OON/surprise billing legislation passed

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okayplayer

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www.nytimes.com

Surprise Medical Bills Cost Americans Millions. Congress Finally Banned Most of Them. (Published 2020)

Efforts to solve the common consumer problem had been stalled by lobbying pressure and legislative squabbles.
www.nytimes.com www.nytimes.com

www.cnn.com

Congress finally moves to stop surprise medical billing

Congress has finally addressed one of Americans' biggest health care headaches: surprise medical billing.
www.cnn.com www.cnn.com

How catastrophic is this? How long until private insurance reimbursement rates resemble Medicare/Medicaid reimbursement rates?
 
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The ASA got its arbitration process that excludes Medicare/Medicaid rates as opposed to the California style percent markup of Medicare rate/average contracted rate.

Fairly big win.
 
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Small groups will get hurt with a 45-$50 per unit rate. Large AMCs will get reduced to $80-$90 per unit. This is not a win for anesthsia. It is the beginning of the end of the good times for all small and moderate sized private practice groups.

For many groups 2021 will mark the highest year in terms of revenue because all groups must be in network or face arbitration by January 01, 2022

and for more good news the only thing holding back a public option is the Georgia Senate elections. If they were to change parties a public option on the exchange is all but a guarantee.
 
Forgive my ignorance/hijack, but what’s to stop private hospitals from refusing medicare/medicaid/public insurance at some point, creating a two-tiered healthcare system?
 
BLADEMDA said:
Small groups will get hurt with a 45-$50 per unit rate. Large AMCs will get reduced to $80-$90 per unit. This is not a win for anesthsia. It is the beginning of the end of the good times for all small and moderate sized private practice groups.

For many groups 2021 will mark the highest year in terms of revenue because all groups must be in network or face arbitration by January 01, 2022

and for more good news the only thing holding back a public option is the Georgia Senate elections. If they were to change parties a public option on the exchange is all but a guarantee.
Click to expand...

It was pretty clear something was going to be imposed. medical billing is seen as abusive by the public, which placed it high on the political agenda (its really hard to explain unfair/low reimbursement insurance rates to the public).


The alternative proposal was to impose a max percentage of Medicare rates for OON patients. No negotiation. This would have essentially unilaterally price fixed anesthesia services clearly in favor of payers. I would see no reason for the payors to network with anyone if that were the case. Contrast this with arbitration (that excludes examination of Medicare/Medicaid rates) and we at least retain bargaining power vs the payers.

This is probably the best case scenario for anesthesia.
 
Nivens said:
Forgive my ignorance/hijack, but what’s to stop private hospitals from refusing medicare/medicaid/public insurance at some point, creating a two-tiered healthcare system?
Click to expand...
This is the future as I see it.

Hospital A for the masses - run by PA, CRNAs, NPs, and a whole bunch of midlevels. Several docs around to co-sign notes at their leisure for a steady paycheck. Payment is Medicare, Medicaid, and whatever Public Option is out there.

Hospital B for those who care about their health - run by docs with midlevels doing their appropriate duties. Payment is Medicare, Medicaid, Public Option, and $$$ out of pocket vs a private insurance of sorts. At some point the data will be crunched and an appropriate $$$ will be arrived at that allows physicians to provide appropriate care while making an appropriate salary and where the patients do not feel ripped off. I would happily pay several grand for physician only care for my sons while they undergo anesthesia. I am positive I am not alone.

These "hospitals" may even occupy the same building like charter schools which lease space at public schools. This way the bare minimum is being provided while those that can afford it get slightly enhanced care at the physician level. Win-win for all.
 
Nivens said:
Forgive my ignorance/hijack, but what’s to stop private hospitals from refusing medicare/medicaid/public insurance at some point, creating a two-tiered healthcare system?
Click to expand...
Why would they refuse Medicare patients? Hospitals are instead fighting for a bigger market share of all kinds of patients.
 
Zekchar said:
This is the future as I see it.

Hospital A for the masses - run by PA, CRNAs, NPs, and a whole bunch of midlevels. Several docs around to co-sign notes at their leisure for a steady paycheck. Payment is Medicare, Medicaid, and whatever Public Option is out there.

Hospital B for those who care about their health - run by docs with midlevels doing their appropriate duties. Payment is Medicare, Medicaid, Public Option, and $$$ out of pocket vs a private insurance of sorts. At some point the data will be crunched and an appropriate $$$ will be arrived at that allows physicians to provide appropriate care while making an appropriate salary and where the patients do not feel ripped off. I would happily pay several grand for physician only care for my sons while they undergo anesthesia. I am positive I am not alone.

