April 4, 2019

How to solve 'surprise' medical bills, according to consumer advocates

Daily Briefing

    Policy and consumer advocacy groups during a hearing Tuesday told lawmakers on the House Education and Labor Committee that providers and insurers—not consumers—should be responsible for addressing so-called "surprise" medical bills.

    'Surprise' medical bills, explained in 5 charts

    Details on the hearing

    The hearing featured testimony from a number of policy and patient advocacy groups rather than health care providers and insurers, Modern Healthcare reports.

    Many of those who spoke before the committee said there is a significant need to address surprise medical bills. Advocates at the hearing largely agreed that the key to addressing surprise medical bills is removing the incentive for doctors to remain out-of-network.

    For instance, Christen Linke Young of the Brookings Institution explained, "Once a provider like an anesthesiologist or neonatologist is in the hospital practicing, they will receive a flow of patients whether or not they contract with insurance company networks and regardless of what price they set." She continued, "That neonatologist, when they're in the hospital, will be then taking care of those babies, and they have a very limited incentive to join an insurance network and accept a negotiated contract rate."

    Linke Young said it is important for lawmakers "to get rid of that set of incentives and encourage them to get back in network for their payment."

    Frederick Isasi, executive director of Families USA, told lawmakers it is important that the "burden of settling on a fair payment" fall on the shoulders of "providers and insurers, not patients."

    Some advocates also provided specific ideas for addressing surprise medical bills.

    Ilyse Schuman, senior vice president of health policy for the American Benefits Council, suggested setting a single payment rate for out-of-network providers, such as 125% of Medicare payment rates. She also suggested requiring providers who are contracted with an in-network hospital to accept the in-network payment rate or bundled payments.

    Rep. Phil Roe (R-Tenn.) expressed concerns about tying payments to Medicare, saying such a proposal could hurt rural communities, like the one in which he practices as an obstetrician, which struggle financially. "We pay our providers less and can keep less than 10% of [the] nurses we train in the area because we can't pay them," he said.

    Provider groups push back

    In a joint letter sent to committee chair Bobby Scott (D-Va.) and ranking member Virginia Foxx (R-N.C.), the American Hospital Association (AHA), the Federation of American Hospitals, and the American Medical Association wrote that they support limiting patients' bills to in-network rates, but asked lawmakers to keep policies regarding surprise medical bills simple.

    The groups wrote that they "strongly oppose" proposals that would prohibit specialist physicians from billing patients separately from hospitals, which they claimed would require hospitals to enter "a kind of bundled payment model," according to Modern Healthcare. They wrote that such an idea "may seem simple and straightforward in theory; in reality however, this approach would be administratively complex, fundamentally change the relationship between hospitals and their physician partners, and alone, does nothing to protect patients from surprise bills."

    Tom Nickels, AHA's executive vice president, separately said it was "unfortunate" no providers were able to testify before the committee "to be able to address" the panel's criticisms of hospitals. "One reason we sent the letter today, though not the only reason, was to get our view of the issues out there," he said.

    America's Health Insurance Plans (AHIP) in a statement said it believes the federal government should set a standard payment rate for out-of-network doctors. "More than 100 million Americans are enrolled in a self-funded health plan," AHIP said, adding, "Protecting them requires a federal standard that reduces complexity while ensuring they cannot be surprise billed for emergency or involuntary care" (Luthi, Modern Healthcare, 4/2; Bluth, Kaiser Health News, 4/2; McIntire, CQ News [subscription required], 4/2).

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