Physicians For Fair Coverage

Following Senate HELP Hearing, Physicians Urge Congress to Protect Patients from Surprise Bills, Preserve Access to Quality Care

Wednesday, 06/19/19

Physicians for Fair Coverage (PFC), a non-profit, non-partisan alliance of tens of thousands of physicians, issued the below statement following a Senate HELP Committee hearing this morning on the Lower Health Care Costs Act:

“While we are encouraged by the Senate HELP Committee’s commitment to end surprise medical billing, this draft legislation fails to protect patients nationwide and threatens their access to quality care. We are concerned about the draftbill’s one-size-fits-all approach and the significant unintended consequences that would result from it,” said Dr. Sherif Zaafran, Chair of Physicians for Fair Coverage. “Whether it’s network matching or using an arbitrary benchmark to determine out-of-network rates, these policy approaches would lead to further consolidation in the health care market. This would restrict patients’ access to quality care and exacerbate the physician shortage, which means fewer choices and higher costs for patients - particularly in rural areas that are already experiencing hospital closures and operating on razor-thin margins  Furthermore, these approaches would radically upset the balance of negotiations among insurers, providers, and hospitals, and because it is not feasible for every hospital and provider to contract with every insurance plan, network matching fails to eliminate the possibility of out-of-network situations or solve the problem of surprise billing.”

During last week’s House Energy and Commerce Subcommittee on Health hearing on draft legislation proposed by Chairman Frank Pallone (D-NJ) and Ranking Member Greg Walden (R-OR), several members and witnesses expressed concern about the bill’s proposed one-size-fits-all rate-setting approach. Representative Larry Bucshon (R-IN), a cardiovascular surgeon before coming to Congress, expressed concern that a benchmark approach would lead to a reimbursement race to the bottom, encourage narrow networks, limit patients’ access to care, and compound the doctor shortage.

“Any solution to surprise medical billing must increase transparency, fairly reimburse providers for their services, and remove patients from price negotiations. Furthermore, given that commercial out-of-network patients represent only about 5 percent of emergency room visits, any federal solution to end surprise billing should not put 100 percent of the patient population at risk,” Dr. Zaafran stated. “Instead of allowing the federal government to pick winners and losers from the get-go, Congress should look toward the only approach to surprise billing that has a long track record of truly protecting patients: an independent dispute resolution (IDR) model. From Washington to Texas to New York, there has been a groundswell of support in the states for the successful IDR model that has resulted in stronger patient protections, a dramatic drop in out-of-network claims, and increased network participation and transparency for consumers.”

According to a case study on the New York model from the Georgetown University’s Center on Health Insurance Reforms, IDR resulted in a 34 percent drop in out-of-network billing, and there is no evidence that the law had resulted in higher costs. “Indeed, one study found a 13 percent average reduction in physician payments since the law was enacted. State regulators report that there has not been, as yet, an indication of an inflationary effect in insurers’ annual premium rate filings,” according to the case study.