Could A So-Called Baseball-Style Of Arbitration Work As A Solution To Settling Surprise Medical Bills?
One possible way to solve the debate over how to end surprise medical billing disputes is make it a loser pays system with a neutral arbitrator. Each side would submit a price, and the arbiter chooses one. Both sides are bound by the decision, while patients’ charges for out-of-network care are limited to what they would owe to in-network providers. By forcing an arbiter to pick an offer, rather than forging a compromise, both parties are, in theory, encouraged to moderate their bids.
Bloomberg:
Senators Borrow From Baseball To Fix Surprise Medical Bills
In most markets, when a buyer and a seller can’t settle on a price, they walk away. Medicine is different. Doctors and insurance companies often sort out who owes what only after a patient has been treated, especially in emergencies. When they disagree, patients can end up with unexpected bills they can’t pay.
Efforts to keep patients from getting stuck in the middle are gaining steam in Washington. Six senators sent a letter to health plans and providers this week seeking data on surprise medical billing. President Donald Trump pledged in January to stop unexpected medical bills. (Tozzi, 2/7)
In other health care cost news —
Modern Healthcare:
Unnecessary ED Visits From Chronically Ill Patients Cost $8.3 Billion
About 30% of emergency department visits among patients with common chronic conditions are potentially unnecessary, leading to $8.3 billion in additional costs for the industry, according to a new analysis. The report, released Thursday by Premier, found that six common chronic conditions accounted for 60% of 24 million ED visits in 2017; out of that 60%, about a third of those visits—or 4.3 million—were likely preventable and could be treated in a less expensive outpatient setting. The frequency of unnecessary ED visits from the chronically ill is unsurprising given the fee-for-service payment environment the majority of providers remain in, said Joe Damore, senior vice president of population health consulting at Premier. (Castellucci, 2/7)
The Hill:
Father Says He Traveled To Canada For Son's Medicine That Would Cost $53K In US
A Pennsylvania man whose son's medicine isn't covered by their family's health insurance plan says he has been traveling to Canada multiple times per year to purchase medicine. Jon Yeagley told CBS News on Wednesday that because the drug used to treat his son's illness is not covered by his health insurance plan, he has chosen to travel to Canada four times per year to purchase it for a substantially lower price than he can find in the U.S. (Bowden, 2/6)
