(Boston Globe) Ending surprise billing: A moral test for physicians

Below, see highlights from an op-ed published in the Boston Globe: Ending surprise billing: A moral test for physicians by Ashish K. Jha, M.D., MPH. To read the full piece, click here.

• “Most people, quite reasonably, think that if the hospital is in-network, everyone working there will be too. Some physician groups are exploiting this vulnerability, burdening patients with thousands of dollars in medical debt as a result. How do they do it? By choosing not to negotiate with insurance companies — and therefore charging whatever they want, out-of-network. But $28,000 for a couple of hours of anesthesia care during surgery? Sure! Five thousand dollars for a short ER stay? Why not? Actually, here’s why not. This deception is morally repugnant. It undermines the physician-patient relationship that is at the heart of our profession. It is a corruption of our system.”

• “With artificially high charges as the baseline for arbitration, more physicians are tempted to go out-of-network, inflating their billed charges, and getting large payouts from the arbitrator. Why negotiate with an insurer when you can get 80 percent of whatever charge you want to bill? A better option is to cap how much providers charge for out-of-network services. A cap that bars the most outrageous bills would be a good start, providing motivation for physician companies to negotiate in good faith with insurers. Experts often suggest capping the rate at some multiple of Medicare rates (50 percent higher, or even twice as high). Of course, Medicare is itself a relatively generous payer — and most physicians could get by on Medicare rates alone. Some lobbyists for these physician companies have argued that doctors cannot provide services at Medicare rates, but that’s absurd — ER physicians care for Medicare patients all the time. And the median salary of an ER physician is $336,000 per year. And the median physician rarely sends a “surprise” out-of-network bill — only a small minority do. So eliminating out-of-network billing would largely reduce the pay of doctors who make much more than the median.”

• “Surprise bills are not an accident — but rather an intentional exploitation of weaknesses in our health care system. These physician groups will argue that insurers aren’t negotiating in good faith, and while sometimes that’s true, the primary culprit of this deception has been physician companies whose business model is to exploit patients when they are most vulnerable — in an emergency or under anesthesia. Many of us practicing physicians find the behavior outrageous. We all took an oath to “do no harm.” To financially ruin our patients when they are sick shows a moral rot in our community. If we don’t voluntarily stop this practice, Congress will eventually stop us. And shame on us for making Congress do what we should do on our own.”