Urge Revision of Surprise Billing Provisions to Address Concerns
Robert McLean, MD, MACP
President, American College of PhysiciansWashington, DC (December 11, 2019) — The American College of Physicians (ACP) is appreciative that many of the provisions in the summary of the Lower Health Care Costs (LHCC) Act, as agreed to by the House Energy and Commerce and the Senate Health, Education, Labor, and Pensions (HELP) Committees, will benefit patients by increasing transparency and improving health outcomes, but has significant concerns about the surprise billing provisions included in the legislation.ACP assessed the impact of the LHCC Act based on official summaries of the agreement, and we are encouraged that it supports many important public health initiatives that the College has long advocated for, including:
- Authorizes a national campaign to increase awareness and knowledge of the safety and effectiveness of vaccines for the prevention and control of diseases and to combat misinformation
- Provides funding for programs to reduce maternal mortality
- Funds programs to reduce and prevent health care discrimination, including training of clinicians related to implicit and explicit biases
- Begins to address the costs of prescription drugs by ending anti-competitive practices by brand name manufacturers that keep generic or biosimilar products off the market, prohibiting pharmacy benefit managers (PBMs) from charging a plan sponsor, health insurance plan, or patient more for a drug than the PBM paid the pharmacy for the drug, and requiring PBMs to pass on 100 percent of any rebates or discounts to the plan sponsor
- Raises the age to purchase to tobacco products to 21 and increases regulation of electronic cigarettes
- Strengthens enforcement of and compliance with mental health parity coverage requirements
- Ensures continuation of mandatory funding for community health centers, the National Health Service Corps, and the Teaching Health Center Graduate Medical Education Program for five more years
All of these provisions would make substantial strides in improving health and our health care system for our patients.
While the legislation includes provisions we support, ACP is concerned that the surprise billing provisions in the LHCC Act could destabilize the health care playing field and create barriers to access and to affordability.
We acknowledge that House Energy and Commerce and Senate HELP Committees are engaging in a good faith effort to develop a bipartisan approach that holds patients harmless from surprise bills—and outcome we believe is essential—while seeking to address concerns from physicians, hospitals, and insurers. This process should continue.
However, ACP remains concerned about the impact on both in-network and out-of-network clinicians and access to their services of benchmarking charges to in-network rates. Such benchmarking would empower insurers to essentially set rates for all clinicians at the current median in-network rates. This would negate fair contracting and negotiation over rates and create significant access problems.
We note that elsewhere in the legislation, a grant program is established to create and improve State All Payer Claims Databases, which we strongly support. Such All Payer Claims Databases would provide far better and more complete information on clinicians’ charges and insurers’ allowable payments than benchmarking to in-network median rates.
While we strongly believe that a system of independent arbitration should be implemented, we’re concerned that the dispute resolution process created by the bill imposes unworkable and unnecessary restrictions on accessing arbitration, since it allows arbitration only for bills above a high dollar threshold and limits how many can be sent to arbitration during a period of time. This, combined with the benchmarking described above, significantly tilts the playing field to insurers at the expense of clinicians and their patients. We also reiterate our recommendation that provisions be added to the LHCC Act to require payers to comply with network adequacy standards similar to those created by the Affordable Care Act.
ACP commends the Energy and Commerce and HELP Committees for crafting a bipartisan agreement consistent with many of our recommendations for improving public health, lowering costs, and introducing transparency. We believe the surprise billing provisions need significant improvement and revision, and urge the committees to continue to work on developing an approach that addresses our concerns about tilting the playing field toward insurers at the expense of clinicians and their patients while ensuring patients are completely held harmless from surprise bills. ACP is committed to working with Congress and congressional leadership on advancing a final package that reflects the recommendations in this statement. ( Source: President, American College of Physicians)