Special Report from ASA President Linda Mason, M.D., FASA
The surprise medical bill issue is of significant importance to ABC and our clients. Since the potential outcome of any federal action would impact all of us, I asked for an update on the issue from the ASA. Below is ASA President Linda Mason's response.
With best wishes,
Tony Mira
President and CEO
Dear Colleagues,
The anesthesiology community should be very concerned about the legislation that last week passed the U.S. Senate Health, Education, Labor and Pensions (HELP) Committee. S. 1895, the "Lower Health Care Costs" is authored by Committee Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA) and includes an array of cost saving legislative provisions. However, it also includes ill-conceived provisions seeking to respond to the growth of surprise medical bills. While ASA applauds the bill's protections of patients from surprise medical bills, we are alarmed that the bill includes a mechanism for setting payment for out-of-network providers at the insurer's median contracted rate. This is an unprecedented rate-setting of physician payments in the commercial marketplace. Under this unusual arrangement, the federal government has joined with insurance companies to set and control payment to physicians and other providers.
During the course of the surprise medical bill debate, ASA has worked with our colleagues in medicine to oppose a number of onerous approaches to surprise medical bill solutions We have fought rate-setting to Medicare rates, government mandated in-network arrangements (groups required to be in the hospital's networks), and bundled payments (physician groups can only contract with the hospital and only the hospital may contract with the insurer). We have enjoyed some success in addressing these proposals. However, the HELP Committee's rate-setting approach has proved difficult to defeat. ASA's physician leadership and our lobbying team have joined with a now formalized coalition of medical organizations including our facility-base colleagues at the American College of Emergency Physicians, American College of Radiology and the College of American Pathologists and others, to strongly and actively oppose what is now referred to as the "Alexander-Murray" surprise medical bill provisions. Through extensive face-to-face lobbying and the submission of numerous formal comments and letters, our opposition has been clear. The rate-setting approach is completely unworkable for anesthesiologists. With a maximum payment set in federal law, insurers will have little incentive to negotiate in good faith with physicians and other providers. In fact, insurers will likely cease negotiations recognizing the economic benefits of this new approach. And, of course, we would anticipate that the insurers would be emboldened to "game" the median amount by manipulating their increasingly narrow networks. Those physicians currently above the median, even those with longstanding, good-faith contracts, could be dropped from the insurer's network. This, in turn, would drive down the median. Physicians would have no recourse to address these unfair practices. The impact on our practices would be profound.
Fortunately, all is not lost. On the same day that the Senate HELP Committee passed their poorly constructed "solution" to surprise bills, a group of key health policy leaders in the U.S. House of Representatives introduced an alternative proposal. Congressmen Raul Ruiz, M.D. (D-CA) and Phil Roe, M.D. (R-TN) with the support of bipartisan members of Congress, including anesthesiologist Rep. Andy Harris, M.D, introduced H.R. 3502, the "Protecting People from Surprise Medical Bills Act." ASA worked closely with the authors, both of whom understand the health care marketplace, on this even-handed approach to surprise bills. It is based upon the well-regarded New York state surprise medical bill law which is completely free from rate-setting. New York and H.R. 3502 provide for an insurer to make a payment of a "commercially reasonable rate" to the out-of-network physician. If either the physician or insurer is dissatisfied with the payment amount, an independent dispute resolution (IDR) process is available. We believe the elements of the Ruiz-Roe approach preserve the balance between physicians and insurers in the marketplace. Unlike the Senate's insurance-industry backed approach, Ruiz-Roe picks no winners or losers.
What's next? ASA is taking a two-pronged approach to the current Congressional landscape. In the Senate, we are strongly opposing the Alexander-Murray "solution." We continue to work closely with Senator Bill Cassidy, M.D. (R-LA) and other Senators who are seeking to incorporate elements of the New York law into the Senate HELP bill. These Senators are facing stiff resistance from the insurance industry and its supporters. On the House side, ASA is urging member of Congress to cosponsor the Ruiz-Roe bill. We anticipate that one or more House committees will take up the surprise medical bill issue in the coming weeks and our goal will be to see Ruiz-Roe or its key elements incorporated into any committee product on surprise medical bills.
ASA has a strong Key Contact and grassroots program that has been called into action. Calls with Senators and their staff have already taken place with more coming over this week. We believe that our anesthesiologists, working along with our coalition partners, are making progress. We have seen new awareness with some Senators of the implications of the rate-setting approach. In the House, we have been pleased to see that the Ruiz-Roe bill has already reached 40 cosponsors and we think more supporters are coming soon. Congress is out of session this week for the July 4th Congressional Recess so our members will be meeting with lawmakers at home, creating more opportunities to win over lawmakers of both parties.
We remain cautiously optimistic that we can make progress in quashing the Alexander-Murray approach in the Senate and that we can build support for Ruiz-Roe in the House. We welcome the support of any and all stakeholder in the anesthesiology community in working to win this fight. Please join us. Resources are available at asahq.org/grassroots and our advocacy team can be reached at advocacy@asahq.org.
Sincerely,
Linda Mason, M.D., FASA
ASA President
