding changes take effect in 2021.

 

[deleted109597]

This is the beginning of us all being hospital employees.

 

[southerndoc]

This is the beginning of us all being hospital employees.

Or all of us moving on to urgent care or other careers. If I take a 50% pay cut as predicted by one medical association (emergency medicine specific), I plan to just give up medicine. It's not worth the risk. Yes, we all love to help people (I still get great satisfaction in it), but I'm not going to put my behind on the line with risk of losing my house, savings, etc. without proper reimbursement.

While 125% of Medicare rate may be >$150 now, in a few years it won't be if the E&M coding changes take effect. If you're seeing only 2 patients per hour, you might say that it's >$300 per hour that the hospital, SDG, or CMG is getting. However, you have to keep in mind the overhead involved, malpractice premiums paid, etc. in addition to the "self-insured" that don't pay anything.

This country is on a fast paced course for Medicare for All or another similar single payer program (perhaps a non-government non-profit organization). Not completely opposed to it, but definitely not in favor of it. Medicare for All is a disaster waiting to happen, and luckily they will have a 0.0001% chance of it passing and getting signed into law in the next few years. The government doesn't do well with running healthcare. Medicare and the VA are prime examples. A third-party non-profit insurer that doesn't impose burdensome documentation and billing practices like CMS will likely be a high likelihood of becoming our next healthcare system in the next 10 years. You can bookmark this page and refer to it 10 years from now.

I regularly meet with legislators. Definitely will stay on top of this and I urge everyone to do the same. If you haven't been through a government/legislator affairs training program via AMA, ACEP, NAEMSP, etc., then I highly recommend you do so and get involved. Our profession has already suffered a lot and we need more unity to have a solidified stance.

 

[deleted109597]

I wish I could convince my wife to move to NZ already

 

[southerndoc]

I wish I could convince my wife to move to NZ already

US docs will be emigrating to other countries.

 

[namethatsmell]

As if we needed to again beat the drum of "pay off your loans ASAP."

So should this absurdity become reality...

Our EM profession would become one of the most regulated non-government-employed jobs. EMTALA requires us to see everybody, CMS foists ridiculous sepsis/core measures upon on, and now CMS would tell us what we can get paid for what would become the vast majority of ED visits. Since government regulations would largely define our professional experience I wonder if an enterprising group of docs could sue for federal sovereign immunity.

And how delightful that this law "for the patients" screws the EM doc who performs an actual service to the patient/society while putting even more cash in the pockets of insurers whose first allegiance is to their shareholders.

While we can easily recognize this would worsen the already mismatched ratio of EM physicians+ED beds : patients, you'd think somebody advising the people writing this law could appreciate the basic economics of this. I can imagine the chatter at the table: "hey everybody, let's create some new laws today that can destroy the only safetynet in healthcare...and don't worry we'll still make it to lunch on time." How myopic can the policy writers be?

Thanks southerndoc for keeping us posted on this. l'll be PM'ing you.

 

[namethatsmell]

I wish I could convince my wife to move to NZ already

I've been trying to convince mine for years.

I even buckled and offered Australia, but it didn't sway her.

 

[deleted109597]

local

US docs will be emigrating to other countries.

I've been trying to convince mine for years.

I even buckled and offered Australia, but it didn't sway her.

Yeah, countries that have already gone through this and completed it are way better than what we will have to deal with.

 

[cyanide12345678]

Out of curiosity, what's the reimbursement for Medicare for a level 4 or 5 chart with no critical care time?

 

[cyanide12345678]

So if this law goes through, will we then be better off with universal Medicare to at least cover the large number of uninsured population that doesnt pay a dime?

This sucks -_- and I'm JUST graduating from residency.

 

[southerndoc]

$35.9996 per RVU. E&M level 5 is 4.89 and level 4 is 3.32. So $176 and $120, respectively. 2019 actually saw a slight drop of 0.14 percent due to budget neutrality adjustment. So numbers for 2019 went down slightly to 0.9986% of the 2018 reimbursement. What does this mean? If Congress decides to "neutralize the budget" and lower Medicare reimbursement for the year, then the out-of-network reimbursement would be adjusted for all payers. This is why it's a very bad idea to tie out-of-network reimbursement to Medicare.

