Dr. Ned Carp and Dr. Emma Simpson
There is a bill being discussed in Washington, Lower Health Care Costs Act (S. 1895), that would use the median in-network rate as a benchmark standard for out-of-network reimbursement. Detailed background information about the bill is available via Advisory Board.
For many private practice groups, only a small fraction of their business is out-of-network. Nonetheless, for those patients who get caught in the “surprise insurance gap,” it can be a big problem, and legislators have taken notice. Most everyone agrees that we need a federal legislative solution, but the dilemma is the need to fix one problem without creating other (even bigger) problems. By price-setting, the HELP bill would destroy good-faith negotiations between providers and insurance companies. Insurance companies would enter negotiations in a terrific position, knowing that providers have limited options. If providers don’t like the terms the insurance companies offer them, their only recourse is to go out-of-network, where they would receive a rate which is already discounted based on the advantages of being in-network, but they would get none of the advantages of being in-network. Also, price setting would disincentivize practices to differentiate based on quality or other circumstances which may merit a higher reimbursement rate.
Physicians should come together to make our collective voice heard to the U.S. Senate. There are three ways to reach out: calling, electronic messaging and in-person meetings. Calls are preferable to e-messages (though both are useful).
Plan: Click here to locate and contact your U.S. Senators. This resource provides both a phone number and an option to electronically submit a message. There is also information on how to request an in-person meeting.
1) Phone Call Template
Here are the main talking points for a call.
- I am a doctor, and I oppose how the Senate HELP committee bill, the Lower Health Care Costs Act (S. 1895), addresses surprise billing.
- We agree that for unanticipated out-of-network coverage, patients should be kept out of the middle, but any legislative fix should preserve good-faith negotiations between insurance companies and providers.
- If good-faith negotiations are disrupted, physician groups will adapt to the new financial reality, and patients will likely experience reduced access to care as a result, particularly in rural areas where financial margins are already slim.
- In California, where a state law passed with a similarly low benchmark payment rate, insurers have refused to renew longstanding contracts, initiated contract terminations or demanded significant reductions in physician reimbursement rates which discourage physicians from contracting.
- There are better and proven alternatives that solve the problem of surprise billing. The Independent Dispute Resolution process in New York, which is an online resolution process, has proven to work. It has led to increased network participation, fewer out-of-network claims and stable prices.
2) Electronic Message Template
Simply copy and paste the below message into the body of the electronic message option (feel free to add/edit your own comments as personal emails are worth more than ones that are recognized as stock messages). Click here to locate and contact your Senator electronically.
As a physician, I urge you to oppose Senate Bill 1895, the Lower Health Care Costs Act, based on its use of a benchmark-only approach for surprise billing.
- It Hurts Patients: As physicians are either pushed out-of-network or forced to accept a below-market rate to be in-network, fewer hospital-based physicians will be available. This will impact access to emergency and “on-call” safety net physicians for patients facing a life and death emergency or delivering a baby in the middle of the night. Facilities that serve a higher proportion of uninsured, Medicaid, and Medicare patients or are in under-served urban or rural communities may be even more impacted. These facilities are already struggling financially and don’t have the capacity to compensate for the shortfalls this bill would create.
- It Hurts Doctors and Networks: A benchmark-only approach will empower insurance companies, allowing them to dictate reimbursement rates to doctors. Use of a discounted benchmark rate will incentivize insurance companies to walk away from negotiations to bring providers in-network, which will disrupt the markets where negotiations have been successful. Further, physician practices making less than the median would have little interest in contracting.
- It Hurts Quality of Care: Insurers will have no incentive to negotiate with practices currently paid more than the benchmark rate. This “one-size-fits-all” approach ignores the significant variations in the market in terms of quality, outcomes and cost intensity of different practices. Instead, insurers will systematically terminate providers paid above the benchmark rate, even when those providers are more experienced or have made significant investments in quality improvement programs.
- A Better Way: There are better and proven alternatives that solve the problem of surprise billing. Independent Dispute Resolution, like the system in New York, is an online resolution process. It has led to increased network participation, fewer out-of-network claims and stable prices.
- A benchmark-only approach will dramatically shift the balance of provider-insurer negotiations, leading to cancelled contracts, smaller networks and reduced access to care.
- An independent dispute resolution process is a proven solution.
- I urge you to oppose Senate Bill 1895, the Lower Health Care Costs Act, based on its use of a benchmark-only approach for surprise billing.
3) In-Person Meeting:
If you feel comfortable, please consider requesting an in-person meeting with a Senator and/or their staff. There is information about requesting an in-person meeting on their website, or you can call their office to make a request.
This is a crucial issue for all of us. Now is the time to make your voice heard! Thank you for taking time to connect with your respective Senators.
Ned Carp, MD, President of MEC
Emma Simpson, MD, VP of MEC