A ‘compromise’ on surprise medical billing helps neither patients nor providers

As the temperature drops and the holiday season approaches, COVID-19 is making an unfortunate resurgence, with more than three million new confirmed cases recorded between Nov. 1 and Nov. 22. Hospitals are doing the best they can to responsibly manage their capacity thresholds and medical providers are once again working around the clock to treat patients diagnosed with the virus.

Given the current uptick in COVID-19 cases and its constraint on hospitals, it is surprising to see Congress bring forth proposed legislation that would directly harm both frontline healthcare workers and patients. But, some lawmakers are trying to use the debate around surprise medical bills to pass a so-called “compromise” bill that would lead to doctor shortages, hospital closures, and loss of access to care for sick patients.

Surprise medical bills have been front and center this year after patients who sought a preventative coronavirus test or who received medical care for the virus began to find unexpected bills in their mailboxes. Before the pandemic, these charges were frequently associated with unplanned care, oftentimes occurring during emergency transport or medical interventions that fall outside of a patient’s insurance provider network.

Competing proposals have been circulating for the past year, with insurance companies advancing one particularly harmful approach known as rate setting, which would allow insurers and lawmakers to work closely behind the scenes to dictate medical rates. Make no mistake, the most current so called “compromise” plan would still disproportionately harm rural doctors and nurses who are on the frontlines of the COVID-19.

A recent study by the Chartis Center for Rural Health found that nearly one in four hospitals are at risk of permanently closing, a number only exacerbated by the COVID-19 pandemic. Besides further pushing the patient and healthcare professional out of the decision-making process, if passed, the proposal would harm the hundreds of already struggling medical providers and neighborhood physicians.

Healthcare professionals agree that patients should not be getting bills when there is a gap in coverage, or the insurance company continues to shift more and more financial responsibility to the patient in the name of “boosting profits.” But there is a right way and a wrong way to address this problem, and the current proposal in Congress still represents the wrong way. Thus, key Congressional champions for our healthcare professionals, like our own Senate Majority Leader Mitch McConnell and Senator Rand Paul, should back a fair method that has proven to work – a solution that brings all parties to the table in good faith to promote an adequate resolution to billing disputes with the patient taken out of the financial responsibility equation all together.

One such system that Americans overwhelmingly support is Independent Dispute Resolution (IDR). Multiple states, including New York, Texas, and Florida have successfully implemented this method to solve surprise medical bills. Under an IDR system, should the insurance company shortchange the doctor or nurse who provided care to their patient, they would be afforded the opportunity to take the insurance provider to arbitration, where both parties could settle on a fair and reasonable reimbursement rate. Patients are only responsible for their in-network costs.

The Alexander-Cassidy compromise contains IDR, but only in name. The barriers around this system are so high, and so friendly to insurers, that it will fail to adequately protect patients and their access to care. What lawmakers must realize is that the latest proposed compromise is in fact not a compromise at all – it is rate-setting in disguise.

Moving forward, and especially during this harrowing period, we must provide our doctors and nurses on the frontlines of the COVID-19 pandemic with the support they need to succeed. A “compromise” that heavily favors rate-setting will only set them up for failure.

Ryan A. Stanton sits on the Board of Directors for the American College of Emergency Physicians and is the Medical Director for the Lexington Fire Department.