Most insurers reimburse in-network around $300-600 for a level 5.

Keep in mind that MIPS (Merit-based Incentive Payment System) will affect Medicare reimbursement 2 years following. So in 2020, your 2018 data will affect your reimbursement. This is tied to the physician and will follow the physician no matter where he works. That means that a poor performer will be paid less. A SDG may not be able to take him or her on as a physician if he/she has cuts in payments. Who knows if the base on Medicare will includes MIPS adjustments or if it's the national average (I presume average).

 

[cyanide12345678]

I just googled the bill? @southerndoc are you sure that's the correct bill number? HR 861 was introduced in 2017 and it seems to be the has more to see with the environmental protection act? Unless there is a clause hidden somewhere in between, but doesn't seem like this particular bill has much relevancy to us?

 

[namethatsmell]

I just googled the bill? @southerndoc are you sure that's the correct bill number? HR 861 was introduced in 2017 and it seems to be the has more to see with the environmental protection act? Unless there is a clause hidden somewhere in between, but doesn't seem like this particular bill has much relevancy to us?

H.R.861 - 116th Congress (2019-2020): To amend title XVIII of the Social Security Act to prevent surprise billing practices, and for other purposes.

Summary of H.R.861 - 116th Congress (2019-2020): To amend title XVIII of the Social Security Act to prevent surprise billing practices, and for other purposes.

www.congress.gov

 

[cyanide12345678]

Seems very similar to what acep recommended a few days before the bill was introduced.

Newsroom

newsroom.acep.org

I have limited knowledge on the political landscape, but I don't see anything in this particular bill that is tying reimbursement to Medicare. From what I'm seeing, the hospital can charge the max an in network provider would have paid, and now expect the insurance to actually pay that amount.

The places where I see reimbursement tied to Medicare are old bills dating back to 2017. The Shaheen bill in particular seems terrible, but the current bill HR861 doesn't sound as terrible in comparison. The Cassidy bill sounds fairly reasonable. Anyway, I don't have as deep as understanding as you guys, so please correct me, but sounds like worse bills have been presented to Congress in the past compared to this. And acep has a similar recommendation to the new bill, so cmgs must make more $$$ from this bill since ACEP protects CMG interests.

https://www.healthaffairs.org/do/10.1377/hblog20190221.859328/full/

 

[Hamhock]

This is the beginning of us all being hospital employees.

Deleted. I decided I didn't want that info out there on the interwebs.
HH

 

[southerndoc]

Seems very similar to what acep recommended a few days before the bill was introduced.

Newsroom

newsroom.acep.org

I have limited knowledge on the political landscape, but I don't see anything in this particular bill that is tying reimbursement to Medicare. From what I'm seeing, the hospital can charge the max an in network provider would have paid, and now expect the insurance to actually pay that amount.

The places where I see reimbursement tied to Medicare are old bills dating back to 2017. The Shaheen bill in particular seems terrible, but the current bill HR861 doesn't sound as terrible in comparison. The Cassidy bill sounds fairly reasonable. Anyway, I don't have as deep as understanding as you guys, so please correct me, but sounds like worse bills have been presented to Congress in the past compared to this. And acep has a similar recommendation to the new bill, so cmgs must make more $$$ from this bill since ACEP protects CMG interests.

https://www.healthaffairs.org/do/10.1377/hblog20190221.859328/full/

Please see my original post. A panel on a subcommittee recommended it. It has not been written into the bill yet. The goal is to prevent it from ever being seriously discussed and written into a bill.

 

[deleted547339]

$35.9996 per RVU. E&M level 5 is 4.89 and level 4 is 3.32. So $176 and $120, respectively. 2019 actually saw a slight drop of 0.14 percent due to budget neutrality adjustment. So numbers for 2019 went down slightly to 0.9986% of the 2018 reimbursement. What does this mean? If Congress decides to "neutralize the budget" and lower Medicare reimbursement for the year, then the out-of-network reimbursement would be adjusted for all payers. This is why it's a very bad idea to tie out-of-network reimbursement to Medicare.

Most insurers reimburse in-network around $300-600 for a level 5.

