Bill Overview
Title: Electrodiagnostic Medicine Patient Protection and Fraud Elimination Act of 2022
Description: This bill requires, as a condition for Medicare payment, specified electrodiagnostic services to be furnished by qualified facilities that comply with accreditation, training, and other quality control requirements, as established under the bill.
Sponsors: Rep. Sessions, Pete [R-TX-17]
Target Audience
Population: People using or providing electrodiagnostic medical services through Medicare
Estimated Size: 1400000
- The bill affects facilities providing electrodiagnostic services, thus impacting medical professionals working in these facilities.
- Patients receiving electrodiagnostic services through Medicare will be affected as the services must now meet new compliance and quality standards.
- The bill specifically targets fraud elimination, indicating a focus on ensuring legitimate provision of services, affecting potentially fraudulent entities currently exploiting the system.
Reasoning
- The target population includes 1.4 million Medicare enrollees and professionals interacting with electrodiagnostic services, affecting those managing nerve and muscular diagnostic procedures.
- The realistic budget constraints suggest moderate impact on wellbeing improvements, with notable benefits mainly through fraud reduction and improved service standards.
- Considering the diverse demographic affected by this policy—from healthcare providers to patients—the impacts will vary widely across age, occupation, and regional healthcare availability.
- Medical professionals might face changes in accreditation requirements impacting workload initially, but quality and security of diagnostics will eventually enhance well-being through more accurate results.
- Most patients will experience little visible change quickly, though quality and reliability improvements may have longer-term benefits on health outcomes.
- A portion of the policy's effective impact will be tied to its ability to reduce fraud, leading to financial savings and heightened trust within the Medicare system.
- Regarding cost implications, qualification upgrades and compliance checks will figure prominently within the initial budget, while sustainable savings are expected from minimized fraud long-term.
Simulated Interviews
Retired (Florida)
Age: 67 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 5.0 years
Commonness: 7/20
Statement of Opinion:
- I'm hopeful this policy will mean accurate tests from doctors I can trust.
- I just want to make sure my tests continue without any hassle due to compliance checks.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 8 | 6 |
| Year 20 | 8 | 6 |
Neurologist (California)
Age: 45 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 10.0 years
Commonness: 6/20
Statement of Opinion:
- The new requirements might mean more paperwork, but anything reducing fraudulent practices is positive.
- Accreditation will surely increase the clinic’s credibility.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 7 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 7 | 5 |
Medicare Compliance Officer (New York)
Age: 29 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 20.0 years
Commonness: 4/20
Statement of Opinion:
- The policy adds an extra layer of responsibility, but it aligns with my role's purpose—ensuring quality standards.
- Reducing fraud means better allocation of resources to genuine cases.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 7 |
| Year 10 | 9 | 7 |
| Year 20 | 9 | 7 |
Clinic Manager (Texas)
Age: 50 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 15.0 years
Commonness: 5/20
Statement of Opinion:
- This could resolve a lot of the issues we've been having with Medicare claims.
- Ensuring our facilities meet standards may mean initial hassle but better stability in the long run.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 7 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 8 | 6 |
| Year 10 | 8 | 6 |
| Year 20 | 8 | 6 |
Retired (Illinois)
Age: 73 | Gender: female
Wellbeing Before Policy: 5
Duration of Impact: 5.0 years
Commonness: 6/20
Statement of Opinion:
- I feel this might make the whole system more reliable and quicker in diagnostics.
- I just hope it doesn't mean I lose access to my usual doctors.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 6 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 7 | 5 |
Patient Advocate (Washington)
Age: 38 | Gender: female
Wellbeing Before Policy: 7
Duration of Impact: 10.0 years
Commonness: 5/20
Statement of Opinion:
- My clients could really benefit from this elimination of fraud; it's needed.
- Quality standards are great, but I'm concerned about access and whether this policy could limit their options.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 8 | 7 |
| Year 3 | 8 | 7 |
| Year 5 | 8 | 7 |
| Year 10 | 9 | 7 |
| Year 20 | 9 | 7 |
Hospital Administrator (Ohio)
Age: 55 | Gender: male
Wellbeing Before Policy: 6
Duration of Impact: 15.0 years
Commonness: 8/20
Statement of Opinion:
- This kind of implementation is challenging but absolutely necessary.
- We are well-prepared for adaptations due to past experience in similar accreditation processes.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 6 |
| Year 3 | 7 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 8 | 6 |
| Year 20 | 8 | 6 |
Retired Healthcare Worker (Georgia)
Age: 62 | Gender: female
Wellbeing Before Policy: 6
Duration of Impact: 10.0 years
Commonness: 9/20
Statement of Opinion:
- I see this as a wise step toward patient safety.
- It's reassuring that Medicare will back only certified, reliable service providers.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 6 | 6 |
| Year 2 | 6 | 6 |
| Year 3 | 6 | 6 |
| Year 5 | 7 | 6 |
| Year 10 | 7 | 6 |
| Year 20 | 7 | 6 |
Medical Device Technician (Nevada)
Age: 31 | Gender: male
Wellbeing Before Policy: 5
Duration of Impact: 20.0 years
Commonness: 7/20
Statement of Opinion:
- I hope this doesn't mean job cuts since we're meeting higher standards.
- Improved quality could mean job security, but I’m still unsure what happens immediately.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 5 | 5 |
| Year 2 | 6 | 5 |
| Year 3 | 6 | 5 |
| Year 5 | 6 | 5 |
| Year 10 | 7 | 5 |
| Year 20 | 7 | 5 |
Primary Care Physician (New Mexico)
Age: 58 | Gender: male
Wellbeing Before Policy: 7
Duration of Impact: 10.0 years
Commonness: 6/20
Statement of Opinion:
- Better quality controls can ease referral processes knowing standards are uniformly high.
- I see this as a net gain, potentially increasing diagnostics accuracy though initially it might slow procedures while everyone adapts.
Wellbeing Over Time (With vs Without Policy)
| Year | With Policy | Without Policy |
|---|---|---|
| Year 1 | 7 | 7 |
| Year 2 | 7 | 7 |
| Year 3 | 7 | 7 |
| Year 5 | 8 | 7 |
| Year 10 | 8 | 7 |
| Year 20 | 8 | 7 |
Cost Estimates
Year 1: $20000000 (Low: $10000000, High: $30000000)
Year 2: $15000000 (Low: $9000000, High: $25000000)
Year 3: $12000000 (Low: $7500000, High: $20000000)
Year 5: $10000000 (Low: $6000000, High: $16000000)
Year 10: $8000000 (Low: $5000000, High: $14000000)
Year 100: $5000000 (Low: $3000000, High: $12000000)
Key Considerations
- The bill's compliance requirements could place financial and administrative burdens on smaller facilities.
- There may be a reduction in fraudulent practices, potentially increasing the trust and effectiveness of Medicare services.
- Initial costs may be high but could lead to long-term savings should quality improvements reduce unnecessary procedures.