Get Morning Consult’s Latest Gen Z Data & Insights. Sign Up

Get Morning Consult’s Latest Gen Z Data & Insights. Sign Up

Opinion

Fixing Our Health Care System By Ending Surprise Medical Bills

Throughout my 24-year career, the health care system has undergone a number of changes, but my greatest priority and responsibility as a doctor has remained the same: to provide patients the highest quality of care.

Unfortunately, in recent years, patient health care costs have skyrocketed, placing a huge and often unexpected financial strain on patients that often causes them to delay seeking care. The health care system and profit-seeking practices of health insurance companies are undermining patients’ access to quality care.

Americans enrolled in high-deductible health plans often delay seeking care because of the higher out-of-pocket costs they are obligated to pay through their plans. Personally, I often see patients in the emergency department who have delayed seeking care, such as a patient who needed a cardiac catheterization but could not afford the $10,000 deductible. The patient waited and came to me with an acute heart attack, something that would have been avoided if the patient were able to afford the original required procedure. There needs to be a fair and transparent system that doesn’t put such an enormous financial strain on those receiving treatment that it deters them from seeking the appropriate care.

As policymakers address a byzantine health care reimbursement system, it is important that physicians play a central role in the solution. In accordance with the federal Emergency Medical Treatment and Labor Act, emergency department clinicians are required to provide medical screening exams and stabilization to patients who enter the emergency department without consideration of the patient’s insurance status, ability to pay or national origin, race, creed or color. EMTALA codified emergency medicine’s mantra: Anyone, Anything, Anytime.

Recently, Eileen Appelbaum, co-director of the Center for Economic and Policy Research, penned an op-ed that sought to paint providers and emergency physicians as the source of surprise medical bills; however, Appelbaum’s straw man argument falls apart when presented with the fact that insurance companies’ business models rely on pushing costs onto patients while taking advantage of the financial and ethical pledge of EMTALA, knowing emergency physicians will never turn anyone away.

A Kaiser Family Foundation study found that, over the last 12 years, annual deductibles in employer-sponsored health plans have nearly quadrupled, creating an affordability crisis among those with health insurance. Meanwhile, insurers are expected to pay back a record-setting $800 million in unlawful profits to consumers and, on average, deny 19 percent of in-network claims. Insurance companies arbitrarily decide how much life-saving treatment is worth and who has the right to access that care.

On Jan. 28, the American College of Emergency Physicians released its framework to end surprise medical bills. I stand by that framework.

Congress must end the practice of surprise billing by limiting an individual’s financial responsibility to his or her in-network cost-sharing rate and establishing an independent dispute resolution process that brings hospitals, insurers and doctors to the table. Congress should also curb insurers’ ability to retroactively deny emergency care claims based on the final diagnosis and establish standards for insurance networks, including how many in-network facilities and specialists are in the same geographic area. Adequate standards, coupled with rigid enforcement by local insurance commissioners and federal regulators, will make care more accessible for all patients.

To solve surprise medical bills, we need to look at the facts. We need to find solutions that put patients’ best interests first without the fear of financial ruin.

Thoughtful changes must be implemented sooner rather than later. Too many Americans have already been hurt by this flawed system that punishes people for receiving critical, life-saving care.

The solution to ending surprise gaps in insurance coverage exists. It’s now up to all stakeholders to come together to establish a simple, fair and equitable reimbursement process that puts patients first. We must do it for the health of our health care system, and most importantly, for our patients.

 

Dr. Rebecca Parker is a board-certified, practicing emergency physician in the Chicago area and is the chief medical affairs officer for Envision Physician Services, and from 2016-17, Parker served as president of the American College of Emergency Physicians.

Morning Consult welcomes op-ed submissions on policy, politics and business strategy in our coverage areas. Updated submission guidelines can be found here.