Keep in mind that MIPS (Merit-based Incentive Payment System) will affect Medicare reimbursement 2 years following. So in 2020, your 2018 data will affect your reimbursement. This is tied to the physician and will follow the physician no matter where he works. That means that a poor performer will be paid less. A SDG may not be able to take him or her on as a physician if he/she has cuts in payments. Who knows if the base on Medicare will includes MIPS adjustments or if it's the national average (I presume average).

I’m confused. A 99291 is 4.5 rvu. How is a level 5 more?

 

[Birdstrike]

We have some serious legislation that is pending that will have a large impact on surprise billing. Emergency physicians will likely see a significant cut in their pay -- as much as 50% -- if legislation passes with intended financial goals...

That’s a House (Democrat) Bill you’re referring to. Nothing the socialist leaning Democrat party ever proposes is going to help ‘rich greedy doctors’ who have ‘gotten rich by bankrupting the system’ (according to them). And if they ever claim they’re going to, they are lying to you. Class warfare is their currency. But you can bet your first born each and everyone of them, no matter how socialist and rich-bashing, will be a multimillionaire by the time they leave office.

 

[BoardingDoc]

I’m confused. A 99291 is 4.5 rvu. How is a level 5 more?

You're looking at the work RVUs only. Not the total RVUs for the code. Total RVUs for a 99291 is 6.28.

 

[GonnaBeADoc2222]

So what do we do to fight this?

 

[bravotwozero]

Our group was forced to become in network for all of the hospitals that we staff, so not sure how this would affect us in the future.

 

[emletters]

I won't ever pretend to be an expert on healthcare policy, but just reading up on the issue, it seems like this is a problem created by insurance companies, not by physicians. They intentionally limit the number of in network providers and mismatch in network hospitals with out of network providers (they are contracted separately) all so they can pay less to whichever out of network party (whether hospital or physician) a patient ends up at. This is extremely manipulative and clearly premeditated, so why is legislation targeting physicians? Why not go after insurance companies to make them be more transparent and expand their networks, rather than allowing them to create minefields for patients to navigate and increasing the likelihood a patient will end up at some out of network party?

 

[southerndoc]

Insurance companies have lobbyists and people who actually voice their concerns. Quite frankly, physicians are horrific at political matters. We tend to concentrate on patient care and think everything will be done in favor of the doctor-patient relationship. That is far from the truth and is why states are allowing out-of-network/balance billing issues to linger, independent APC practice, etc.

We really need to solidify our stance and be united on things that affect our specialty. This is one of the key issues. Yes, it's the fault of insurance companies. They are for-profit entities with CEO's who rake in >$10 million in bonuses for good performance. Of course they are playing the out-of-network card right now because they get away with doing what they are contracted to do: pay for their members' healthcare.

 

[RustedFox]

Because they get away with NOT doing what they are contracted to do?

 

[TooMuchResearch]

Because they get away with NOT doing what they are contracted to do?

Yes.

 

[namethatsmell]

The big insurers’ lobbyists must be epically good. How these guys are still allowed to function as for-profit entities, or at least not be heavily regulated, is still beyond me...

 

[emletters]

So we recognize the problem-what do we do about it? What does solidifying our stance mean? I'm not trying to be critical or patronizing, I genuinely want to do something about this. Do we contact our representatives? What?

 

[gamerEMdoc]

So what do we do to fight this?

Advocacy, and for 99% of us, that can be as simple as donating to political action committees for EM docs. ACEP nationally and your state chapter is going to be lobbying hard to make these and any other legislation that affects EM and reimbursement for EM more friendly for EM physicians. To do that, they need money. Donate to their PACs. They can do more as a group when pooling their money and lobbying resources than any of us can do individually by writing letters to congress.

 

[gamerEMdoc]

For example, PA is looking at legislation to combat balanced billing. Many states already have laws about this to protect patients. Some aren't bad for physicians. But if EM doesn't have a seat at the table to explain to congress why this is bad for healthcare and the safety net throughout the state, the state congress doesn't know any better. Every year I donate to the PACEP PAC. Sure, I could go and try to meet with my congressman. But it doesn't carry the same weight as the President of PACEP or their board of directors meeting with them and making donations to their campaign funds. Lobbying sucks. And its not free. But unfortunately, this is our political system, so you have to play the game to try and prevent disastrous legislation from passing.

