The knives are out over legislation to end surprise medical bills and specifics haven’t even been unveiled yet.
The industry is pushing back hard against a particular principle laid out by President Donald Trump last week.
The administration wants all out-of-network charges from a doctor at an in-network hospital to be wrapped into a single bill from the hospital.
How this provision will technically play out in policy is yet to be seen, as the Senate health committee plans to release its legislative package on surprise medical bills this summer.
But the administration’s position has roiled hospital groups and specialty physicians like emergency doctors, radiologists and anesthesiologists, who don’t always share the same insurance network as hospitals and have higher than average charges.
“Untested proposals such as bundling payments would create significant disruption to provider networks and contracting without benefiting patients,” American Hospital Association CEO Rick Pollack said in a statement shortly after Trump made his remarks. He reiterated the AHA’s position that all Congress needs to do is enact a ban on balance billing and leave the rest to industry to figure out.
Specialty physicians argue that a single bill will complicate all the billing processes on the back-end with hospitals and insurers.
Dr. Sherif Zaafran, a Texas anesthesiologist, said he doesn’t see room within the White House framework for a policy he could support. He sees it as undercutting specialty physicians’ independence from hospitals. “As a patient I think a single hospital bill on the surface sounds really good, but in the reality of how most of us practice it’s probably not very practical,” Zaafran said. “A single bill would imply you’re marrying the system for how a physician gets paid with other components that bill completely separately.”
He expects a resulting policy would end up cutting pay for both hospitals and ancillary physicians—hospitals taking a hit as they try to collect the fee and reimburse the physician, and physicians taking a hit if hospitals need to negotiate with insurers on their behalf.
“There are downstream effects that folks haven’t thought through,” Zaafran said.
But the administration’s stance shows how thinking around policy has morphed during months of scrutiny of the issue. And analysts have been documenting the trajectory of high ancillary physician charges in part to lay out the argument for payment bundles.
Discussions started last fall with an initial legislative push from a bipartisan group led by Sens. Bill Cassidy (R-La.) and Michael Bennet (D-Colo.). Cassidy and his co-sponsors introduced a draft proposal to cap out-of-network charges at a regional average. Not long after, Sen. Maggie Hassan (D-N.H.) pitched arbitration to settle disputes between insurers and providers.
As the months passed, the debate transitioned into a look at the underlying contracts between hospitals and insurers—even as policy analysts note that the problem of surprise medical bills is limited to a small number of hospitals.
Experts and economists from think tanks like the Brookings Institution, American Enterprise Institute and the Urban Institute have weighed in, aided by data from states that have tried to curb the practice in the individual insurance markets that fall under their regulating power.
Several have warned that if lawmakers don’t handle the policy carefully, they could end up inflating overall costs, leading to higher premiums and expenses in an already costly system.
(Note from your Revenue Cycle Management partner at ebix, Inc. – We are always at the forefront of industry insights and believe this article from Susannah Luthi, Modern Healthcare, published May 11, 2019 will be of interest to you.)