Surprise Billing Legislation - contact your representatives

[lane]

The most recent iteration of the surprise billing legislation from HELP and E&C is not particularly favorable to physicians. It includes an Independent Dispute Resolution (ie arbitration) model BUT sets the threshold at $750 (lower is better) and does NOT allow for batching. Anything outside of that falls into a median rate... which could quickly become a race to the bottom.

The ASA and state societies will likely reach out soon, but you need to take a few moments to call/email your local representatives. This needs to be revisited more thoroughly rather than pushed through quickly at the end of the year.

The White House issued a press release that basically stated anything presented will be signed.

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[CheGuevaraMD]

It's over man. Once this much sunlight is on an issue, "contacting your representatives" as a special interest isn't gonna work. Some legislation that greatly benefits patients at the expensive of physicians is sure to pass.

 

[deleted941485]

It's over man. Once this much sunlight is on an issue, "contacting your representatives" as a special interest isn't gonna work. Some legislation that greatly benefits patients at the expensive of physicians is sure to pass.

Do it anyway

 

[lane]

It's over man. Once this much sunlight is on an issue, "contacting your representatives" as a special interest isn't gonna work. Some legislation that greatly benefits patients at the expensive of physicians is sure to pass.

It’s not over. Contact them. You’re a respected professional and they’d rather hear directly from you. You don’t know how familiar they are with the issues and potential fallout.

 

[Lecithin5]

I know for a *fact* that due to an overwhelming response from physicians, our state surprise legislation bill voting keeps getting delayed, with an ever-increasing possibility of amendment. It doesn’t hurt to contact your reps, and it may even help.

 

[anes121508]

The most recent iteration of the surprise billing legislation from HELP and E&C is not particularly favorable to physicians. It includes an Independent Dispute Resolution (ie arbitration) model BUT sets the threshold at $750 (lower is better) and does NOT allow for batching. Anything outside of that falls into a median rate... which could quickly become a race to the bottom.

The ASA and state societies will likely reach out soon, but you need to take a few moments to call/email your local representatives. This needs to be revisited more thoroughly rather than pushed through quickly at the end of the year.

The White House issued a press release that basically stated anything presented will be signed.

For young people like myself who do not fully understand Can you explain the threshold, batching ect? I’d like to reply and am self conscious because I don’t fully understand all of the implications of the plan

 

[lane]

For young people like myself who do not fully understand Can you explain the threshold, batching ect? I’d like to reply and am self conscious because I don’t fully understand all of the implications of the plan

Anything out of network below $750 (or whatever the threshold may be) cannot be negotiated/challenged through the IDR (arbitration) model. That means it defaults to the median in network rate. If your negotiated rate is above the median, you lose. Suddenly their willingness to negotiate any in-network rates will disappear. If insurance companies wish to game the system (as they already did with TeamHealth by booting them out of network), that median rate will likely fall and it will create a race to the bottom. This will affect everyone regardless of your current in-network strategy.

Bundling allows multiple claims that fall below the threshold to be handled at once. This should allow the provider to have greater access to the IDR. The current legislation actually restricts access to the IDR by disallowing claims for the same service for 90 days. This is a killer.

Keep in mind this affects other specialties significantly as well.

The big push for rushing this through is so it may be added to the funding bill on the 20th. The two primary sponsors are not running for re-election in 2020, so ensuring their legislation is postponed should be a big win toward negotiating a better policy.

 

[lane]

From the president of New York’s medical society

 

[AdmiralChz]

Everyone need to be together on this - all physicians, specialty societies, AMA. But given how bad we have done supporting each other over mid level encroachment (especially in primary care) and the AMA being a pathetic bunch of losers overall... I’m not optimistic.

 

[BLADEMDA]

If this law passes “as is”it will be devastating over the next 2-3 years. I assume there will be many court challenges to the law as it appears to be unconstitutional. (At least to me anyway). Physicians may simply stop accepting those insurance companies altogether and demand payment upfront. I don’t believe the govt can force me to work for a wage they essentially set without my consent.

Eventually even Ortho, ENT, Urology, etc will be crushed by such a law thus forcing many to completely opt out. Again, the govt can’t pass a law forcing one party to accept a payment far below their consensual charge. After all, the end result could literally be minimum wage if taken to the extreme or in our case Medicaid rates which is far below plumbers and electricians in most states

 

[apoondoc]

I was hoping this discussion would inform the reader a little more.

