I read it. It sounded familiar - like it was ghostwritten by one of the lobby groups I’ve come to know quite well. The ones that take advantage of poor understanding of the financing and business of healthcare...and EMTALA. I’ll share some different data. 1/n
I work in MN, the state with the lowest rate of OON billing. My independent practice (50years old) doesn’t balance bill charges to the <2% OON patients we see. Yet we expect the benchmark you advocate for to drive us out of business. healthsystemtracker.org/brief/an-exami…
A little tutorial on how private practice docs are paid:We don’t get a salary like docs in academia.We aren’t paid by hospital. Our pay is based on reimbursement - what the government/insurers/patients pay us. No patients, no pay. No paying patients, no pay.
My group is fiercely independent. We have actively worked to keep PE away. Independent docs have less burnout. Studies show equivalent quality and less expensive care from independent docs. news.rice.edu/2019/09/04/whe…
Do you know about EMTALA? Because it fundamentally changes everything about the financing of emergency medical services. Every patient is screened & stabilized regardless of ability to pay, balance owed or what their insurance has agreed to pay. acepnow.com/article/emtala…
EMTALA is UNFUNDED. But it is also a $100K fine per violation (not per patient) to the physician & hospital who violate EMTALA. It applies to ED docs as well as on call specialists like neurosurgeons. A fine is not covered by malpractice insurance and it’s probably career-ending.
Because of EMTALA, the ED serves as the safety net. Patients who can’t afford the copay to see their internist or owe a balance to their specialist come to the ED. Patients with Medicaid who can’t get an appointment because the slots are limited by their PMD come to the ED.
Office-based practices can limit the visits for patients that pay badly or owe a debt. Hospital EDs can’t. That’s why we provide 2/3 of acute care for the insured and 1/2 of all Medicaid/CHIP acute care visits.
EMTALA is also the reason why emergency care providers have such high levels of bad debt even for insured patients. On average, bad debt levels of 85% under high deductible plans. The insurers don’t pay it. The physicians themselves subsidize the care. crowe.com/news/rca-q4-20…
EMTALA is the reason why a benchmark would cede rate setting power to #BigInsurance and start a race to the bottom. Insurance doesn’t need “network adequacy” and will benefit from dropping contracts, driving the “median” down. highyieldscript.com/take-action-ag…
What will happen if the benchmark legislation passes? kevinmd.com/blog/2019/07/p…
“Simply put, certain proposed solutions for surprise billing will kill you or someone you love. It’ll save a ton of money for the insurance industry, but it will absolutely destroy the provision of emergency services nationwide. linkedin.com/pulse/your-chi…
Don’t believe me that a benchmark will impact all of us physicians...not just the “bad actors”? How about the Congressional Budget Office? “The cost of surprise bills is a small portion of all health spending, but policies...affect negotiations between insurers and providers.” 
Per the CBO: “The vast majority of health care is delivered inside patients’ networks and more than 80% of the [deficit savings] would arise from CHANGES TO IN-NETWORK PAYMENT RATES.” They (under)estimate a 20% cut in rates.
Anyone who understands anything about EMTALA and contracting understands what the benchmark legislation will do. It’s obvious to pretty much every doc who actually runs their own business.
And the expected impacts of benchmark legislation - well, they’ve been happening already. cmadocs.org/newsroom/news/….
Oh, and by the way, the numbers and analysis they fed you about IDR in NY are wrong. It has actually saved $400M, reduced out-of-network billing by 34% and lowered in-network emergency physician payments by 9%. governor.ny.gov/news/governor-…
And it’s been refreshingly effective and encouraging good behavior via a “baseball style” arbitration system that has been viewed as fair by both insurers and physicians. And used in < 0.0113% of cases. nationaldisabilitynavigator.org/wp-content/upl…
BTW. Medicare rates for emergency physician services are not generous. Another piece of nonsense the lobbyists fed you. Medicare administered rates are not market rates. And they don’t account for EMTALA care, nights and weekends shift differential, 24/7/365 standby readiness.
You mentioned a $5,000 ER bill. Do you know the difference been a facility fee and a professional fee? The vast majority of emergency doc professional fees are a fraction of facility fees, in the hundreds of dollars. That’s why a $750 threshold for IDR is meaningless.
Here is the actual data on allowable amounts from FAIR Health, the nonprofit endowed from the ~$400M paid by insurers for their fraudulent practice in the Ingenix scandal. You do know about Ingenix, right? img1.wsimg.com/blobby/go/5921…
Our government passed the #EMTALA mandate but didn’t fund it. As @813JAFERD said: “The truth of the matter is the way we have funded EMTALA in our country is commercial insurance.” @RealCedricDark is right...this is a moral question of how we will care for the uninsured.
Commercial insurers and the government see a way to get out of paying. But the benchmark mostly “saves” money at the direct expense of physicians who will exclusively and solely bear it. The people who train for 7+ years and work nights/weekends/holidays to save lives.
Do you know about PAYGO? Do you know why Lamar Alexander said he picked the benchmark? “Because the CBO said it would save the most” in deficit $ that he can now spend that on community health centers without raising taxes. But I thought we were trying to solve surprise billing?
So, the editor wrote the headline? How about the rest of it? It doesn’t take a lot of bravery to write a piece signaling your virtue and claiming moral superiority - especially when it doesn’t impact you. But at least you could get your data right.
