The surgeon who operated on a cancerous prostate gland earned $1,843. The assistant who handed him the instruments earned $50,456. Welcome to arbitration under the No Surprises Act.
New York Times reporters Margot Sanger-Katz and Sarah Kliff did another deep dive into the exorbitant and excessive IDR awards that have come to define the IDR process. Their latest reporting found surgical assistants are out-earning the surgeons they support by as much as 25 to 1 — including one who billed the equivalent of $22,000 an hour.
Highlights are included below (emphasis added). To read the full article, click here.
Surgical assistants are routinely out-earning the surgeons they assist — sometimes by 25 times what the doctor makes.
- “The assistants outearning primary surgeons are sometimes doctors but more often nurses or physician assistants. ‘For assistants to regularly be able to earn so much more than the main surgeon is crazy,’ said Brady Connaughton, a lawyer in New Jersey who advises union health plans. ‘It’s a very blatant disregard of both the spirit of the law and what the law says,’ she said.”
- “In March, for example, a surgical assistant in Dallas earned $50,456 through arbitration for a prostate removal operation. The surgeon, who accepted the patient’s insurance, earned $1,843.”
- “In one instance, arbitrators awarded [assistant surgeon] Dr. Reitzen-Bastidas $210,000 for her work assisting with an operation that involved reshaping bones around the eyes. Bastidas [the primary surgeon] earned $12,767 for the same case. A partial review of recent cases involving Dr. Reitzen-Bastidas found she had won at least $1.4 million in arbitration as an assistant for such cases since 2025.”
- “A Wisconsin neurology practice received $196,215 for a 2024 spinal fusion operation — $125,058 to the main surgeon, Dr. Arvind Ahuja, and $70,707 to his assistant, according to documents reviewed by The Times. Typically, health plans would pay the surgeon $9,310 and the assistant $1,562. The practice split the operation into multiple bills, enabling them to bring 11 separate cases to arbitration, winning all of them.”
One case resulted in a $22,000-an-hour payout for a single assistant’s work on one surgery.
- “The $100,000 award meant Dr. Pierce [assistant surgeon] was paid more than $22,000 an hour for the 4.5-hour operation.”
- “The primary surgeon in the case, Dr. Lisa Schneider, accepted an in-network payment of $2,707 for the entire operation. Both doctors work in the same practice as Dr. Norman Rowe, who has earned high payments for breast reductions through arbitration.”
- “The $100,000 award was just for Dr. Pierce’s work on the right breast. He won an additional $11,000 in arbitration for an anesthesia injection, bringing his total earnings from the operation to $111,000.”
As IDR costs have exploded, the trend has raised alarm that providers are forgoing in-network contracts and making healthcare more expensive for employers and consumers.
- “When Congress passed the No Surprises Act, lawmakers thought it would lower health care costs. The Congressional Budget Office estimated that it would cause more doctors to take insurance and reduce some payments. In a blog post this month, three analysts from the budget office said they were rethinking those expectations. ‘Emerging evidence suggests that the law might not have the effects that C.B.O. anticipated,’ they wrote.”
- “‘The threat I see is that, as it becomes more lucrative for these providers to be out of network, eventually they aren’t going to want to be in network,’ said Thomas Nyhan, the executive director of TeamCare, a health plan that covers about half a million union workers across the country. His plan has spent $19 million on arbitration cases since 2022, including to the assistant who won $50,456 in the prostate case.”
- “Owen Rumelt, a partner at the law firm Cary Kane, who advises union health plans, said many of his clients have begun canceling contracts with hospitals where out-of-network operations are common. ‘This is the road-to-hell-is-paved-with-good-intentions legislation,’ he said.”
You can read the full New York Times article here. For more on how out-of-network providers are exploiting the IDR process, click here.
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