Senate Bill Supports the Insurers “Fix”
In June 2019, a Senate Bill was approved, with full backing by Health, Education, Labor and Pensions Committee Chairman Lamar Alexander (R-Tennessee.) If this bill passes, benchmarking will be used to resolve surprise bills. Out-of-network providers would be forced to accept a payment based on local median rates for similar services provider by other in-network physicians.
Physician lobbyist groups, like Doctor Patient Unity, argue that insurers are being given the ability to unethically manipulate out-of-service medical fees. The surprise billing issue exists as a byproduct of favoring insurance profits over patient well-being, so a balanced solution that does not concentrate power with the insurance companies is needed to effect lasting change. A group of orthopedic surgeons (allied with medical providers from a list of other specialties) have been calling for change that benefits patients. These groups have gone to Capitol Hill and spread the word via social media, using the hashtag #patientsbeforeprofits.
The American Medical Association and the American Hospital Association think benchmarking is a form of price fixing. Benchmarking, they say, puts control of the financial aspects of doctor patient care in the hands of private insurance companies, to the benefit of only those companies. An increasing number of lobbyists representing medical providers are opposing this bill, as there is significant concern it will decrease doctor compensation by giving insurers an advantage in negotiations.
The Physician/Patient “Fix” – The New York Model
New York was one of the first states to address surprise billing by implementing in 2015 a “baseball-style” arbitration model. It cut out-of-network billing 34% and resolved an estimated 57% of consumer complaints.
Under the so-called “baseball-style” arbitration system, any physician’s bill and insurance company coverage offers are reviewed by a third-party arbiter. That arbiter sets the healthcare costs using an independent charge database called FAIR health. Not the insurance company.
The loser in the New York process pays arbitration costs. It’s called the Independent Dispute Resolution (IDR) process.
AAOS is on the record supporting the IDR process.
Georgetown University reviewed the effects of New York’s surprise billing law, almost five years after its enactment, through interviews with state regulators, insurance companies, doctors, hospitals, consumer advocates, insurance company representatives, physicians, and expert observers. It reported that, overall, the law was “working as intended to protect consumers from a significant source of financial hardship.”
Dr. Choi’s and Dr. Weber’s Fight on Behalf of All Orthopedic Physicians
If federal law does not allow arbitration in cases of billing surprises, said Dr. Choi, it will hurt doctors, the vitality of private practices and clinics, and the number of providers available nationwide.
In addition, said Dr. Choi, surprise billing exacerbates already urgent problems of physician burnout and the increasing suicide rates among orthopedic doctors—in part due to the pressures of massive amounts of student loans, along with decreased time for patients and increased time required for electronic documentation.
“People are really just not happy practicing medicine,” said Choi. He fears that benchmarking laws could cause more and more doctors to abandon the field, limiting the availability of care for those in need.
Dr. Weber went on to communicate AAOS concerns in their December statement, saying that “As Congress evaluates this proposal and considers passing legislation before the end of the year, AAOS urges it to incorporate proven solutions like the FAIR market IDR standard employed successfully in New York. Using an independent database outside of physician or insurer control is the only way to protect access to care while saving consumers millions of dollars and taking patients out of the middle.”
Will Congress listen to the physician advocates or the insurance company lobbyists?
Let’s lend AAOS and Dr. Choi our support.
