Dr. Kathleen Quinn
I am prompted to write this opinion based on two perspectives. One is as a professional healthcare provider and the other is a wife. I have seen the devastating effects to family finances and the impact of catastrophic medical emergencies. I have seen families driven into bankruptcy and foreclosure of their homes to pay for “Surprise medical billing events.” By the very definition, there is no way to be prepared for a catastrophic medical event for which there was no preparation. Let me share my second perspective. Six weeks ago, my husband was catastrophically injured in a vehicle accident when he was moving furniture from one state to another. He was so injured that survival was not a possibility. Even so, he was transported from the scene of the accident to a university medical center nearby. As a healthcare professional and his wife, I know that the humane and caring approach would have been to hold him as he died. Without any input from me, or my authorization (that is the definition of uncontrolled decisions regarding “heroic and unnecessary medical actions) he was airlifted to the medical center where he died without regaining consciousness.
Subsequent to these events, I was notified that the hospital waived a $45,000 emergency room bill, however, the air flight company holds an outstanding bill against me and our home. That bill is $47,000. The entire event has used all of his pension and savings. The only thing we have left of value is our home. Which may be in jeopardy. That we rely on our legislators to intervene into this problem is crucially important. Perhaps understanding how this can happen to ordinary families is important.
Surprise medical billing is a longstanding problem that many working in health care want to see solved. While Congress seems to be working on a solution, not all the proposals that have been introduced in the House and Senate would fix the medical billing problem without undermining other areas of our health care delivery system.
One proposed solution known as benchmarking would allow the government to set out-of-network rates for providers based on insurance companies’ in-network averages. Because in-network averages include steep discounts, using them to determine out-of-network payments would slash reimbursements to providers.
That would push major financial losses onto the backs of struggling hospitals and emergency rooms, potentially worsening an already noticeable doctor shortage and driving up hospital consolidation rates. That means fewer choices, higher costs, and diminished access for patients seeking care.
On the other hand, legislative solutions that call for ending surprise billing through a process known as Independent Dispute Resolution (IDR) offer a far more sensible approach. IDR would create an open, transparent negotiation process for providers and insurers to settle out-of-network payment issues. Not only would the process separate patients them from these billing disputes, but it would help ensure payments are fair and based on the true cost of care.
Essentially, IDR would enable both parties to submit their payment offers via an online portal. Within 30 days, a neutral, third party mediator would help determine a final payment amount. In the meantime, initial payments would help protect at-risk hospitals and emergency rooms by providing an additional layer of financial stability. This would help ensure medical professionals like nurses—especially those running key portions of a medical practice—are able to continue providing seamless, uninterrupted care for all the patients we treat.
A bill in the House, the No Surprises Act, attempts to blend benchmarking and IDR, but would only implement IDR in cases that exceed $1,250, which is higher than most physician claims. In most cases, that means only the flawed benchmarking approach would be used. This is not good enough.
Representative Steve Scalise should oppose this IDR-in-name-only bill and work to support a truly IDR-focused solution, like the one that has been outlined in the STOP Surprise Medical Bills Act from our own Senator Bill Cassidy. Ultimately, it is through this IDR framework that we can best protect patients while maintaining a strong, reliable health care system. I take the position we must act for the good of families in jeopardy and support the No Surprises Act.
