New recommendations from the Bipartisan Policy Center zero in on surprise medical bills and the need to tackle these unfair charges as part of a system-wide approach to addressing unsustainable health costs. The bipartisan group of health care experts — led by former Sens. Tom Daschle and Bill Frist, M.D. — noted that the best way to safeguard patients from bankrupting charges is through a local, market-based approach that ties out-of-network reimbursement to the median in-network rate.
- “Patients receive ‘surprise medical bills’ when they receive services from an out-of-network provider at an in-network facility. In 2017, 18% of all emergency visits and 16% of in-network inpatient hospital stays had at least one out-of-network charge. Generally, patients receive services from certain specialty physicians who practice in hospital settings, including emergency physicians, anesthesiologists, radiologists, and pathologists who are unwilling to accept in-network insurance rates. This trend has escalated as hospitals are increasingly using third-party staffing companies to contract with physicians and ambulances. These physicians can often use the threat of staying out-of-network to negotiate for higher in-network rates.”
- “An early and bipartisan version of Senate HELP Committee legislation tied provider reimbursement to a benchmark payment that represents the median in-network rate. This decision was influenced by a CBO report that found greater federal savings associated with using a benchmark rate. CBO has calculated the proposal would reduce commercial rates by 1% and reduce the federal deficit by $25 billion over 10 years.”
- On the other hand, “CBO estimates that allowing arbitration in some cases would increase costs relative to an option that tied all payments to a benchmark set at median rates.”
- “We support a policy that relies on private negotiations between the parties to resolve the problem, backed by a limit on payments tied to a median rate as recommended in the bipartisan proposal originally reported by the Senate HELP Committee. Arbitration is unnecessary in our view and risks increasing costs, which could drive up premiums for consumers. Further, arbitration benefits larger group practices that can afford to hire attorneys over small and independent physicians’ practices.”
To view the full report, click here.