April 04, 2019

House Panel Analyzes Potential Solutions for Surprise Medical Bills

In a year thus far lacking in substantive legislative activity, the issue of surprise medical billing practices has retained a unique bipartisan interest from lawmakers on both sides of the Capitol.

The willingness of Democrats and Republican legislators to address this issue was on display this week as the House Education and Labor Committee’s Subcommittee on Health, Employment, Labor and Pensions convened a hearing entitled, “Examining Surprise Billing: Protecting Patients from Financial Pain." The hearing featured a single witness panel with representatives from the Brookings Institution, American Benefits Council, Families USA and Georgetown University’s Health Policy Institute.

Throughout the hearing, the Subcommittee, led by Chairwoman Frederica Wilson (D-FL) and Ranking Member Tim Walberg (R-MI), articulated concern over the rising incidence of surprise medical bills and their impact on patients and the health care system overall. Both expressed optimism for a bipartisan agreement that identifies tangible solutions.

Despite such confidence from lawmakers regarding their ability to craft and advance a comprehensive solution for the issue of surprise medical bills, the American College of Radiology (ACR) and other physician stakeholders are concerned that a disproportionate amount of “blame” is being directed at physicians.

As a result, several of the suggested “solutions,” such as setting an out-of-network payment cap at 125 percent of Medicare rates or new bundled payment mechanisms where a single payment would be made to the hospital for all services rendered during a patient’s episode of care, lack support from the provider community because such policies do not address the role health care insurers have played as primary sources of out-of-network payment problems.

However, there are important areas of agreement. Many stakeholders agree that patients should only be responsible for in-network, cost-sharing payment rates after receiving care that results in unanticipated medical bills. They stress that any potential federal legislative solution(s) must apply to all plan types, including employer-sponsored ERISA plans.

Lawmakers also remain open to analyzing successful state-based solutions that have often included provisions for mediation or a sequential alternative dispute resolution process for those circumstances where the minimum payment standard is insufficient.

Given that the hearing’s witness testimony largely targeted the physician role in surprise medical billing, ACR staff is collaborating with other physician organizations to broaden lawmakers’ perspective on this complex issue.

This effort includes the reiteration of joint principles articulated by the American Medical Association on behalf of coalition members in a February letter to Congress. Key points included urging Congress to consider the importance of insurer accountability, limits on patient responsibility, transparency and the need for robust network adequacy standards that should require an adequate physician-to-patient ratio for emergency physicians, hospital-based physicians, and on-call specialists and subspecialists.

Additional Congressional committees are expected to schedule hearings on the topic of surprise medical bills. The ACR will be encouraging these committees to identify witness panels representing a more diverse set of stakeholders.