I know that the knee-jerk reaction is to think that a anything government suggests is bad, specifically if it threatens reimbursement. But if we are going to fight something that benefits from such attractive framing (let's be honest: surprise bills cannot, by themselves, be defended...especially from anesthesiologists. A patient goes where her surgeon has privileges and her insurance has a contract, and then some some faceless entity (TeamHealth, Envision, or any of an increasing number of rotten organizations who have weaseled their way between the anesthesiologist and the patient) hits her with a huge bill?? Come on, that can be defended, and you know it.), we need to have something more meaningful to say than: GOOD doctor fear BAD government!! Money Money Money!!

I see that Richard Neal and Kevin Brady (of the House Means and Ways Committee) have put together another bill, and now the kerfuffle surrounding competing bills threatens push passage of either into 2020.

But I don't claim to I understand which bill is better. Can anybody help me?

Listen, we all know that these are the last days of wrangling extra money from insured patients. (And I can't say that I will shed a tear. When TeamHealth and Envision are on one side of an issue, you can be pretty sure the right answer is on the other side...even if that means you begrudgingly have to agree with both Republicans and Democrats.) I want to be part of the discussion. I don't want to engage in fearmongering ("race to the bottom!"). I don't want to be so easily dismissed as just another doc looking only after my own bottom line. I want to be able to suggest a remedy that favors the patients and the doctors (in that order...and kindly note that I did not say "provider"). If that same legislation hurts (in order) insurance companies, Anesthesia Management Companies, hospitals, and the Care Team Model...that'd be even better.

 

[Mikkel]

I was hoping this discussion would inform the reader a little more.

I know that the knee-jerk reaction is to think that a anything government suggests is bad, specifically if it threatens reimbursement. But if we are going to fight something that benefits from such attractive framing (let's be honest: surprise bills cannot, by themselves, be defended...especially from anesthesiologists. A patient goes where her surgeon has privileges and her insurance has a contract, and then some some faceless entity (TeamHealth, Envision, or any of an increasing number of rotten organizations who have weaseled their way between the anesthesiologist and the patient) hits her with a huge bill?? Come on, that can be defended, and you know it.), we need to have something more meaningful to say than: GOOD doctor fear BAD government!! Money Money Money!!

I see that Richard Neal and Kevin Brady (of the House Means and Ways Committee) have put together another bill, and now the kerfuffle surrounding competing bills threatens push passage of either into 2020.

But I don't claim to I understand which bill is better. Can anybody help me?

Listen, we all know that these are the last days of wrangling extra money from insured patients. (And I can't say that I will shed a tear. When TeamHealth and Envision are on one side of an issue, you can be pretty sure the right answer is on the other side...even if that means you begrudgingly have to agree with both Republicans and Democrats.) I want to be part of the discussion. I don't want to engage in fearmongering ("race to the bottom!"). I don't want to be so easily dismissed as just another doc looking only after my own bottom line. I want to be able to suggest a remedy that favors the patients and the doctors (in that order...and kindly note that I did not say "provider"). If that same legislation hurts (in order) insurance companies, Anesthesia Management Companies, hospitals, and the Care Team Model...that'd be even better.

Insurance companies want rates set at median so that they can keep dropping docs to negotiate lower payments.

Insurance premiums will continue to increase.

The only beneficiary of a median rate is the insurance company.

Docs getting paid less for the same work as before will surely have unintended consequences, all of which will most likely be to the detriment of patients.

It's not complicated.

Is it us (patients and doctors) versus them (insurance companies)? Seems like it.

Why are doctors getting the short end when they're the ones taking care of patients?

 

[Lecithin5]

I was hoping this discussion would inform the reader a little more.

I know that the knee-jerk reaction is to think that a anything government suggests is bad, specifically if it threatens reimbursement. But if we are going to fight something that benefits from such attractive framing (let's be honest: surprise bills cannot, by themselves, be defended...especially from anesthesiologists. A patient goes where her surgeon has privileges and her insurance has a contract, and then some some faceless entity (TeamHealth, Envision, or any of an increasing number of rotten organizations who have weaseled their way between the anesthesiologist and the patient) hits her with a huge bill?? Come on, that can be defended, and you know it.), we need to have something more meaningful to say than: GOOD doctor fear BAD government!! Money Money Money!!

