The Senate Health, Education, Labor, & Pensions (HELP) Committee held a hearing on Wednesday titled “How to Reduce Health Care Costs: Understanding the Cost of Health Care in America,” which covered issues such as unexpected out-of-network bills, price transparency, and administrative burden. The hearing witnesses included Melinda Buntin, PhD (Vanderbilt University School of Medicine), Ashish Jha, MD, MPH (Harvard School of Public Health and Professor of Medicine), Niall Brennan, MPP (Health Care Cost Institute), and David Hyman, MD, JD (Georgetown University Law Center).
Senators used several examples of patients who received care at an in-network facility, but out-of-network bills from the physicians, including one anecdote presented by Chairman Lamar Alexander (R-TN) of an $1,800 bill from an out-of-network emergency physician. During Ranking Member Patty Murray’s (D-WA) Q&A with the witnesses, Dr. Jha acknowledged third-party contracting groups are more commonplace than they have been and this has led to an increase in out-of-network providers and balance billing, but he also discussed how reckless it is that some insurers are trying to retrospectively deny patients’ emergency care claims.
Chairman Alexander and Ranking Member Murray have stated they intend to conduct several additional hearings on reducing health care costs over the coming months.
To view the hearing, click here.
A coalition of a dozen medical associations and groups sent a letter to Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma today responding to a request for information on price transparency that is included in an annual Medicare hospital payment regulation.
“Emergency physicians believe that it is the insurers’ responsibility to provide clear information about medical costs upfront to patients,” said Paul Kivela, MD, FACEP, president of the American College of Emergency Physicians (ACEP). “While providers and hospitals may be able to provide raw prices to patients, without accompanying information from insurers, little can actually be achieved in the form of true transparency for the patients.”
Dr. Kivela adds that emergency physicians never want to put patients in the position where they are forced to make life and death decisions based on the costs of care. Informing patients up-front or in-advance about their potential out-of-pocket costs could be a violation of the Emergency Medical Treatment and Labor Act (EMTALA) and could cause negative consequences for patient care because people delay medical care out of fear of large bills.
“Health insurance companies have a long history of denying coverage for emergency care, said Dr. Kivela. “No insurance policy is affordable if it abandons you in an emergency.”
Patients can’t choose where and when they will need emergency care and they should not be punished financially for having emergencies. We are calling for transparency by insurance companies and the use of open and independent databases, such as FAIRHealth, to make information on usual and customary physician charges available to the public. This data in turn can be used to inform reimbursement.
“The Emergency Department Practice Management Association (EDMPA) has been working with many other specialties to make sure patients can access information on their health care coverage and are not surprised by a gap in their insurance, said Dr. Andrea Brault, Chair of the Board for EDMPA. “We want to ensure that health insurance companies pay the usual, customary, and reasonable rate for out-of-network care before asking patients to cover the rest of the bill.”
The letter was signed by ACEP and EDPMA, along with Physicians for Fair Coverage, American College of Osteopathic Emergency Physicians, American Society of Anesthesiologists, American Academy of Emergency Medicine, Society for Academic Emergency Medicine, Healthcare Business Management Association, Radiology Business Management Association, American College of Radiology, American Psychiatric Association and Medical Group Management Association.
In addition to this joint group letter, ACEP separately sent comments to CMS on both the issue of price transparency and other issues in the regulation that affect emergency physicians and the patients we serve. EDPMA also separately sent comments to CMS addressing out-of-network and other issues.
Highlights from ACEP’s Leadership and Advocacy Conference, the Surgeon General’s address to emergency physicians, a new poll by ACEP on drug shortages and emergency preparedness, and FDA letter on drug shortages, an ACEP member testifying on Capitol Hill about opioids and a preview of ACEP’s tele-town hall meeting on gun violence and injury prevention. This is the latest coming out of Washington that affects emergency physicians and patients.
Dr. Mark Rosenberg on the ACEP Board of Directors was appointed to the HHS Pain Management and Best Practices Task Force by the Secretary of the Department of Health and Human Services.
ACEP also submitted comments to the Senate Finance Committee regarding efforts that Medicare and Medicaid can take to improve our current opioid situation. ACEP is also working to address areas of concern under CARA 2.0. While this legislation has benefits, there are also areas that are concerning such as limiting prescribing to 3 days for opioids without exception. While this may be okay for many patients, there may be some that would benefit from a few more days and physicians should be able to exercise their own judgement. You can view ACEP’s responses to the Senate Finance Committee here. ACEP Response – Senate Finance Committee – Opioid Request – 02162018
SB 870 was voted out of the Senate Local Government Committee, and HB1919 was heard in the House Feb 13th at noon in HR6. Under this act, emergency medical technicians and paramedics shall only perform medical procedures as directed by treatment protocols approved by the regional medical director or as authorized through direct communication with online medical control. Basically, these bills prevent EMS providers from being forced to draw blood for police in the field. This was particularly a problem when EMT’s where caught in the middle as this was likely outside of their scope of practice and not approved by their medical director.