Congressional doctors sparked resistance to accidental medical billing policy
But now many doctors, their medical associations and members of Congress are vocalizing that the rules for implementing the law issued by the Biden administration in September are beneficial to insurance companies and are not in line with the spirit of the legislation.
“The government’s recent regulations to start implementing this law are not in line with Congress’s intentions and may incentivize insurance companies to artificially set low payment rates, which will narrow the supplier’s network and may force small clinics to close, thereby limiting patients’ access to care. “Congressman. Larry Bucshon (R-Ind.), he was a doctor and helped take the lead A letter The complaint this month was stated in a statement to KHN.
Nearly half of the 152 lawmakers who signed this letter are Democrats, and many doctors who serve in the House of Representatives signed this letter. But the strong opposition did not win the support of some powerful Democrats, including the chairman of the Energy and Commerce Committee Frank Palon (New Jersey) and the chairman of the Senate Health, Energy, Labor and Economics Committee Senator Pattimey (Washington State).Pension committee, he wrote to the government urging officials Forward` Plan with them.
According to the aides of the MPs, some MPs who are also doctors held a conference call with the government at the end of last month and lodged complaints. They were unable to speak publicly because they did not have the authorization to do so. “Doctors in Congress are angry about this,” said a staff member familiar with the phone. “They are very clear about making laws in a year or two years, debating which way to go.”
The dispute involves the arbitration-focused part of the proposed final statute.
The letter of the legislator-organized by Congressmen Thomas Suozzi (DN.Y.), Brad Wenstrup (R-Ohio), Raul Ruiz (D-Calif.) and Bucshon-stating that the law clearly prohibits arbitrators from favoring specific benchmarks to determine which should be directed Provider payment. Explicitly excluded are the rates paid to Medicare and Medicaid, which are often lower than the rates of insurance companies, and the average rates charged by doctors, which tend to be much higher.
The arbitrator will be instructed to use the median in-network rate of the service as one of several factors in determining fair payment. They must also consider items such as the doctor’s training and quality of results, the local market share where the participants may have a huge influence, the patient’s understanding and complexity of the service, and past history.
But the Proposed rules The arbitrator will not be instructed to weigh these factors equally. It requires them to start with the so-called qualified payment amount, which is defined as the intermediate rate that insurance companies pay to in-network providers for similar services in the region.
If doctors think they deserve better rates, then they can point out other factors allowed by the law-doctors in Congress think this is contrary to the bill they wrote.
The lawmaker told government officials in the letter that the terms in the new rules “do not reflect the way the law is made, do not reflect the policies that could have passed Congress, and did not establish a balanced procedure to resolve payment disputes.”
Opponents of the rule believe that the result will be a process that benefits insurance companies, not doctors, and pushes prices down. They also argued that this would harm the network, especially in rural and underserved areas, because it incentivizes insurance companies to lower the rates they pay to in-network providers. If the in-network fee rate is lower, the default rate in arbitration is also lower.
That’s a special argument litigation Last month, the Texas Medical Association filed a lawsuit against the Biden administration.
The lawsuit alleges that in a few states that already have similar strategies, such as California, Recent studies Shows that the payment rate has been pushed down.Quote that data and A survey The California Medical Association’s lawsuit claims that insurance companies now have an incentive to terminate contracts with higher-income in-network medical service providers or force them to accept lower rates, because out-of-network medical service providers will subsequently receive the same lower rates. The constraints of the baseline.
Jack Hodley of the Georgetown University Health Policy Institute said that the results may work in either way, depending on whether the insurance company or provider is stronger in a particular market.
“In some markets, insurance companies dominate, and they can say to suppliers:’Accept or leave. Because we represent most of the insurance business, we represent most of the patients,'” Hodley said.
But elsewhere, there may be a stronger group of providers. “All anesthesiologists may be engaged in a large business in a market, and they can basically say to insurance companies in that market,’Accept or give up,'” he said.
When issuing the rules, the Center for Medicare and Medicaid Services stated An analysis Data from the Congressional Budget Office shows that the no surprises bill will reduce premiums by about 1% and reduce the federal deficit by $17 billion.
Reducing premiums is a particularly important goal of the government and some of its allies (such as patient rights groups and labor unions).
Hodley said whether the supplier network will be reduced is still an open question. The investigation cited in the Texas lawsuit also shows that in some states, the use of in-network services has increased, and the benchmarks are similar to national laws, but it is not clear whether more doctors are joining the network or more people are turning to the network. provider.
It is unclear whether the government will consider the concerns of lawmakers. Some Hill staff who participated in the boycott believed that this process may be too far to change and must be resolved in court. Others saw an opportunity for last-minute transformation.
A member of the House of Representatives pointed out that more than 70 Democrats who filed a complaint with the White House of Democrats may have an impact.
“Together with the madness and legal threats of the amazing bill wars over the past few years, I think there are still many ball games,” the staff member said.
subscription Free morning briefing to KHN.