These "hospitals" may even occupy the same building like charter schools which lease space at public schools. This way the bare minimum is being provided while those that can afford it get slightly enhanced care at the physician level. Win-win for all.
Click to expand...

Most patients don’t have a few thousand dollars laying around. Of those who do, only a tiny fraction would pay more out of pocket.
 
nimbus said:
Most patients don’t have a few thousand dollars laying around. Of those who do, only a tiny fraction would pay more out of pocket.
Click to expand...

I disagree. You're a doc. Would you pay $5,000/year to ensure you and your children get seen by physicians instead of PAs in the ER/clinics and that when they go for surgery, an anesthesiologist is directly performing their care? I sure would. Many others would as well. Most aging boomers, who hold the country's wealth would do so too. I recognize that I pulled the $5k number out of my butt ... but I am sure there's a break even point which would satisfy both the consumer and the provider.

There's a reason why we're not all driving cheap Hondas and eating at McDonalds when we go out. Many of us are willing to pay extra to get extra. This applies to every commodity and healthcare absolutely is a commodity. In my above example, Hospital A is there for everyone and is the floor. Hospital B is for those who are able and willing to pay extra.
 
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Zekchar said:
I disagree. You're a doc. Would you pay $5,000/year to ensure you and your children get seen by physicians instead of PAs in the ER/clinics and that when they go for surgery, an anesthesiologist is directly performing their care? I sure would. Many others would as well. Most aging boomers, who hold the country's wealth would do so too. I recognize that I pulled the $5k number out of my butt ... but I am sure there's a break even point which would satisfy both the consumer and the provider.

There's a reason why we're not all driving cheap Hondas and eating at McDonalds when we go out. Many of us are willing to pay extra to get extra. This applies to every commodity and healthcare absolutely is a commodity. In my above example, Hospital A is there for everyone and is the floor. Hospital B is for those who are able and willing to pay extra.
Click to expand...

This thread is about people crying and moaning about OON bills which are typically a few hundred to a couple thousand dollars. People like to spend money on cars, vacations, and new kitchens. They hate spending money on healthcare.
 
nimbus said:
This thread is about people crying and moaning about OON bills which are typically a few hundred to a couple thousand dollars. People like to spend money on cars, vacations, and new kitchens. They hate spending money on healthcare.
Click to expand...
Yes exactly- ppl pay cable bills, top-of-the-line cellphone, their car getting fixed, their plumber, their nice vacations etc with no complaint, yet bemoan a 20 dollar copay at their doc’s office.
 
Lecithin5 said:
Yes exactly- ppl pay cable bills, top-of-the-line cellphone, their car getting fixed, their plumber, their nice vacations etc with no complaint, yet bemoan a 20 dollar copay at their doc’s office.
Click to expand...
I hate paying my phone bill, mechanic, plumber etc because those are all mostly unavoidable utilities

A nice vaca or a $1400 cell phone is a pleasure spend that is 100% elective.


Like it or not, non-cosmetic healthcare falls in the former category and most everyone is not going to spend money on it as if it's the latter category.
 
Zekchar said:
This is the future as I see it.

Hospital A for the masses - run by PA, CRNAs, NPs, and a whole bunch of midlevels. Several docs around to co-sign notes at their leisure for a steady paycheck. Payment is Medicare, Medicaid, and whatever Public Option is out there.

Hospital B for those who care about their health - run by docs with midlevels doing their appropriate duties. Payment is Medicare, Medicaid, Public Option, and $$$ out of pocket vs a private insurance of sorts. At some point the data will be crunched and an appropriate $$$ will be arrived at that allows physicians to provide appropriate care while making an appropriate salary and where the patients do not feel ripped off. I would happily pay several grand for physician only care for my sons while they undergo anesthesia. I am positive I am not alone.

These "hospitals" may even occupy the same building like charter schools which lease space at public schools. This way the bare minimum is being provided while those that can afford it get slightly enhanced care at the physician level. Win-win for all.
Click to expand...
Isn’t that Australia’s system?
 
vector2 said:
I hate paying my phone bill, mechanic, plumber etc because those are all mostly unavoidable utilities

A nice vaca or a $1400 cell phone is a pleasure spend that is 100% elective.


