Op-ed: There’s only one true solution to end surprise medical billing

Dr. Camille Samujh is a practicing physician anesthesiologist in the Western Washington area.  She completed her anesthesia residency training in New York City and also holds a Master of Public Health degree from the University of Washington. She wrote the following op-ed on policy solutions to end surprise medical billing. 

 

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Ensuring the most positive, painless patient experience possible is one of my top priorities as an anesthesiologist. Unfortunately, there is little we can do to protect our patients from the pain of surprise medical billing once they leave our care.

Sadly, surprise medical bills can hit patients when they are at their most vulnerable, adding economic burdens and emotional stress when they should only be focusing on recovery. As a physician on the front lines of patient care, I have heard far too many horror stories from patients and their families about how this unfair billing practice has negatively impacted their lives. It is time for federal legislators to stop debating this problem and come up with a real solution.

Washington is fortunate to be one of the few states that has passed a smart solution to address this issue head-on. HB 1065 was passed earlier this year and will go into effect next year.  This bill takes patients out of the middle of the out-of-network billing disputes between insurers and providers that result in surprise medical bills.

Our new law will accomplish this by providing a negotiation process called Independent Dispute Resolution (IDR), which will enable medical providers and insurers to settle out-of-network payment disputes amongst themselves via a simple, online process. IDR helps ensure payments are fair and based on the true cost of providing clinical care in different geographical regions and facility types.

This is the approach Congress should seek to replicate in federal legislation to protect patients nationwide from being impacted by surprise medical billing. While there are several solutions that have been introduced in both the House and Senate, not all of them take this balanced approach. One particularly misguided proposal called “benchmarking” could, in fact, make things worse for patients and providers by unfairly tilting the playing field in favor of big insurance companies.

The benchmarking approach being pushed by insurers would see the government setting out-of-network rates based on insurance companies’ in-network averages. These in-network rates, however, have been steeply discounted during the contract negotiation process. In other words, using them as a benchmark for out-of-network rates would shift exorbitant costs onto providers, including local hospitals and emergency rooms.

For smaller, independent health care facilities—particularly at-risk ones serving hard-to-reach rural communities—these new financial losses could spell disaster. Rural hospital closures are already reaching unsustainable levels. A benchmarking approach to solving surprise billing could force many more to either close down or consolidate, limiting patient options and access while driving up costs. This is not a responsible solution.  As a physician who has a strong background in community oriented public health I am very cognizant of access to care issues being a major social determinant of health. Unfortunately, this bill has a serious potential to harm rather than help patients in the long run.  Healthcare providers only seek to offer safe and quality care to our patients. The benchmark approach only makes this more difficult in our already delicate healthcare system.

Senator Patty Murray’s current surprise medical billing legislation, the Lower Health Care Costs Act, relies on benchmarking to the detriment of her own constituency. She should use her influence as the ranking member of the Senate Health, Education, Labor and Pensions Committee to support a more balanced, equitable approach based on Washington’s state law. By championing an IDR-focused solution, Senator Murray can help protect patients nationwide from surprise medical billing while preserving the strength of our venerable health care institutions.