AAOS works with Congress to address surprise medical billing
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In a statement, the American Association of Orthopaedic Surgeons thanked the House Ways and Means Committee for its recent proposal that would protect patients from surprise medical billing and create a framework for independent dispute resolution.
“We are also pleased that it does not include a threshold for mediation, which would impede access to this proven process for settling disputes,” Kristy L. Weber, MD, FAAOS, president of the AAOS, said in a press release. “However, we ask that the committee continue working with us and the entire physician community in good faith to improve the bill.”
Weber said legislation should further clarify that the median in-network rate is meant to be a floor and starting point for negotiation, not the primary factor. If not, insurers may use it as a de facto benchmark to dictate prices and manipulate the market, which could decrease access to care and choice of provider. The bill underestimates the effort required for physicians to accurately value procedures with reimbursement data they currently may not have access to, Weber noted.
“We urge the committee to heed these concerns and look for ways to ensure that the bill more directly addresses the real problem — inadequate networks,” Weber said. “Our doctors and our patients depend on the outcome, and we will continue to advocate for a fair, accessible process that empowers them both.”
In late 2019, the AAOS commended Congress for its dedication to find a solution that addresses surprise medical bills by removing patients from the middle of medical billing disputes with a combined version of the Lower Health Care Costs Act of 2019.
“We appreciate that the new version of the bill includes Independent Dispute Resolution (IDR), as well as a lowered threshold for access to this critical process,” Weber said in a press release. “These positive improvements, however, are overshadowed by the committees’ continued use of the median in-network rate — a number controlled by insurers.”
According to Weber, use of a median in-network rate as a benchmark is similar to government rate-setting, even when filtered through arbitration, and will allow insurers to serve their bottom line by driving down in-network rates, which will harm patient access to care nationwide. In addition, the effectiveness of the IDR process, meant to bring both sides to the table and incentivize fair, reasonable offers, will be undermined by the proposed 90-day waiting period between disputes for the same procedure types.
“As Congress evaluates this proposal and considers passing legislation before the end of 2019, AAOS urges it to incorporate proven solutions like the fair market IDR standard employed successfully in New York,” Weber said.
- References:
- AAOS statement on surprise billing proposal from House and Senate committees. Available at: https://aaos.org/aaos-home/newsroom/press-releases/aaos-statement-on-surprise-billing-proposal-from-house-and-senate-committees/. Accessed Dec. 11, 2019.
- AAOS statement on Ways and Means surprise billing proposal. Available at: https://www.aaos.org/aaos-home/newsroom/press-releases/aaos-statement-on-ways-and-means-surprise-billing-proposal/. Accessed Feb. 12, 2020.
- For more information:
- Kristy L. Weber, MD, FAAOS, can be reached at University of Pennsylvania, 3400 Civic Center Blvd., Philadelphia, PA 19104; email: kristy.weber@pennmedicine.upenn.edu.
Disclosures: Weber reports no relevant financial disclosures.
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