Jamie @jshoemakermd

This new study (7/27/26) of nearly 5M patients confirms with data what other studies have shown, e.g. RAND Corp. study of emergency physician reimbursements (April 2025), that persistent declines in Medicare reimbursement rates are having a negative impact on patient's access to care. From 2025 to 2023, adjusted for inflation (recall that physicians are alone in not receiving a CPI-U adjustment in the CMS fee schedule), the Medicare fee schedule has declined over 48%. With over 10K seniors entering Medicare each day, Congress must respond to continued access to care threats. Two Decades of Medicare Payment Declines Associated with Worsening Patient Access Gaps neimanhpi.org/press-releases… via @neimanhpi

@MCEP_NEWS Loving Mackinac and the MCEP delegation!

We had a great time kicking off our #MEMA26 at the Grand Hotel on the marvelous front porch!

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It is obvious that the insurance industry is working overtime to paint physicians as the problem with the No Surprises Act. Yes there are bad actors, and I am happy to go after them, but when insurance companies withhold hundreds of millions they owe, they are the problem.

Thanks Doc and not a mention in the NYT of the issue with the initial payments (QPA) being about ~300% below the true median allowed amounts required by law. No mention either of huge payment compliance issues with the health plans not paying for one cohort of ED physicians nearly 50% of IDRs in compliance w/ law & totaling about $245M for 2025, and that I have cited here more times than I can count.

Robert Berry, DO @txsportsdoc

2 weeks ago

This article mischaracterizes the issue and making doctors the villains as usual. At no point does the NYT article discuss that doctors made 3x for common surgeries in 1990. They want to use the outliers as the norm. Doctor may not have been paid for a majority of cases and wins

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@senthomtillis @SenTedBuddNC @virginiafoxx 🚨 Congress passed the #NSA. Insurers are ignoring it. Physicians are fed up w/ delayed payments & insurers defying binding rulings. H.R. 4710/S. 2420 is a simple fix: enforce the law. Lawmakers — cosponsor now. Patients & physicians can’t wait. @ZP_PAC

1/@BlueCrossNC meanwhile is issuing demand letters to hospital based groups claiming coding errors and demanding literally many millions of $s from these groups. NC Blue has given no explanation of how they are using extrapolation to reach their many $Ms in claimed overpayments. The federal gov’t has a well defined process for using extrapolation and “progressive corrective action” for groups identified with coding issues. The groups vehemently deny the degree and extent of coding errors. Oh and BlueCross NC is threatening to use “voucher deductions” on future claims if the $6.27M demanded from one ED group is not paid. Rumor is that another larger group has been hit w/ a +$10M demand. These groups have no choice but to “lawyer up” to respond to these existential threats. In 3+ decades in this state I have never seen this level of aggressive misconduct by a health plan—one whose CEO is an MD! Blue Cross regains North Carolina’s state health plan contract while Aetna loses out beckerspayer.com/contracting/bl…

@PatrickVelliky This. 100% this.

ACEP’s value proposition is simple: Alone , we practice emergency medicine. Together, we protect it. Humbled to be a candidate for the next ACEP President-elect. I will not disappoint

After commenting multiple times, 100s of hours of work and waiting nearly 2.5 years, our considerable advocacy as a community has paid off—here are the highlights from the CMS Final Rule on IDR Operations under the #NoSurprisesAct —my editorial comments in are in bold: 1. Plans and issuers must use CARCs and RARCs to communicate NSA-related information on remittance advice. Huge potential win for physicians and will reduce the ineligible claims significantly. 2. Open negotiation must move through the Federal IDR portal, with expanded notice content. The plans have been ignoring the open negotiation (ON) process—not sure that will be working so well for them now. 3. A new open negotiation response notice is required within the first 15 business days. See previous comments. 4. IDR initiation notices require more information, and the non-initiating party must respond within 3 business days. Potentially neutral. 5. Certified IDR entities get 5 business days after final selection to make eligibility determinations. Also potentially good when the CARCs and RARCs are mandated. 6. Plans and issuers must register in the Federal IDR portal. This could be huge but the devil will be in the details. 7. Batching rules are expanded and clarified. Could be a plus/minus 8. Cooling-off for batched disputes is reduced to 30 business days. Better, but we wanted 1 day cooling but way better than the current 90 days. 9. The administrative fee is reduced to $15 per party per dispute. Huge win here as the current CMS fee is $115 per party. 10. CMS declines to finalize certain proposed fee-collection changes and reduced-fee structures for low-dollar or ineligible disputes. The low dollar structure could have really helped radiology. For those who question the resources spent in time and money for advocacy by the physician and supporting community, this rule, subject to reviewing all 600+ pages, could be Exhibit A for why we do it. cms.gov/files/document…

Ohio ACEP was a fantastic opportunity to highlight the importance of EM Reimbursement as we fight for us and our patients. #ACEPs4Corners #Shoemaker4PE

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Thank you @OhioACEP for the opportunity to attend your annual advocacy day and present on EM reimbursement. Amazing chapter and leadership!

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I’m honored to officially announce my candidacy for President-Elect of the American College of Emergency Physicians (ACEP). This moment is both humbling and energizing. Emergency medicine has given me purpose and I’m ready to give back even more!

As ER doctors, @jshoemakermd and I witness how insurance denials force patients into the ED. We provide lifesaving treatment in seconds, but insurers take 1.2 seconds to deny care. Prior auth was meant to protect patients; instead it delays diagnoses and drives up costs.

TIME @TIME

11 months ago

Dr. Nicholas Cozzi and Dr. James Shoemaker: Here's why patients are flooding emergency rooms time.com/7319387/health…

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Is this real life?! 👀 Special guests from the @HBO hit series, The Pitt, are joining us in SLC! 🎉 Hear from star, Noah Wyle, writer & producer Joe Sachs, MD, FACEP, & medical advisor @MelHerbert, for an exclusive panel discussion @ ACEP25! Get registered! 📲 #ThePitt #acep25

Column: Why watching "The Pitt" feels so cathartic for ER doctors like me 📝 Nicholas Cozzi time.com/7276040/the-pi…

EM leaders call for policy changes and more insurer oversight in new report by RAND supported by EMPI. Read the press release and report via the link in our bio 🔗 bit.ly/4llyevM

How do you get diabetic retinopathy when you don’t have diabetes? The answer is you can’t. But ask United healthcare. They billed Medicare for them. Medicare advantage plans are defrauding the taxpayer for hundreds of billions of dollars every year. #StopMAFraud.

"In 1992, the Medicare conversion factor was $31.00. Today? $32.36. That’s a $1.36 total increase in 33 YEARS. If it had just kept up with inflation, it would be over $64.00 today. Instead, it’s more than 50% below where it should be."

Dutch Rojas @DutchRojas

a year ago

Today, a physician working at the same productivity level is stuck with $32.36 per RVU—which means, adjusted for inflation, they’re effectively making HALF of what they used to. Think about that: same work, half the pay. Meanwhile: Hospitals get sweetheart site-of-service

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