Like it or not, non-cosmetic healthcare falls in the former category and most everyone is not going to spend money on it as if it's the latter category.
Click to expand...
My point is that ppl don’t seem to complain about the plumber or the auto mechanic or their HVAC (all very expensive but considered necessities), but when it comes to healthcare (also a necessity- perhaps the biggest necessity of all!), they all of a sudden have a lot to say. And often, these are the very same folks who spend a lot on non-necessities such as a nice phone, cable tv, netflix, or vacations- things they can’t afford in the first place.
 
Lecithin5 said:
My point is that ppl don’t seem to complain about the plumber or the auto mechanic or their HVAC (all very expensive but considered necessities), but when it comes to healthcare (also a necessity- perhaps the biggest necessity of all!), they all of a sudden have a lot to say. And often, these are the very same folks who spend a lot on non-necessities such as a nice phone, cable tv, netflix, or vacations- things they can’t afford in the first place.
Click to expand...

Plenty of people, including myself, complain about the cost of the plumber, the mechanic, the HVAC, and myriad other sunk costs. My health plan is also pretty awesome lest I'd be complaining about that too if I was forced repeatedly to eat a bunch of out of pocket costs. I don't know where you got the idea that people "don't seem to complain" about all these things.....sites like Angies List and Home Advisor exist for a reason..
 
vector2 said:
Plenty of people, including myself, complain about the cost of the plumber, the mechanic, the HVAC, and myriad other sunk costs. My health plan is also pretty awesome lest I'd be complaining about that too if I was forced repeatedly to eat a bunch of out of pocket costs. I don't know where you got the idea that people "don't seem to complain" about all these things.....sites like Angies List and Home Advisor exist for a reason..
Click to expand...
I get that from family and friends who are physicians and dentists and have offices, and have to constantly chase copays or hear complaints about how exorbitant their 140 dollar fee is... while they clutch their fancy iphone or drive in their decent ride. I’m not saying people don’t complain about other things, and I know I’m making a generalization, but this is a unique phenomenon that you see especially in healthcare.

It’s also one thing to complain, which is fine and we all complain about everything, but it’s another thing to not pay, and we see a lot of folks in healthcare not paying. And I’m not talking about the very expensive healthcare costs- Obviously not many folks can afford a $20,000 out of pockey surgery bill etc. I’m talking about the smaller fees in medicine, fees that patients can definitely pay, but instead would rather pay for other nonessential things. Priorities.
 
BLADEMDA said:
Small groups will get hurt with a 45-$50 per unit rate. Large AMCs will get reduced to $80-$90 per unit. This is not a win for anesthsia. It is the beginning of the end of the good times for all small and moderate sized private practice groups.

For many groups 2021 will mark the highest year in terms of revenue because all groups must be in network or face arbitration by January 01, 2022

and for more good news the only thing holding back a public option is the Georgia Senate elections. If they were to change parties a public option on the exchange is all but a guarantee.
Click to expand...
Blade, I hope you haven’t seen Biden’s (and Bill Gates) wealth plan tax. It’s a major shift from Donald Trumps leniency.
 
Lecithin5 said:
I get that from family and friends who are physicians and dentists and have offices, and have to constantly chase copays or hear complaints about how exorbitant their 140 dollar fee is... while they clutch their fancy iphone or drive in their decent ride. I’m not saying people don’t complain about other things, and I know I’m making a generalization, but this is a unique phenomenon that you see especially in healthcare.

It’s also one thing to complain, which is fine and we all complain about everything, but it’s another thing to not pay, and we see a lot of folks in healthcare not paying. And I’m not talking about the very expensive healthcare costs- Obviously not many folks can afford a $20,000 out of pockey surgery bill etc. I’m talking about the smaller fees in medicine, fees that patients can definitely pay, but instead would rather pay for other nonessential things. Priorities.
Click to expand...
I get what you're saying but it ain't unique to healthcare, man. People hate spending money on utilities, even if their own body is the upkeep cost in question, and even if it's to their personal detriment.
 
Lecithin5 said:
I get that from family and friends who are physicians and dentists and have offices, and have to constantly chase copays or hear complaints about how exorbitant their 140 dollar fee is... while they clutch their fancy iphone or drive in their decent ride. I’m not saying people don’t complain about other things, and I know I’m making a generalization, but this is a unique phenomenon that you see especially in healthcare.

