To foster a more productive dialogue, TeamHealth will continue to provide commentary that corrects misinformation in surprise medical billing media reporting.
Physicians and other healthcare providers have voiced their support for legislation to end surprise medical billing, but recent media reports have only highlighted what commercial insurance companies have proposed to fix the issue.
The proposals from commercial insurance companies highlighted in the news media will threaten emergency care access for patients across the country, particularly those in rural and underserved areas. Both patients and physicians deserve to be involved in the conversation for legislation that ends surprise medical billing while still ensuring patients can access care when they need it. See the column from Leif Murphy, President and CEO, in Real Clear Health addressing this issue.
An opinion column in the Washington Post entitled, “No one likes surprise medical bills. So why does congressional action seem so unlikely?” includes a claim that “hospitals and the private-equity-backed companies that have largely taken over their emergency rooms — are standing in the way” [of surprise medical billing reform].
Ezekiel Emanuel’s opinion column erroneously assigns blame for surprise medical bills to medical provider groups such as TeamHealth, and misrepresents a Yale University research study to do so. Emanuel’s accusation that surprise medical bills increase at TeamHealth-operated emergency rooms is patently false. TeamHealth ended the practice of balance billing years ago. When arbitrarily underpaid by an insurer, TeamHealth pursues legal action to force insurers to uphold their commitments to patients.
We never put the patient in the middle of a dispute. The Yale Study shows that TeamHealth is out-of-network for 13 percent of its encounters, and not that a balance bill is ever generated. It is a reflection of inadequate rates being offered for network participation and not a measure of surprise billing. We unquestionably support a ban on surprise medical billing and you can see our full response commentary here.
A recent Modern Healthcare piece entitled, “Surprise Medical Billing Threatened by Provider Lobbying” – included a quote from a Congressional staff member saying, “It’s not a matter of tweaks to get providers to stand down, it’s that provider groups don’t want to see a solution here. They want the status quo. They’ve charted out where Congress could end up, and they are ready for the whole thing to come down. For them surprise billing can stay in the mix.”
The article inexplicably fails to interview a representative from any of the specialty societies or provider organizations referenced which would reveal that emergency medicine providers unequivocally want a solution to surprise medical billing. Instead, their objection to the legislation currently under consideration stems from the creation of an unsustainable rate setting standard that will alter the reimbursement equilibrium that exists today, which is necessary to cross-subsidize uncompensated indigent care and underfunded Medicaid reimbursement.
A recent analysis piece in Health Affairs, entitled, “Surprise Billing: Choose Patients Over Profits” includes a claim that, “…groups of physicians—particularly emergency physicians and anesthesiologists—stay out of insurance networks, levy outrageously high bills on unsuspecting patients, and maximize their revenue. This is their business model. These groups of physicians have organized to gain market power, often with the backing of a private equity firm. They take advantage of the fact that, in most cases, patients do not get to choose them: Ancillary providers such as emergency doctors or anesthesiologists, which patients typically do not choose, are more likely to send a surprise bill.”
Emergency medicine providers are typically in-network, and it is false to assert that they choose not to contract with insurers. The author fails to cite that many emergency groups have in-network rates with 80%+ of the commercial insurance market and for many groups, balance billing is a rare or almost non-existent occurrence (< 20 BPS). It is misleading to claim there is an organized effort among the provider industry to gain market power by opposing surprise medical billing legislation when in fact the industry unanimously supports it.
Instead, providers merely oppose the solution proposed by the Senate HELP and House E&C bills that undermine reimbursement by benchmarking it to an arbitrary median solely determined by insurance companies. The author further fails to reflect that the insurance industry is operating in an organized and disingenuous manner by using surprise medical billing legislation as an attempt to ratchet back in-network agreements that they willingly entered and are now strategically terminating in an effort to default to an artificially low out-of-network benchmark rate.
A recent analysis in Kaiser Health News entitled, “Doctors Argue Plans To Remedy Surprise Medical Bills Will ‘Shred’ The Safety Net” contends that problems do exist with rural hospital closures and emergency room staffing, but solving those problems should be separate from dealing with surprise bills.
The article and the cited research fails to acknowledge that emergency medicine groups have helped to mitigate additional closures and are able to do so by cross-subsidizing themselves. Emergency medicine groups attempt to secure higher reimbursement from the commercial insurance market to offset the amounts that are received at unsustainable levels in disadvantaged communities which have a disproportionate share of indigent, uninsured and Medicaid patients.
Furthermore, the article fails to reference the fact that many rural hospitals are recipients of federal funding (DSH) to off-set the losses they incur in servicing these communities which does not incur to the benefit of emergency clinicians as no such similar program exists for the delivery of professional services.
A recent opinion piece in the Washington Post includes a claim, “… under this approach, medical specialists’ prices overall still might not decline as much as they should, people’s insurance premiums might remain higher than need be and the federal government might pay too much.”
The authors inexplicably fail to explain why the goal of this legislation should go beyond protecting patients from surprise medical billing and instead has turned to reducing prices (reimbursement). The author further takes the leap to assume that reducing prices to a desired amount will reduce insurance premiums proportionately and fails to speculate how insurers and their investors will react to falling stock prices and falling profits of the insurance industry.