As the Biden Administration moves forward with implementation of the No Surprises Act, out-of-network providers and private equity firms are pushing to create new loopholes that would raise costs for consumers and families.
Groups representing emergency room physicians and air ambulance providers – two specialty areas with the highest concentration of private equity influence – urged regulators to take a more expansive approach to arbitration decisions that would favor higher rates to these providers. Keep in mind – these are the very private equity-backed providers behind the surprise medical billing crisis.
Leading health policy experts have recently warned against the expanded use of arbitration. In detailed recommendations on the best way to protect consumers from additional cost pressures, Brookings’ researchers urged the Biden Administration to prioritize “minimizing the administrative costs created by the arbitration system, and ensuring that the [No Surprises Act] reduces prices of health care services that were inflated by the threat of surprise billing.”
The best way to achieve that goal is clear: we shouldn’t follow private equity’s lead. Instead, “arbitrators should begin with the presumption that the ‘qualifying payment amount’ (the median, in-network rate) is neither too high nor too low…arbitrators should choose the offer closest to this amount.”
Researchers at Georgetown pointed to the experience in the states where expansive use of arbitration can backfire on patients, ultimately leading to far higher costs as a result of surprise billing reforms. They note that, “regulators should heed the lessons from states such as New Jersey, New York, and Texas by reinforcing the law’s focus on the in-network rate as a key arbitration factor that is consistent with controlling costs.”
To view solutions for protecting patients from higher costs in the No Surprises Act, click here.