No one likes surprise medical bills. So why are there so many roadblocks in the way of actually achieving a legislative fix? Read below excerpts from Ezekiel Emanuel’s op-ed in the Washington Post. You can read the full piece here.


  • “Essentially no one in the United States likes surprise medical bills. That’s why Democratic and Republican leaders in both the House and the Senate pulled together common-sense bills earlier this year to curtail the practice. So why isn’t such legislation a slam dunk? Because special interests — specifically hospitals and the private-equity-backed companies that have largely taken over their emergency rooms — are standing in the way. As lawmakers return to session next week, they should make it a priority to end this abusive tactic.”


  • Surprise medical bills are the doing of the financial sorcerers at companies such as EmCare and TeamHealth, both owned by private equity firms, which are responsible for outsourced emergency rooms in hundreds of hospitals across the country. Yale University researchers have found that when these companies take over an emergency room, the frequency of surprise billing skyrockets. For instance, EmCare takeovers of ERs caused a jump in surprise billing by almost 82 percentage points. And when TeamHealth employs the physicians, the frequency of surprise billing increased by 33 percentage points. (After the Yale study was published, EmCare negotiated with insurers to counter the torrent of negative press.)


  • “The House — but so far not the Senate — has also proposed an appeals and independent arbitration process if physicians and hospitals are not happy with the benchmark payment. This is a sop to physicians, but it hasn’t kept special interests from spending millions of dollars on lobbying and political ads that target congressional members and portray physicians as poor victims of rapacious insurance companies. Their complaints are hard to take seriously. Radiologists, anesthesiologists and emergency-room physicians are paid very well. Private insurers on average pay anesthesiologists about 3.5 times what Medicare pays, even while other physicians get on average only 1.3 times Medicare rates from private insurance. The average salary for radiologists is nearly $420,000 per year and for anesthesiologists is almost $390,000.


  • Hospitals fear, too, that they would be paid less under such legislation. They routinely warn that without the higher payments, they would have to reduce services or even close. But extorting patients with surprise bills hardly seems the way to shore up hospitals’ finances. Hospitals and their fellow special interests also don’t have a viable policy alternative. They suggest making every single billing disagreement between insurers and the physicians — including at least 30 million surprise bills from emergency rooms alone — subject to arbitration. Talk about creating a complex, costly, administrative morass. Only the lawyers would win in such a situation.


Read the full op-ed here.