Commercial risk will be a critical catalyst of progress – it’s complicated, but is it possible? We think so.


January 24, 2019

Trump vows to stop 'unfair' surprise medical bills (but it's not clear how he'll do it)

Daily Briefing

    Read Advisory Board's take: How can hospitals tackle surprise billing?

    President Trump on Wednesday said his administration will take steps to protect patients from so-called "surprise" medical bills.

    More patients see surprise medical bills

    Up until about two decades ago, it was expected that doctors would participate in the same networks as the hospitals where they practiced. However, experts say these kinds of arrangements became less common around 2000, as major physician staffing firms started gaining market power.

    As more out-of-network physicians practice at in-network hospitals, more patients are facing medical bills from doctors whom they thought were in their health plan's provider networks. A 2018 survey from NORC at the University of Chicago found 54% of U.S. residents have received a surprise medical bill for physician services they thought their insurance would cover, and 43% have received a bill for a hospital or other health care facility care they thought would be covered. 

    Trump says his administration will 'stop' surprise medical bills

    During a roundtable at the White House with top deputies and patients from across the country who have experienced high medical bills, Trump said, "The health care system too often harms people with some unfair surprises ... medical bills and the like." He said there are patients who "go in, they have a procedure, and then all of a sudden they can't afford it, they had no idea it was so bad."

    Trump said, "We're going to stop all of it, and it's very important to me." He said he would like patients to know "exactly what the cost [of care] is" before they undergo treatment.

    What can the Trump admin do?

    While Trump did not specify how he would go about addressing the problem, Axios' "Vitals" reports that there are a few non-legislative options his administration could take. For example, according to "Vitals," Trump could order DOL to:

    • Clarify what authority states have to establish provider rates, including in cases when patients receive surprise medical bills;
    • Determine when bills from out-of-network providers can count toward a patient's out-of-pocket maximums;
    • Require employer-sponsored health plans to comply with a state's dispute resolution process; and
    • Require employer-sponsored health plans to notify patients when their providers might be out of their plans' networks.

    However, Trump is unlikely to have the authority needed to completely address the issue of surprise medical bills without congressional action, "Vitals" reports. Federal lawmakers are expected to take bipartisan action on surprise medical bills, and some already have introduced legislation intended to address the issue (Sullivan, The Hill, 1/23; Luthi, Modern Healthcare, 1/23; Baker, "Vitals," Axios, 1/24; Leonard, Washington Examiner, 1/23).

    Advisory Board's take

    Robin Brand, Senior Director, Revenue Cycle Advancement Center

    As Trump's comments show, the media and legislative scrutiny over "surprise" billing has amplified the issue to a matter of national debate. This isn't an issue that is going away soon.

    Although many hospitals and health systems are trying hard to eliminate surprise medical bills (and thus increase the likelihood that patients will actually pay), their efforts have generally focused on scheduled procedures and hospital stays. Now, with the recent spotlight on surprise billing in the ED (due to more media coverage of large ED bills and these billing stories being introduced in legislative debate), the ED financial experience is increasingly under scrutiny.

    “The ED financial experience is increasingly under scrutiny.”

    The ED is an inherently tricky setting. Care happens fast, there's no way to predict what may happen, and traditional tactics to promote price transparency—such as online tools or point-of-service collections—either aren’t practical or are ill-advised.

    But increasingly, as sky-high ED bills are garner more attention, hospitals and health systems will need to tackle the topic. Among the questions they'll have to consider moving forward:

    • How do we ensure we are sending bills that are correct, timely, and accurate in terms of charges?
    • How can we proactively let patients know whether the ED and/or the doctor is within network for them?
    • Are there opportunities to more proactively triage to lower cost care settings?
    • Can we begin the process of financial counseling and payment post-care but prior to the patient leaving so as to eliminate surprises and proactively provide patients with answers to their questions?

    Recently, my team in the Revenue Cycle Advancement Center surveyed more than 1,000 patients who had recently undergone surgery to learn about their financial experience. Although we targeted non-emergency patients, their responses still shed light on the aspects of the financial experience that matters most to patients. If you're a Revenue Cycle Advancement Center member, download our research note from Q4 2018 to learn more.

    Download Now

    If you're not a Revenue Cycle member but want to prepare for the future of price transparency, download our other related research reports to learn:

    Have a Question?


    Ask our experts a question on any topic in health care by visiting our member portal, AskAdvisory.