As a physician, providing patients with the highest quality of care and the best possible experience is one of my top priorities — from the moment they schedule an appointment through treatment and recovery. That is part of the reason I believe it is imperative that Congress address the issue of surprise medical billing.
For patients and their families, getting hit with high, unexpected bills for the cost of care not covered by their insurance plans creates unnecessary financial and emotional burdens that can impede recovery and drain bank accounts. New Mexico legislators took an important step in passing a state law to protect patients from this burdensome billing practice; however, our law still leaves roughly 35 percent of New Mexicans vulnerable. That is why Congress must address this situation at the national level.
However, as federal lawmakers continue to deliberate the most effective approach to ending this nightmare for patients, they must consider the impact any new policies they pass would have on the larger health care landscape in America. One particularly harmful “solution” currently under consideration could have a dire impact on a separate but related problem that is already taking its toll in many New Mexico communities, especially our many rural ones: America’s growing physician shortage, which is quickly becoming its own public health crisis.
The solution in question is known as federal “benchmarking,” and it would essentially permit the U.S. government to set payment rates for all physicians. To determine these rates, the government would rely on biased, often inaccurate data from insurance companies, including their in-network median rates. As in-network rates include steep discounts that arise during the contract negotiation process, this approach would mean insurance companies would have all the leverage to slash physician reimbursements dramatically.
Such a shift would transfer enormous financial losses onto local hospitals and emergency rooms, which are already struggling to attract and retain talented medical professionals in the face of a growing physician shortage. This shortage has been a long time in the making.
Unfortunately, there doesn’t seem to be a solution to the nation’s doctor shortage on the horizon anytime soon. In fact, according to the Association of American Medical Colleges, the demand for physicians continues to outpace supply and, by 2032, the United States will face a shortage of nearly 122,000 physicians. In addition to overall population growth, an increase in the population of seniors — who require more medical services and higher levels of medical care — is contributing to the increased demand being placed on physicians and providers, stretching resources even thinner and further undermining access, quality and affordability for all patients.
However, rural communities and patients continue to feel the impact of our nation’s physician shortage the most. AAMC estimates that patients in rural communities are five times more likely to live in a county with a doctor shortage than their urban and suburban counterparts. Moreover, according to the National Rural Health Association, only 9 percent of physicians practice in rural communities, despite 20 percent of Americans living in these areas.
Sadly, it is these vulnerable, hard-to-reach communities that will also be the most hurt by a benchmarking solution for surprise medical billing. Further compounding the financial woes facing health care providers and slashing reimbursements to physicians will likely only add fuel to the fire of America’s doctor shortage, which is already a raging inferno at this point — further undermining access, quality and affordability for patients. In short, benchmarking would make an untenable situation even worse.
For that reason, Congress should oppose this misguided approach and focus instead on legislative solutions that include a different mechanism for separating patients from the out-of-network billing disputes that result in surprise billing, called the independent dispute resolution. Essentially, IDR would protect patients from surprise medical billing by enabling insurers and physicians to resolve out-of-network payments through an open, transparent online process to handle payment disputes.
Not only would the IDR process help guarantee fair, market-based payments, but it would also ensure providers receive interim payments that would be especially beneficial for at-risk hospitals operating in rural and underserved communities. While this may not be enough to reverse the trend of America’s physician shortage, it will at least not contribute to it, unlike the woefully misguided benchmarking approach.
There is no question that Congress should pass legislation to end surprise medical billing once and for all; however, it is critical that in solving this problem, Congress avoid exacerbating other ones, including our nation’s doctor shortage. Benchmarking would unequivocally make this situation worse, so it is vital that whatever solution Congress passes incorporates the vastly superior, and far-less disruptive, IDR framework.
Dr. Annette Fontaine, MD, is a practicing medical oncologist in Albuquerque, N.M., and a member the American Medical Association, the American Society of Hematology and the American Society of Clinical Oncology.
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