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Industry, analysts clash over scope of balance billing legislation

By Susannah Luthi  | February 20, 2019

The healthcare policy and industry worlds are poised for a clash over the forthcoming bill to end all surprise medical bills. 

The tension over the expected legislation lies in its potential scope as a catch-all for widespread frustration over healthcare costs.

All this was in evidence Wednesday as a coalition of hospitals led by the American Hospital Association outlined for congressional leaders the overarching principles they want policymakers to keep in mind. They included a warning that they don’t want Congress to foray into their negotiating relationships with insurers. 

“Policymakers here have a broader agenda, and we’re happy to talk with anyone about broader issues of health reform—but to take the surprise billing issue and to use that as an excuse for broad payment reform we think is inappropriate,” said Chip Kahn, president and CEO of Federation of American Hospitals that represents for-profit hospitals. “Frankly it’s using surprise billing like a Trojan horse.”

Hospitals want the legislation to keep it simple: Take the patient out of the middle and leave the rest to hospitals and insurers to work out.

“Once the patient is protected, government doesn’t need to get involved,” said Molly Smith, vice president for coverage and state issues at the American Hospital Association.

The effort on surprise medical bills started last fall with a discussion draft of bipartisan legislation led by Sen. Bill Cassidy (R-La.) that would cap out-of-network charges to a regional average. Sen. Maggie Hassan (D-N.H.) followed with a separate proposal that pitched arbitration as a way to resolve out-of-network disputes between insurers and providers. President Donald Trump weighed in earlier this year, vowing to end the practice.

It’s unclear when the legislation, which is still in the works as Senate health committee staff meet with patient groups and the spectrum of interested industry parties, will be introduced.

But with Trump on board, policy experts and patient advocates are watching closely for all it could entail. And their hopes are, unsurprisingly, for a more ambitious proposal than what industry wants.

Also Wednesday, seven analysts from the non-partisan think tank Brookings Institution released a paper focused on state-based solutions to surprise bills that shows how deep policymakers could go, through this single piece of legislation, on overall pricing reform.

“It became more clear how inflated the prices we’re paying for these services are today,” said Loren Adler, a co-author of the study under the USC-Brookings Schaeffer Initiative for Health Policy.

The analysis flagged particularly exorbitant charges: One in five anesthesiologists bill at more than 11 times the Medicare rate, the authors found. One in five radiologists bill at more than eight times the Medicare rate for diagnostic CT scans.

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Chris J. Stewart

Chris currently serves as Chief Operating Officer at Ortho Spine Partners. Prior to that, he was the assistant vice president and business unit leader of Medical Device Management for HealthTrust.

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