Payer groups and hospital groups do not see eye to eye on how legislation can improve the surprise medical bills issue.
Hospitals are at odds with payer and healthcare business groups about how to address surprise medical bills, with both cohorts issuing statements on the matter.
On March 18, payer industry leaders sent a letter to Congress outlining key issues that should be included in any legislation addressing surprise medical billing.
Surprise medical billing occurs when a patient receives a set of charges that she was not expecting or did not expect to be so high. Surprise medical bills often happen when a patient unwittingly receives out-of-network care or care from an out-of-network provider in an in-network facility.
This is a practice that impacts patients across the country, the group said, and therefore deserves the widespread attention it has recently received.
“We applaud the recent, bipartisan attention this issue has received from members of both chambers,” wrote the group of 17 trade organizations, including America’s Health Insurance Plans (AHIP) and the BlueCross BlueShield Association (BCBSA). “We ask that Congress take action this year to pass legislation that will protect patients from surprise medical bills and reign in out-of-control health care costs.”
Specifically, the group called on Congress to release legislation that prohibits doctors from sending a surprise medical bill for emergency treatment, treatment the patient receives when she was incapacitated, involuntary care, or other instances in which the patient did not have a choice in provider.
Additionally, legislation should require healthcare organizations to disclose a provider’s network status to patients without requiring that patient to agree to out-of-network care, the group asserted.
The group also requested Congress configure reimbursement rates in such a way that patient premiums and other out-of-pocket costs would not be impacted. Specifically, the group recommended Congress set costs based on the amount that doctors are paid for similar work done in the same geographic region.
High list prices for medical procedures are one of the biggest drivers of expensive surprise medical bills, the group contended. Anesthesiologists, for example, charge 580 percent the rate that Medicare pays. Emergency department (ED) doctors charge 798 percent of the Medicare rate.
Studies have indicated similar trends, finding that charge lists for doctors who are out of a patient’s provider network are extraordinary. Recent data from UnitedHealth Group revealed that out-of-network ED doctors charge 150 percent more than in-network docs, a fact that exacerbates the surprise medical bill issue.
Controlling this cost inflation will be essential to ending surprise medical bills, the 17 trade organizations wrote.
“These excessive bills distort health care markets, create tremendous financial hardship on families and drive up premiums for everyone enrolled in commercial coverage,” they said.
But proposals to set reimbursement rates were not met kindly by leading hospital groups. In a statement published soon after the initial payer letter to Congress, the American Hospital Association (AHA) and the Federation of America’s Hospitals lambasted the payers’ approach, saying it would set a dangerous precedent in American healthcare.
“Beyond protecting patients and ensuring adequate health plan provider networks, it is essential that insurers and providers of care retain the ability to negotiate appropriate payment rates,” the two groups wrote. “Not only is it a dangerous precedent for the government to start setting rates in the private sector, but it could also create unintended consequences for patients by disrupting incentives for health plans to create comprehensive networks.”
Legislation that would require organizations to disclose any out-of-network care and patient financial responsibility will be essential for capping the surprise medical bill issue. Legislation should also prohibit balance billing, AHA and the Federation of America’s Hospitals said.
Outside of those regulations, ending surprise medical billing will require collaboration between providers and payers.
“Our patients come first and the hospital community has proposed a plan to protect them from surprise bills. Consumers, health insurers, employers, and hospitals all agree and should seek a common solution,” the two groups wrote.
“The hospital community is actively engaged in finding solutions to this issue for our patients. We want to ensure that patients are protected from surprise gaps in coverage that result in surprise bills, and we look forward to working with policymakers to achieve this goal.”
Date: March 22, 2019