Just when you thought IDR awards couldn’t be any more outrageous, the latest data released by CMS confirms that the extreme and excessive IDR payouts in 2025 alone have totaled nearly $15 billion – a 275% increase from 2024.
IDR abuse is the healthcare affordability crisis that can’t be ignored. In the recent New York Times article – Trump Administration Says Surprise Billing Law Is Being ‘Gamed’ by Doctors – Christopher Krepich, a CMS spokesman, said: “The system is being gamed to get higher prices, and C.M.S. is actively working to clean it up.”
The Times article noted that “the data included a few implausibly large awards, like nine payments for emergency room visits that were more than $200 million each in 2025.” “Implausibly large awards” have become the standard with IDR as many recent investigations have found:
- A recent investigation by The New York Times found surgical assistants using IDR to out-earn the surgeons they support by as much as 25 to 1. In one case, the surgeon who removed a cancerous prostate earned $1,843; the assistant who handed him the instruments won $50,456. Another assistant billed the equivalent of $22,000 an hour.
- A recent analysis from Turquoise Health highlighted in STAT found a common spine surgery that costs $1,400 in-network drawing median IDR awards of nearly $34,000 — 24 times higher. STAT’s reporting also highlighted the exorbitant IDR awards for breast reduction surgery, which is “one of the highest-volume surgical codes in federal arbitration, with about 2,700 cases and about $150 million in total payments to providers since 2023.”
- For that procedure, “Turquoise found the median in-network rate was $1,420, while the median IDR award was almost $61,000, or 43 times higher, with some awards extending above $180,000.” The New York Times also recently profiled a New York surgeon whose practice once got $440,000 for that procedure under IDR.
- Bloomberg reported on new data from the Elevance Health Public Policy Institute, which found that “over the last two years, median arbitration awards won by out-of-network doctors for the most common billing codes for planned procedures are 53 times the in-network rate.”
- The Congressional Budget Office has even warned that “arbitration outcomes could lead to higher prices over time.” CBO added that “the number of IDR cases has far exceeded projections, and awarded payments are often much higher than anticipated. Amounts from arbitration settlements may be much larger than the typical prices for health care services…”
Unchecked IDR costs are translating directly into higher premiums for employers and employees – an unsustainable trend that will make millions of Americans pay more for healthcare. “It’s shocking that it’s rising so fast,” said Jack Hoadley, a research professor emeritus at Georgetown University’s Center on Health Insurance Reforms, on the cost of IDR in the Wall Street Journal.
The Washington Examiner editorial board put it plainly: IDR has become “a multibillion-dollar windfall for hospitals, doctors, lawyers, and arbitrators. Patients pay the price through higher insurance premiums.” Its verdict: “This is not patient protection but industrialized lawfare,” and “Congress ended surprise bills once. Now it must end the arbitration racket it created.”
Extreme IDR award after extreme IDR award is now the norm. Congress and the Trump administration cannot delay in overhauling the IDR system that is in desperate need of reform.
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