September 17, 2019

Out of Network: The Future of Emergency Medicine is on the Line

By Mike Ruzek, DO, YPS Chair-Elect
While the fight to end surprise billing plays out on Capitol Hill and in the media, insurance companies continue to advocate for legislation that increases their bottom lines and employ divisive tactics in an attempt to undermine the patient-clinician relationship.
There is real concern that proposals being considered in Congress that include benchmarking or rate setting will impact emergency physician groups of all sizes; but smaller, independent groups will be particularly hard-hit, endangering access to lifesaving care for Americans residing in communities across the country who are served by these groups of emergency physicians. These proposals will result in an avoidable and lucrative giveaway to the insurance industry. Smaller groups are already disadvantaged when attempting to negotiate contracts with insurers, and rate-setting could drive them out of the market entirely, leading to increased consolidation, reduced competition, and higher costs throughout the health care system.
For years, insurers have been manipulating the health care system to reap excess profits. And now they are using those profits to lobby Congress to interfere with the free market and increase insurers’ advantage over physicians without concern about what that could mean for patients. As Congress works to protect patients from surprise bills, it should listen to the American people and not swing the scales further in favor of the insurance industry. 
We’ve heard that Congress has been swayed by a recent surge in physicians
who have spoken up about their concerns. ACEP has a surprise billing toolkit that provides resources to help you raise your voice, including talking points, FAQs about the issue, and sample social media posts for you to use. (You have to be logged into the ACEP website as a member to access the toolkit.)

Let your representatives know that an independent dispute resolution (IDR) process MUST be included in ANY surprise medical billing legislation.

Any surprise billing legislation passed that does not include an IDR process, but rather rate setting to determine the payment amount for out-of-network care, will create an unsustainable healthcare system, hurting patients, clinicians and hospitals. The government rate setting approach proposed by the Senate would cause clinicians to bear more than their fair share of the uncompensated care not paid by insurance companies.

If we do not give this our best effort and Congress passes the insurer-backed, rate-setting solution, there will be significant impacts:

  • Physicians will see lower reimbursement rates. 
  • Insurers will cancel contracts.
  • Patients will lose access to the crucial care you work so hard to provide every single day.

I encourage you to take action and send a message to your legislators. Together, we have made significant strides, but we have the potential to make an even greater impact if legislators hear your voice. 

[ Feedback → ]