Opinion

Congress Must Protect Patients from Surprise Medical Bills

When I became a doctor, my goal was simple: to provide patients with the best possible care. In my decades of practice, I’ve never once considered a patient’s ability to pay when they’ve walked through my emergency room doors — providing lifesaving treatment has been and always will be what matters most.

Watching my patients receive a surprise medical bill is antithetical to the promise I made to protect them, so I strongly believe that no patient should receive a surprise medical bill — ever. That is why I commend Senators Bill Cassidy (R-La.) and Michael Bennet (D-Colo.) for leading a bipartisan working group to introduce compromise legislation to end surprise medical billing. I join physicians around the country in urging Congress to pass the Stopping the Outrageous Practice (STOP) of Surprise Medical Bills Act.

To understand the significance of this proposed policy, we have to address the complexity of a surprise medical bill and the challenge in stopping them. Each year, millions of Americans seek emergency care at a hospital. In these often scary and stressful situations, people shouldn’t be expected — and sometimes simply don’t have the ability — to stop and ask if the doctor who is saving their life, or the hospital they were taken to, is in their insurance network. That can result in a surprise medical bill.

Everyone wants to protect patients from receiving a surprise bill, but some proposed solutions could cause a series of unintended consequences, of which lawmakers must be mindful. For example, highly disruptive proposals such as bundling by hospitals, network matching, or using an arbitrary benchmark to determine out-of-network rates could compound the doctor shortage and restrict patient access to quality care, particularly in rural areas that are already experiencing hospital closures and operating on razor-thin margins. Additionally, Congress should be wary of any approach that picks winners and losers among stakeholders.

Therefore, any federal legislation to address the problem must: remove patients from the middle of disputes between providers and insurers; increase transparency; and support patients’ access to the best doctors in an emergency without the threat of unexpected medical bills.

From Colorado to Texas to New York, states around the country are turning to one particular solution proven to stop surprise bills: an independent dispute resolution (IDR) model. Under IDR, patients are removed from the fight between plans and providers, and they are only held responsible for their usual in-network care rate. If there is a dispute between insurance companies and providers over an out-of-network medical bill, an independent arbiter is involved as a last resort option to settle it. All of this occurs without involving patients or leaving them to foot a surprise bill — they should never be used as a bargaining chip.

So far, 10 states and counting have enacted laws based on this approach, and the results in New York are proof positive that IDR works. In just two years, the number of patients who received out-of-network care dropped by 68 percent, and in 2017, only 645 claims — out of the more than 3 million emergency room visits in New York annually —went to an arbiter. Furthermore, according to a recent case study from Georgetown University’s Center on Health Insurance Reforms, New York state officials reported a “dramatic decline” in consumer complaints and that the law has “downgraded the issue from one of the biggest [consumer concerns our call center receives] to barely an issue.” Despite concern that this model could inflate health care prices, the same study reported there has not been “an indication of an inflationary effect in insurers’ annual premium rate filings” and that insurers, providers and consumer stakeholders generally agree that the law is fair to all parties, its implementation went smoothly and it is working as intended to protect consumers.

The STOP Surprise Medical Bills Act is modeled on the only solution to end surprise billing that has a groundswell of support in the states and a track record of proven success: IDR. As a doctor, I’m certain the STOP Surprise Medical Bills Act is the best path forward because it’s a compromise and the only federal bill on the table that will truly protect patients from surprise medical bills. Congress must pass the STOP Surprise Medical Bills Act; patients around the country are depending on it.

Dr. Brad Watling is Regional Vice President for US Acute Care Solutions.

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