Senators’ Decision To Go With ‘Benchmark Payment’ Strategy To Address Surprise Bills Deals Blow To Hospital Groups
Under the revised bill from Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.), when a patient is seen by a doctor who isn’t in their network, insurance would pay them the “median in-network rate,” meaning the rate would be similar to what the plan charges other doctors in the area for the same procedure. The health committee had presented three options on the surprise billing front in its discussion draft, including an arbitration arrangement that's favored by other lawmakers.
The Hill:
Key Senators Release Bipartisan Package To Lower Health Care Costs
A pair of key senators on Wednesday unveiled a revised version of their bipartisan package aimed at lowering health care costs, ahead of a committee markup expected next week. Sens. Lamar Alexander (R-Tenn.) and Patty Murray (D-Wash.) released the package, which takes steps to protect patients from receiving massive “surprise” medical bills when they get care from an out-of-network doctor. It also cracks down on anti-competitive clauses in hospital contracts with insurers that can drive up costs, and encourages the introduction of cheaper generic drugs. (Sullivan, 6/19)
Politico:
HELP Committee Leaders Back Benchmark For 'Surprise' Billing
The benchmark is pegged to the median in-network rate for an area, the same approach advanced by House Energy and Commerce Committee leaders in a bipartisan discussion draft last month. HELP Chairman Lamar Alexander (R-Tenn.) wants to mark up the legislation next week. The committee's remedy for surprise bills is different than a proposal Alexander said on Tuesday he "instinctively" liked — requiring all physicians at the same facility to be considered in-network.Alexander in a statement acknowledged the change, noting that CBO indicated the benchmark approach is "the most effective at lowering health care costs." (Roubein, 6/19)
Kaiser Health News:
Sen. Alexander Details His Plan To Fix Surprise Medical Bills
Alexander and Murray formally introduced their wide-ranging bill Wednesday, but they had offered a broad outline before without taking a stand on how to mediate between health care providers and patients on the surprise bills. When a patient is seen by a doctor who isn’t in their network, the Alexander-Murray bill says insurance would pay them the “median in-network rate,” meaning the rate would be similar to what the plan charges other doctors in the area for the same procedure. If there aren’t enough other doctors covered by the plan to compute a median in-network, the plan would use a database of local charges that is “free of conflicts of interest.” (Bluth, 6/19)
Modern Healthcare:
Senate Health Bill Includes Pay Cap For Surprise Bill Disputes
The committee's choice of the "benchmark payment" policy is a blow to hospital groups, which have staunchly opposed any kind of reimbursement cap. This rate cap would also hit air ambulance companies. While air ambulances have made headlines for particularly high balance bills, they weren't originally included in the May discussion draft. (Luthi, 6/19)
CQ:
Senate Health Measure Aligns With House's On Surprise Bills
Sen. Bill Cassidy, R-La., who prefers to allow arbitration as the negotiating mechanism if providers and plans disagree over the median in-network rate, warned that the bill should include safeguards to ensure that providers aren't disadvantaged by benchmarking. He told CQ Roll Call that he's working with Alexander "to find something that protects the interest of all, most importantly the patients' access." "If there's not safeguards for providers, you won't be able to recruit providers to certain hospitals and those hospitals will close. There is a kind of dynamic that will absolutely occur," he said. (McIntire, 6/19)
Meanwhile, a new study shows how urgent the problem is —
Kaiser Health News:
1 In 6 Insured Hospital Patients Get A Surprise Bill For Out-Of-Network Care
About 1 in 6 Americans were surprised by a medical bill after treatment in a hospital in 2017 despite having insurance, according to a study published Thursday. On average, 16% of inpatient stays and 18% of emergency visits left a patient with at least one out-of-network charge. Most of those came from doctors offering treatment at the hospital, even when the patients chose an in-network hospital, according to researchers from the Kaiser Family Foundation. Its study was based on large employer insurance claims. (Bluth, 6/20)
The Associated Press:
1 In 6 ER Visits Or Hospital Stays Triggers 'Surprise' Bill
Roughly one in every six times someone is taken to an emergency room or checks in to the hospital, the treatment is followed by a "surprise" medical bill, according to a study released Thursday. And depending on where you live, the odds can be much higher. The report from the nonpartisan Kaiser Family Foundation finds that millions of people with what's considered solid coverage from large employers are nonetheless exposed to "out-of-network" charges that can amount to thousands of dollars. (Alonso-Zaldivar, 6/20)
