Constraining Specialists From Billing Out-Of-Network Prices Would Lower Health Spending By $40B A Year
Specialists like anesthesiologists have more power to negotiate higher in-network payments because they're able to bill so much out-of-network. Limiting that power would have a significant effect on spending, a new study finds. Congress has been working to find a way to curb out-of-network surprise bills, but although they've made progress in recent weeks, nothing has passed yet.
Modern Healthcare:
Surprise Billing By Specialists Boosts Spending By $40 Billion
Patients who seek care at in-network hospitals have a significant risk of being treated by and receiving a surprise bill from out-of-network anesthesiologists, pathologists, radiologists or assistant surgeons, a new study by Yale University researchers found. The ability of these four specialties to send patients out-of-network bills allowed them to negotiate high in-network payments from insurers, which leads to higher insurance premiums for individuals, according to the study published Monday in Health Affairs. (Livingston, 12/16)
Kaiser Health News:
Surprising Swings In Momentum For Legislation On Surprise Medical Bills
After months of hearings and negotiations, millions of dollars in attack ads, full-court press lobbying efforts and countless rounds of negotiations, Congress appeared to be moving toward a solution to the nation’s surprise medical bill problem. Sort of. Surprise bills, the often-exorbitant medical bills that come when a patient doesn’t realize they’ve been seen by a provider outside their insurance network, have in recent months been viewed as public enemy No. 1 on Capitol Hill. (Bluth, 12/17)
In other hospital news —
Modern Healthcare:
Beaumont Health, Universal Health Services Break Ground On Mental Health Hospital
Beaumont Health and Universal Health Services broke ground on a new mental health hospital in Dearborn, Mich., the not-for-profit and for-profit health systems announced Monday. Construction is slated to start in early 2020 on the $40 million, 150-bed hospital that will double Beaumont's inpatient mental health capacity. The 100,000-square-foot facility, which includes substance use disorder treatment and an integrated assessment and referral center, will open by mid-2021. (Kacik, 12/16)
Modern Healthcare:
Judge Denies Hospitals' Request To Strike Down CMS Site-Neutral Policy
A federal judge on Monday denied hospitals' request to halt the CMS' plan to implement its so-called site-neutral payment policy in 2020. U.S. District Judge Rosemary Collyer had ruled against the policy in September for 2019 payments because it wasn't budget-neutral. Despite that ruling, the CMS built it into next year's Outpatient Prospective Payment System rule. (Cohrs adn Brady, 12/16)
