No Surprises Act, starting Jan. 1, aims to curb high medical bills: gunshots

No Surprises Act, starting Jan. 1, aims to curb high medical bills: gunshots


HHS Secretary Xavier Becerra says doctors in Congress who oppose the rules of the No Surprises Act don’t pay attention to patients. “I don’t think it will harm the charger if someone overcharges [accept] a fair price, “says Becerra. The Congressional Budget Office estimates that the Biden team’s rules would cut insurance premiums by 0.5% to 1%.

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HHS Secretary Xavier Becerra says doctors in Congress who oppose the rules of the No Surprises Act don’t pay attention to patients. “I don’t think it will harm the charger if someone overcharges [accept] a fair price, “says Becerra. The Congressional Budget Office estimates that the Biden team’s rules would cut insurance premiums by 0.5% to 1%.

BRYAN R. SMITH / FP via Getty Images

Overpriced doctors and other medical service providers who cannot charge a fair price for their services could be taken out of business when new rules against surprise medical bills come into effect in January. in defending the regulations.

The proposed rules represent the Biden government’s plan to implement the No Surprises Act, which Congress passed to save patients from the shockingly high bills they receive if one or more of their providers is unexpectedly found to be outside of the network of their insurance plan.

The law – comes into force on January 1, 2022 – shields patients from those bills and requires providers and insurers to negotiate first and then, if they cannot agree, to arbitrate how much to pay the doctors or hospitals.

However, medical groups and some medical associations have beaten the tentative final rules that HHS unveiled last month, stating that they favor insurance companies in the arbitration phase. Because although the rules dictate that arbitrators take many factors into account, they are instructed to start with a benchmark largely set by insurers: the median negotiated for similar services between network providers.

The bottom line is patient protection

The medical groups say that if insurers got the upper hand, they could cut payment rates and potentially drive doctors off the networks or even out of business, thereby limiting access to health care.

The department heard these concerns, Becerra says, but the bottom line is patient protection. Medical providers that have taken advantage of a complicated system to charge inflated prices will have to pay their share of the cost, he says, or shut down if they cannot.

“I don’t think it will harm the charger if someone overcharges [accept] a fair price, “says Becerra.” If you ask too much, you either have to tighten your belt and do it better, or you won’t hold out in business. “

“It’s not fair to say that we have to let someone hollow us out in order to be in business,” he added.

Still, Becerra says he doesn’t expect a wave of closings or restricted access for consumers. Instead, he suggests that a competitive, market-driven process will find a balance, especially when consumers know better what they are paying for.

“We are ready to pay a fair price,” he says, but emphasizes: “I pay for the best, but I don’t want to have to pay for the best and then three times more and be taken by surprise by the bill.”

The crux of the matter: How high bills are negotiated and arbitrated

Becerra also points to a surprise medical bills report that HHS will release Monday, pre-made available to Kaiser Health News, highlighting the ramifications of bargaining and arbitration laws already in place in 18 states.

The report, which summarizes previous research, found people were charged with surprise bills averaging $ 1,219 for anesthesiologists, $ 2,633 for surgical assistants, $ 744 for births, and north of $ 24,000 for ambulances.

In those states that use benchmarks similar to what doctors suggest in place of the agency’s current proposal – like New York and New Jersey – the report found costs increased. For example, New York has a “baseball-style” system in which the arbitrator chooses between the provider’s and insurer’s offers, despite directing the arbitrator to consider the offer that is closest to the 80th percentile of fees. “Since the amount that the providers are usually much higher than the actually negotiated tariff, there is a risk with this approach that the total costs are significantly higher,” said the report. In New Jersey, billed fees, or “common and custom” rates, are taken into account.

“When the arbitration process is wide open, there are no limits, at the end of the day healthcare costs go up, not go down,” says Becerra of the methods doctors prefer. “We want the costs to go down. And that’s why we want to build a system that helps us to give us the signs to stay efficient, transparent and economical. “

The system chosen by the Biden government is expected to lower insurance premiums by 0.5% to 1%, estimates the Congressional Budget Office.

“Everyone has to give a little to get to a good place,” says Becerra. “This sweet spot, I hope, is one where patients … get pulled out of this battle for food at a lower cost.”

While the administration has chosen a yardstick that doctors and hospital groups dislike, the law dictates that other factors should be considered in setting the price of a medical procedure or service, such as the vendor’s experience, the market, and the complexity the treatment case. Becerra said these factors help ensure that the arbitration is fair.

“We just made a rule that says, ‘Show the evidence,'” says Becerra. “It has to be relevant, material evidence. And let the best person in this fight win in arbitration.”

The tentative final rules were released on October 7th, giving stakeholders 60 days to comment and request changes. More than 150 members of Congress, many of them physicians, have asked HHS and other relevant federal agencies to reconsider this before the law goes into effect.

Rules that are this advanced usually go into effect with little or no change, but Becerra says his department is still listening. “If we think there is a need for change, we are ready to do so,” says the secretary.

The HHS report also notes that once the law comes into effect, it will require extensive monthly and annual reporting to regulators and Congress to determine if regulations are getting out of hand or causing undesirable consequences that doctors warn of.

Becerra says he believes the rules strike the right balance and favor not insurers or doctors, but the people who need medical attention.

“We want to be transparent in order to lead to more competition and to keep costs low. Not just for the payer, the insurer, not just for the service provider, the hospital or the doctor, but above all for the patient, ”he says.

Kaiser health news is a supraregional, editorially independent editorial and broadcast of the Kaiser Family Foundation. KHN is not affiliated with Kaiser Permanente.



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Rachel Meadows

Rachel Meadows

Trending topics news writer who enjoys cooking, walking her dog and travel.

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