Improper Payment Could Harm Patient Care for Those With Access Issues
The American College of Emergency Physicians (ACEP), American College of Radiology® (ACR®) and American Society of Anesthesiologists (ASA) submitted their fifth amicus brief in support of the Texas Medical Association’s (TMA) suit challenging the federal government’s improper implementation of the No Surprises Act. The societies contend that significant portions of federal agencies’ July 2021 interim final rule (IFR) implementing the NSA are flawed.
The brief advocates that the United States Court of Appeals for the Fifth Circuit should uphold an earlier district court’s judgment that invalidated the final rule’s provisions, which unlawfully favor the Qualified Payment Amount (QPA) when determining out-of-network payments.
The medical societies argue that in the July IFR, the mechanism or formula adopted by the federal agencies conflict with the text and intent of the No Surprises Act by using a calculation determined solely by the insurer and does not reflect the fair market value of physician services. By using this faulty formula and other guidance, the brief argues that payments for anesthesiology, radiology and emergency services will be undervalued by empowering insurers to lower in-network rates, which will reduce out-of-network rates. This under-compensation of out-of-network care will threaten smaller and independent physician practices and staff, resulting in the potential consolidation or closure of these practices. This may lead to fewer services in rural and other underserved communities, which ultimately will harm the care of patients in those areas already struggling with accessibility to quality treatment.
The Texas case does not in any way impact or undermine the important patient protections included in the No Surprises Act, which ACEP, ACR and ASA advocated strongly for and continue to fully support, nor does it raise patient out-of-pocket costs.
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