 

[emletters]

It looks like the AMA already sent a letter that was supported by 50 or so medical organizations, and the AHA (American Hospital Association) also sent one. While this is great, EM seems to be uniquely affected and particularly compromised due to EMTALA. ACEP was one of the organizations to endorse the letter sent by the AMA, but would it be beneficial for an EM specific organization to write their own letter to the committee? It seems that both letter already submitted were very passive, meek, and didn't really convey their points in a clear manner (in my inexperienced humble opinion).

GamerEMdoc, I think donating to PACs to give them more of a voice at the table is awesome, but how can med students, who make nothing, and residents, who make little, contribute?

https://csms.org/wp-content/uploads/2019/02/Feb-4-2018-Surprise-Billing_Ways-and-Means.pdf

https://fah.org/fah-ee2-uploads/website/documents/HEC_FINAL.pdf

 

[gamerEMdoc]

One way is to get involved with EMRA. I'd also suggest maybe attending ACEPs LAC (leadership and advocacy) conference if its within driving distance and you can get the time off, it is in DC every year. It's like $60 for residents and students. You'll actually have the opportunity to lobby your congressmen with ACEP at LAC.

Once you become a resident, you can use your CME money to attend something like this. Once you are a resident, you could also join your states ACEP chapter and become a resident rep to their advocacy committee if they allow that to get involved at the state level. Otherwise, it never hurts to write to your congressman/woman, that's free.

 

[gamerEMdoc]

I think we always look at these things nationally, but the reality is, most of the time, the legislation that affects us is state by state. Almost half the states already have some sort of balance billing legislation, and in some cases they aren't bad laws and actually do protect patients. I'd really recommend getting involved at a state level if you have the opportunity. First, its easier to get involved, the pool of people wanting to get involved with a state chapter is much smaller than a national organization. If you have the opportunity to get involved as a resident in your states ACEP chapter, I think most would find it very rewarding.

 

[GonnaBeADoc2222]

What is a reasonable dollar amount that attendings typically give to these PACs?

 

[gamerEMdoc]

IDK. Every bit helps. I've heard people say stuff like "give an hour", meaning give your hourly rate as a donation, which would be around $200. Is that what everyone gives? Who knows. Only the people in the PACs know what people really give.

The issue with PACs usually isn't the amount of money that the members donate, it's the number of members that actually donate. The percentage of members that donate anything is typically a low percentage.

 

[TooMuchResearch]

What is a reasonable dollar amount that attendings typically give to these PACs?

I gave $250 to AAEM PAC and $250 to AAEM...one of their other ones, probably the foundation.

 

[VA Hopeful Dr]

It looks like the AMA already sent a letter that was supported by 50 or so medical organizations, and the AHA (American Hospital Association) also sent one. While this is great, EM seems to be uniquely affected and particularly compromised due to EMTALA. ACEP was one of the organizations to endorse the letter sent by the AMA, but would it be beneficial for an EM specific organization to write their own letter to the committee? It seems that both letter already submitted were very passive, meek, and didn't really convey their points in a clear manner (in my inexperienced humble opinion).

GamerEMdoc, I think donating to PACs to give them more of a voice at the table is awesome, but how can med students, who make nothing, and residents, who make little, contribute?

https://csms.org/wp-content/uploads/2019/02/Feb-4-2018-Surprise-Billing_Ways-and-Means.pdf

https://fah.org/fah-ee2-uploads/website/documents/HEC_FINAL.pdf

Seems like radiology and anesthesia would be affected by this as well if not to quite the same degree (and pathology I suppose, but they don't have to deal with the emergencies like the other 3 of y'all do).

 

[GonnaBeADoc2222]

I would imagine hospitalists too

 

[sum dude]

I'm DEFINITELY worried about balance billing legislation, but here's what I want to know. If I bill for $1-2 million dollars in physician fees every year, and this legislation takes a 30% cut to that, lets say its 1.5 million down to 1 million, the hospital is STILL profiting 600k off my work if I make 400k. Yes, their profit margins go down, but they are still making money based on my billed for services compared to my salary, right? This is going to destroy hospitals, and yes that will get passed down to all employees I guess. But I just don't know how big of a salary hit this will lead to because in the end, they are still making money off our care even at the lower reimbursement rate. So in the marketplace, if they don't want to pay me say 400k and ONLY make 600k a year in profit off me, I'd imagine some other struggling hospital would be happy to take on that bargain.

