The Senate proposal uses a median-in-network rate to resolve payment disputes but the pro-competition provisions of the bill are unlikely to realize their potential compared to a framework that uses arbitration to resolve such disputes. ASCs contribute to the physical and economic health of communities across the country, and it is critical that ASCs and other providers have the opportunity to negotiate with payers on an even playing field. Silencing providers’ voices, and instead leaving consideration of health care costs under the sole control of insurers runs the risk of lowering reimbursement, negatively impacting the viability of ASCs and other small providers resulting in limited access to care. Conversely, arbitration maintains provider input, allows for timely resolution of disputes, and removes the patient from the process.
While policymakers on the federal level are exploring options to eliminate surprise billing nationwide, on the state level, almost half of the states in the nation have some form of protection against surprise medical bills for patients in state regulated insurance plans. However, a state’s ability to regulate surprise medical bills is limited by the Employee Retirement Income Security Act of 1974 (ERISA), which precludes states from regulating self-funded employer plans. These self-funded plans cover more than 100 million Americans.
The federal proposals mentioned above have not been passed by their respective chamber yet and the dialogue continues in Congress. ASCA will continue to support its members’ efforts to ensure that patients and other providers in their local community can access the information they need. This includes information on the price of a procedure and the quality and safety of a facility, so that potential patients can make informed decisions about whether an ASC is the highest value setting for their procedure.
For more information, please write Steve Selde.