June 13, 2019

Energy & Commerce Health Subcommittee Debates Surprise Billing Solutions

Congress is continuing its focus on developing a bipartisan solution for the issue of surprise medical billing. The most recent activity occurred earlier this week with the Subcommittee on Health of the Committee on Energy and Commerce convening a June 12 hearing entitled, “No More Surprises: Protecting Patients from Surprise Medical Bills.” The hearing provided the first opportunity for Committee members to offer public comments on the bipartisan legislative framework released by Committee leadership in mid-May. In addition, the witness panel included representatives from a broad range of stakeholder organizations, which allowed for a robust discussion relating to the pros and cons associated with various policy proposals.

As highlighted throughout the duration of the hearing, lawmakers and stakeholder organizations continue to align in a collective desire to remove patients from out-of-network (OON) payment disputes. However, consensus on the mechanism to determine payments for physicians providing OON care continues to elude. Overall, patient advocate and consumer stakeholder groups prefer an approach to establish a payment benchmark, in this case the median in-network rate, for all OON episodes of care. Whereas health care providers (hospitals and physicians) favor a comprehensive approach that includes an opportunity for Independent Dispute Resolution (IDR) via an independent, unbiased entity. The American College of Radiology (ACR), American Medical Association (AMA), and others from the provider community, have argued that setting an arbitrary payment rate for OON care disincentivizes good faith negotiations between providers and health insurance plans and will lead to downward compression of physician payments overall.

Playback of the entire hearing is available on the Energy and Commerce website, and the witness testimony is available via the below links.

Patient Advocate

Physicians for Fair Coverage

Association of Air Medical Services

ERISA Industry Association

American Hospital Association

American Health Insurance Plans

Families USA

American College of Emergency Physicians

The ACR Government Affairs team is working closely with lawmakers in the House and Senate, as well as their staff, to advance a legislative solution for the issue of surprise medical billing. Additional Committee activity will occur throughout the summer, with the Senate Committee on Health, Education, Labor and Pensions scheduled to meet on June 18.