Maybe this is too simplistic of a view of our reimbursement for our professional fees I guess. Maybe I'm way off on the average amount of profession fees I think are billed under most EM docs care. Medical economics is definitely NOT my strong point. I just think we are vastly underpaid for what the hospitals/CMGs bill for in terms of our professional fees to begin with (not even considering the rest of the ED bill, which doesn't exist without us either).

You've misunderstood how billing works. Unless you work for a hospital, what you bill doesn't go to the hospital (certainly there's things that you can say in your chart that increase hospital reimbursement, but let's ignore that and break it down. Average COLLECTION per patient, which is the only thing that matters (who cares what you bill--it's like a car dealership using the sticker price for accounting--it doesn't mean anything), is about $150/patient (give or take, depends on where you are in country, payor mix, etc). To bill for that, it takes about $10-15 per chart, so that drops you to $135-$140 per patient. Assuming you see 2 patients per hour and work 2000 hrs a year (which is high for Attending life), you're taking in 560k at max. You're malpractice, payroll taxes, etc is probably $100-115k per year. So right there, you're at 460k per year. Now add in insurance, ancillary group staff (eg scheduler, HR, CEO, etc.), and you're around 400-450k at max per physician (and that's being generous). True, I'm not including APP's (which are a huge money maker for every group, including SDG's, which is elephant in the room when it comes to expansion). So nobody, not even the CMG's are clearing 400-600k on you, unless you are committing fraud. I know, I worked at one and saw the books, I knew what they were making per physician.

 

[sum dude]

I gave $250 to AAEM PAC and $250 to AAEM...one of their other ones, probably the foundation.

No offense to AAEM, which has its purposes, but AAEM swings no weight when it comes to DC lobbying. ACEP has pretty big (relative) political might--I think it's 3rd largest PAC among all specialties. Whatever you think of ACEP, they're running the show in advocacy on the BB debate in DC.

The Health Insurance Lobby, however, is probably one of the strongest in the US. They probably run your state, as they privatized Medicaid (the largest expenditure in your state) long ago. The problem is that doctors can't stick together to save their lives (even in EM, where independent members fight CMG's while the Insurances are working to crush us all). To use a GOT analogy, Insurances are the White Walkers, and they're going to destroy every physician, hospital, etc. unless we band together.

 

[TooMuchResearch]

No offense to AAEM, which has its purposes, but AAEM swings no weight when it comes to DC lobbying. ACEP has pretty big (relative) political might--I think it's 3rd largest PAC among all specialties. Whatever you think of ACEP, they're running the show in advocacy on the BB debate in DC.

The Health Insurance Lobby, however, is probably one of the strongest in the US. They probably run your state, as they privatized Medicaid (the largest expenditure in your state) long ago. The problem is that doctors can't stick together to save their lives (even in EM, where independent members fight CMG's while the Insurances are working to crush us all). To use a GOT analogy, Insurances are the White Walkers, and they're going to destroy every physician, hospital, etc. unless we band together.

I haven't seen it.
The CMGs have deep pockets. I imagine they will continue to fund ACEP, and I'll give my SDG earned dollars to AAEM.

 

[sum dude]

I haven't seen it.
The CMGs have deep pockets. I imagine they will continue to fund ACEP, and I'll give my SDG earned dollars to AAEM.

I don't care what you have or haven't seen. ACEP and it's $1.2M PAC is running the show for BB, not AAEM's 40k PAC, and that's based on what I have seen. how this BB ends up will affect you more than anything else going on on ACEP or AAEM's agenda. So do whatever you want with your SDG money, but I'll continue to send my SDG earned dollars to the ones who are at the table.

Health Professionals | OpenSecrets

 

[TooMuchResearch]

I'd still bet the vast majority of that $1.2M was from the CMGs.

 

[RuralEDDoc]

I'd still bet the vast majority of that $1.2M was from the CMGs.

This is Federally regulated PAC money, not dark money. Nearly all of this comes from individual physician donations, which are not tax deductible.

 

[sum dude]

I'd still bet the vast majority of that $1.2M was from the CMGs.

CMG's have their own PACS...you bet wrong. CMG's are boogeyman, but they're not the biggest enemy--insurance companies are