I see that Richard Neal and Kevin Brady (of the House Means and Ways Committee) have put together another bill, and now the kerfuffle surrounding competing bills threatens push passage of either into 2020.

But I don't claim to I understand which bill is better. Can anybody help me?

Listen, we all know that these are the last days of wrangling extra money from insured patients. (And I can't say that I will shed a tear. When TeamHealth and Envision are on one side of an issue, you can be pretty sure the right answer is on the other side...even if that means you begrudgingly have to agree with both Republicans and Democrats.) I want to be part of the discussion. I don't want to engage in fearmongering ("race to the bottom!"). I don't want to be so easily dismissed as just another doc looking only after my own bottom line. I want to be able to suggest a remedy that favors the patients and the doctors (in that order...and kindly note that I did not say "provider"). If that same legislation hurts (in order) insurance companies, Anesthesia Management Companies, hospitals, and the Care Team Model...that'd be even better.

And when insurance companies are on one side of a bill (not ‘issue,’ as no one is arguing surprise billing is fine), you can be sure the answer is on the other side. No, I don’t trust the usaps and northstars, and I certainly don’t trust the blue crosses.

 

[BLADEMDA]

I was hoping this discussion would inform the reader a little more.

I know that the knee-jerk reaction is to think that a anything government suggests is bad, specifically if it threatens reimbursement. But if we are going to fight something that benefits from such attractive framing (let's be honest: surprise bills cannot, by themselves, be defended...especially from anesthesiologists. A patient goes where her surgeon has privileges and her insurance has a contract, and then some some faceless entity (TeamHealth, Envision, or any of an increasing number of rotten organizations who have weaseled their way between the anesthesiologist and the patient) hits her with a huge bill?? Come on, that can be defended, and you know it.), we need to have something more meaningful to say than: GOOD doctor fear BAD government!! Money Money Money!!

I see that Richard Neal and Kevin Brady (of the House Means and Ways Committee) have put together another bill, and now the kerfuffle surrounding competing bills threatens push passage of either into 2020.

But I don't claim to I understand which bill is better. Can anybody help me?

Listen, we all know that these are the last days of wrangling extra money from insured patients. (And I can't say that I will shed a tear. When TeamHealth and Envision are on one side of an issue, you can be pretty sure the right answer is on the other side...even if that means you begrudgingly have to agree with both Republicans and Democrats.) I want to be part of the discussion. I don't want to engage in fearmongering ("race to the bottom!"). I don't want to be so easily dismissed as just another doc looking only after my own bottom line. I want to be able to suggest a remedy that favors the patients and the doctors (in that order...and kindly note that I did not say "provider"). If that same legislation hurts (in order) insurance companies, Anesthesia Management Companies, hospitals, and the Care Team Model...that'd be even better.

To End Surprise Medical Bills, New York Tried Arbitration. Health Care Costs Went Up

As Congress considers legislation to end surprise medical billing, some are looking at lessons learned from New York's experiment with "baseball-style" arbitration.

www.npr.org

The Senate should adopt New York's law. This still allows physicians to bill at around the 80th percentile. I think it hurts the AMCs who bill at over 90th percentile while protecting the little guy who is quite happy to get 80th percentile.

 

[apoondoc]

If we are asking government to provide the solution, how about something like this:

make it illegal for a doctor to bill anybody but the patient directly.

We bill the patient. The patient pays the bill. Then the patient demands reimbursement from the insurance company. Maybe then the insurance company will start being responsive to patients. And maybe then doctors can start viewing patients as their customers, rather than insurance companies. (And then doctors can start laying off billing specialists/hoop jumpers/paper pushers by the thousands...)

That's a pipe dream, of course.

I note that the California Medical Association prefers New York's approach to California's own. (CMA urges Congress to follow New York’s successful surprise billing model). My experience is not meant to be universal, but the anesthesia groups I work for in California have seen only favorable reimbursement trends since 2017. Our sky is not falling, that is. Then again, we consider ourselves competitors to Envision, TeamHealth, and Somnia, so maybe the insurance companies are happier to deal with us then with them. Again, it might be only that I'm dreaming...

 

[anbuitachi]

i wonder , even at 120 medicare rates, would it actually help the really poor hospitals (with mostly medicaid and uninsured patients?)

 

[BLADEMDA]

If we are asking government to provide the solution, how about something like this:

make it illegal for a doctor to bill anybody but the patient directly.