It’s also one thing to complain, which is fine and we all complain about everything, but it’s another thing to not pay, and we see a lot of folks in healthcare not paying. And I’m not talking about the very expensive healthcare costs- Obviously not many folks can afford a $20,000 out of pockey surgery bill etc. I’m talking about the smaller fees in medicine, fees that patients can definitely pay, but instead would rather pay for other nonessential things. Priorities.
Click to expand...
It’s all about perceived value. Let’s face it. MOST doctors visits don’t provide significantly high value to patients -especially perceived value. Trust me, I have had countless patients come to me with real concerns and are desperate for answers. Many have literally told me they would pay me every dime in their bank account if I can figure out what’s wrong with them. Unfortunately, most of the time I can’t. And even if I can, there is usually no easy solution... if any at all.

And a significant percentage of primary care and other follow up outpatient visits is to make small incremental changes. While these changes are important in the long run, they offer little tangible improvement in the short term. Therefore the perception to patients is “I have been told I have a problem and the doctor is making small adjustments to my medications... I feel no different.”

These sentiments are entirely different if a patient is going to see an oncologist. Every visit for chemotherapy or follow up scan has very high perceived value. People would literally empty out savings and take out loans for cancer treatment, even if futile. It’s all about perception.
 
bronx43 said:
It’s all about perceived value. Let’s face it. MOST doctors visits don’t provide significantly high value to patients -especially perceived value. Trust me, I have had countless patients come to me with real concerns and are desperate for answers. Many have literally told me they would pay me every dime in their bank account if I can figure out what’s wrong with them. Unfortunately, most of the time I can’t. And even if I can, there is usually no easy solution... if any at all.

And a significant percentage of primary care and other follow up outpatient visits is to make small incremental changes. While these changes are important in the long run, they offer little tangible improvement in the short term. Therefore the perception to patients is “I have been told I have a problem and the doctor is making small adjustments to my medications... I feel no different.”

These sentiments are entirely different if a patient is going to see an oncologist. Every visit for chemotherapy or follow up scan has very high perceived value. People would literally empty out savings and take out loans for cancer treatment, even if futile. It’s all about perception.
Click to expand...
Very well said.

It is also worth noting that Americans pay thousands of dollars per year on health insurance already, which only adds to the lack of perceived value. We don't expect auto insurance to cover oil changes or other maintenance costs. There is a certain degree of this expectation built into many health insurance plans where there are copays or other types of "maintenance" care is included.
 
kmurp said:
Isn’t that Australia’s system?
Click to expand...

Basically. And it actually works incredibly well. A major difference in the Aussie system from what is described above being the public and private hospitals are both run exclusively by physicians (the US is basically the only country on earth that has sold out its healthcare system to midlevels).
 
sidefx said:
Basically. And it actually works incredibly well. A major difference in the Aussie system from what is described above being the public and private hospitals are both run exclusively by physicians (the US is basically the only country on earth that has sold out its healthcare system to midlevels).
Click to expand...
Lol. AMC’s are also “run by physicians “
 
okayplayer said:
www.nytimes.com

Surprise Medical Bills Cost Americans Millions. Congress Finally Banned Most of Them. (Published 2020)

Efforts to solve the common consumer problem had been stalled by lobbying pressure and legislative squabbles.
www.nytimes.com www.nytimes.com

www.cnn.com

Congress finally moves to stop surprise medical billing

Congress has finally addressed one of Americans' biggest health care headaches: surprise medical billing.
www.cnn.com www.cnn.com

How catastrophic is this? How long until private insurance reimbursement rates resemble Medicare/Medicaid reimbursement rates?
Click to expand...

If the Funding bill passes what will the E/M CMS cuts be for anesthesiology? My field (rads) went from -10% to -4%. Of course this is only temporary for the upcoming year.

I think CMS reimburses about 80% of private insurers for most fields. I've heard that this is way less for you guys, is that true? If so how do private groups survive? Hospital subsidies?

Hard to remain positive about the future of physician reimbursement. CMS's fund becomes insolvent in 2024, US population is rapidly aging resulting in more demand for services, CMS/Private insurers have direct incentive to pay physicians less per unit work, medical education and med-malpractice costs rising, increasing threat from mid-levels, increasing threat from AI (particularly for rads), physicians are perceived to be "greedy" by the public etc
 
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We can reasonably complain all day about the distorted patient preferences signaled by what patients are willing to pay for (luxuries > good healthcare), but the reality is we can do little to nothing in changing those preferences. In many specialties, restricting your services to the "ideal" patient will leave you starving because of insufficient volume. And in many of the select few niche practices that do financially thrive, you end up having to grift, peddle nonsense, and/or ingratiate yourself to every patient whim.
 
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