UPDATE: CMS Proposes ACEP-Supported Quality Measure on Timeliness, Access
The Centers for Medicare & Medicaid Services (CMS) is proposing to adopt a new quality measure developed and supported by ACEP members. The measure is designed to improve access to and timeliness of emergency care.
This measure calculates the proportion of four metrics that quantify access and timeliness of care in an ED: patient wait time exceeding one hour, whether the patient left the ED without being evaluated, boarding time exceeding four hours, and time from ED arrival to physical departure exceeding eight hours.
The Emergency Care Access & Timeliness electronic clinical quality measure (eCQM) was proposed for inclusion in the Hospital Outpatient Quality Reporting program and the Rural Emergency Hospital Quality Reporting Program as part of the 2026 Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems (OPPS) proposed rule issued on July 15. ACEP has long advocated for more thorough and transparent reporting of ED waiting and boarding times to tackle the boarding crisis. Emergency physicians worked closely with the Partnership for Quality Measurement to develop and recommend specifications, and ACEP strongly applauds CMS for including it in the proposed rule.
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Click here for a more detailed summary of OPPS provisions that impact emergency physicians. |
July 15, 2025
Proposed CMS Rule Includes Medicare Pay Increase, ACEP-Suggested Telehealth Fixes
The new proposed revisions to the 2026 Physician Fee Schedule include what could become the first Medicare payment increase for emergency physicians in six years, and ACEP Advocacy helped make it possible.
The Centers for Medicare & Medicaid Services (CMS) released the 2026 Revisions to Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment Policies Proposed Rule (CMS-1832-P) on July 14, 2025. This annual proposed rule includes changes related to Medicare physician payment and the Quality Payment Program (QPP).
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Click here for a more detailed summary of PFS and QPP provisions that impact emergency physicians. |
The rule as proposed would increase the conversion factor, the dollar amount used to translate Relative Value Units (RVU) into specific payment amounts, but it would lower the relative value of some practice expenses associated with codes billed by emergency physicians. Together along with a statutory update that starts this year from the Medicare Access and CHIP Reauthorization Act (MACRA) and a 2.5% one-year payment increase from the recently passed One Big Beautiful Bill Act, these changes would lead to an overall positive adjustment of around 1-2% for most emergency physicians, depending on the level of ED E/M code billed.
CMS has incorporated ACEP’s suggestion to streamline the processes for adding services to the Medicare Telehealth Services List by making formerly provisional telehealth services, including those billed under emergency medicine and critical care codes, permanent.
Requests for information incorporated into the proposed rule span well-being and nutrition measures, the current data environment and digital quality measurement, payment for services in urgent care centers, and other areas that may impact emergency physicians.
ACEP will submit formal comments by the conclusion of the comment period on Sept. 12, 2025.
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