We bill the patient. The patient pays the bill. Then the patient demands reimbursement from the insurance company. Maybe then the insurance company will start being responsive to patients. And maybe then doctors can start viewing patients as their customers, rather than insurance companies. (And then doctors can start laying off billing specialists/hoop jumpers/paper pushers by the thousands...)

That's a pipe dream, of course.

I note that the California Medical Association prefers New York's approach to California's own. (CMA urges Congress to follow New York’s successful surprise billing model). My experience is not meant to be universal, but the anesthesia groups I work for in California have seen only favorable reimbursement trends since 2017. Our sky is not falling, that is. Then again, we consider ourselves competitors to Envision, TeamHealth, and Somnia, so maybe the insurance companies are happier to deal with us then with them. Again, it might be only that I'm dreaming...

When they are paying the AMCs $130-$140 per unit the insurance companies are indeed much happier dealing with you.

 

[okayplayer]

Doctors Win Again, in Cautionary Tale for Democrats (Published 2019)

Surprise billing legislation suddenly stalled. Like “Medicare for all,” the proposal would have lowered the pay of some physicians.

www.nytimes.com

Good news.

 

[kmurp]

A victory for private equity.

 

[deleted941485]

A victory for private equity.

Down but certainly they will be revisiting this issue. Again PE put a lot of money on the table to fight this but honestly if it was just a bunch of private practices which a lot of practices still are then congress wouldn’t have given two ****s about it.

I don’t like PE but congress’ fixation on Evil PE companies is just a distraction. They talk about this being beneficial to patients but they fail to mention the third player in all of this commercial payers, who also play games.

 

[deleted941485]

House leader aims for surprise billing deal by Presidents Day

House Majority Leader Steny Hoyer (D-Md.) said he wants to move on a surprise billing deal as early as mid-February if committee leaders can work out their differences.

www.modernhealthcare.com

 

[lane]

Bump, as legislation as been making its way through committees.

Also note UHC has become quite aggressive in pushing hospitals (ie Houston Methodist) and practices out of network in anticipation for any passed legislation.

Regardless of your feelings on AMCs, this will affect everyone. Contact your representatives, donate to the ASA PAC, and take some time to educate your colleagues.

 

[deleted941485]

Bump, as legislation as been making its way through committees.

Also note UHC has become quite aggressive in pushing hospitals (ie Houston Methodist) and practices out of network in anticipation for any passed legislation.

Regardless of your feelings on AMCs, this will affect everyone. Contact your representatives, donate to the ASA PAC, and take some time to educate your colleagues.

Good catch the two are definitely related.

 

[2.0%]

Also note UHC has become quite aggressive in pushing hospitals (ie Houston Methodist) and practices out of network in anticipation for any passed legislation.

Could you explain the ramifications of this further for me?

 

[vector2]

This article explains the whole issue pretty well

https://www.healthaffairs.org/do/10.1377/hblog20190521.144063/full/

 

[BLADEMDA]

Average rates paid to specialists in comparison to Medicare rates

 

[Morzh]

This article explains the whole issue pretty well

https://www.healthaffairs.org/do/10.1377/hblog20190521.144063/full/

Interesting how this article focuses solely on physician balance billing, rather than the hospital's own balance billing practices - that's where the problem really lies.

 

[aneftp]

The easy fix is to to tie physician surprise billing to 10% of total hospital/facility payments! Than u shift the focus from doctors to the real issue. The hospitals!

So if that ED bill for the kidney stone is 30k (that’s a real number). The physicans should get 10% of that. ED doc $1000. Urologist $1000 for their consult. $1000 for radiologist reading the scan.
Everyone happy!!

 

[deleted941485]

View attachment 296351

Average rates paid to specialists in comparison to Medicare rates

Idk when that was taken but I can imagine it’s way higher now since Medicare really doesn’t change its rates year to year much anyway. Which is probably 1 reason the commercial market costs have ballooned over the years.

 

[lane]

Could you explain the ramifications of this further for me?

They’re trying to push the median in-network rate down, and put the patients and providers at odds with each other.

 

[marr65]

They’re trying to push the median in-network rate down, and put the patients and providers at odds with each other.

I don’t know you personally or have anything against you but could you please stop using PROVIDERS in place of physicians? We as PHYSICIANS are fighting this bill, I don’t see PAs and CRNAs doing the same.