Below is an excerpt from Axios
Hospitals’ Dog In The Surprise Billing Fight
Although the surprise billing debate is often framed as a battle between insurers and doctors, hospitals also have a huge financial stake in the issue and are fighting tooth and nail to make sure they get their way.
Why it matters: Congress’ effort to rein in surprise medical bills is on the rocks, thanks largely to industry opposition, and its failure would leave patients at risk.
How it works: Congress’ leading solution would set a benchmark rate that insurers would pay the doctors and hospitals who are outside their coverage networks. It would only apply in certain circumstances.
- Some experts say that would erode hospitals’ negotiating power with insurers — staying outside an insurer’s network wouldn’t be as lucrative, and therefore hospitals wouldn’t be able to make as many demands by threatening to remain out-of-network.
- By reducing hospitals’ leverage, this approach to surprise billing could help insurers pay hospitals less.
- “That’s a pretty hefty threat that the hospital implicitly has with any negotiation with an insurance company,” said Loren Adler of the Brookings Institution. “That is a reason for insurance companies to pay a hospital more than they otherwise would have.”
Hospitals “don’t have a dog in the fight — they have an elephant in the fight,” USC health economist Glenn Melnick said.
- Hospitals can profit from turning a blind eye to independent physician practices’ billing, or in some cases they’ll explicitly agree to share those profits, Yale’s Zack Cooper said.
Go deeper: ER bills are skyrocketing
Read the full story at Axios.