1/ The “No Surprises Act” is deeply flawed. It should not advance in its current form. Work must continue to reach a meaningful remedy to “surprise medical bills” #SMB that keeps patients out of the middle and provides balance.

Here are several concerns w/ the current proposal:
2/ The proposal should require that the initial “interim payment” made by the insurer for out-of-network services be considered the plan’s offer for IDR, to incentivize the insurer to pay a fair initial reimbursement.

But, the proposal does not.
3/ The proposal should allow the IDR process to consider UCR and an independent charge-based database. Lest it be a form of price-fixing by insurers since the qualifying payment is indexed to the insurer-set in-network median rate (w/CPIU adjustment).

But, the proposal does not.
4/ The proposal should avoid a complex administrative burden that threatens practice viability and leads to consolidation and higher healthcare costs for patients. Cost effective independent physician practice provides patients choice.

But, the proposal does not.
5/ The proposal should explicitly prohibit the IDR process from considering Medicare, Medicaid, and other public payer rates. These are well known to be below the cost of providing care and these programs are not implicated by the #SMB provisions.

But, the proposal does not.
6/ The proposal should require that ERISA plans must submit claim information to the APCD. The growth of ERISA plans makes this an imperative. Federal statute is necessary to stipulate.

But, the proposal does not.
7/ The proposal should clearly hold all health plans accountable, with enforcement and audit programs, as robust for ERISA plans as for other health plans.

But, the proposal does not.
8/ The proposal should clearly impose penalties on plans that fail to reimburse providers for out-of-network care or that provide false or inaccurate information on their median contracted rate.

But, the proposal does not.
9/ The proposal should omit revenue cycle timelines unreachable for physician practices - small businesses; omit penalties to physicians due to delayed responses from insurers; and limit insurers’ unwarranted opportunities to operate on the float.

But, the proposal does not.
10/ The proposal should explicitly hold out-of-network physicians harmless for erroneous information an insurer includes in its in-network physician directory, especially unbeknownst to the physician and without physician input.

But, the proposal does not.
11/ A flawed #SMB proposal will:

•Further narrow networks
•Limit access to care for patients
•Jeopardize health equity, and
•Put at risk healthcare jobs for employees

This has direct and indirect economic impacts.
12/ A flawed proposal fails to hold insurers accountable for their fundamental role driving #SMB thru:

•narrow networks
•high deductibles with disproportionate cost sharing
•take-it-or-leave-it contracts spurred by market dominance

It rewards insurers reaping record profits.
13/ A flawed #SMB proposal whose CBO score indicates 80% of “savings” comes from cuts to in-network providers while physicians risk our lives fighting a pandemic, sends the message that physician service is not valued.

Esp. now is not the time to rush a flawed SMB proposal.
14/ @PAMEDSociety urges Congress to go back to the drawing board on this:
15/ @AmerMedicalAssn writes “...we oppose enactment of the bill in its current form...”

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More from @MarilynHeineMD

17 Dec
@JonnyJenk 1/ TY for your inquiry @JonnyJenk.

Factors drive #SMB: insurers’ narrow networks, high deductibles w/disproportionate cost-sharing for OON, physicians OON d/t take-it-or-leave-it contracts, health plans’ inaccurate provider directories. Patients are surprised by #insurancefail.
@JonnyJenk 2/ In terms of increased administrative burden that the current proposal would impose:

There will be a struggle for small practices to navigate the IDR efficiently and effectively, ensuring they have the resources to stay afloat while they challenge inefficient payments.
@JonnyJenk 3/ That is why AMA is asking to remove the 90-day cooling off period in the proposal - so that practices don’t have to hold claims for three months before they can pursue sufficient payment.
Read 6 tweets
12 Oct
1/ Thank you @CongBoyle @RepBrianFitz @CongressmanGT @RepMeuser @RepJohnJoyce @RepDwightEvans @RepDean @RepHoulahan @RepSusanWild @GReschenthaler @MikeKellyPA @RepConorLamb for signing the Bera-Bucshon letter to help keep physician practices and emergency viable. Urgent issue.
2/ @mgs @USRepMikeDoyle @RepCartwright @RepFredKeller @RepScottPerry 
@RepSmucker should join their colleagues from PA in this strong bipartisan support. It is an issue of access to care for patients and healthcare jobs for physician practice employees.
3/ The #COVID19 #pandemic has taken a toll on physician practice revenue.  Survey data shows physician practice revenue plunged 50% March to May and remains on average 32% less than in February. Practice costs are ⬆️ due to PPE. Volume is ⬇️ due to required physical distancing.
Read 9 tweets
3 Aug
1/ Time is running out...

Physician practices are essential to the nation's health care system.

Before Congress adjourns, it must pass legislation to:

•Continue expansion/add flexibility for Medicare Accelerated/Advanced Payments: Better allow physicians to address the crisis
2/ •Better address Medicare/Medicaid payment policy. Account for lack of + updates to assist doctors caring for patients

•Include direct $ support to help sustain physician practices thru the pandemic. Include addit emergency relief fund grants, access to small business loans
3/ •Permanently lift geographic & site restrictions on #telehealth tech so all #Medicare beneficiaries have access to telehealth services, incl from home, regardless of where they live

•Institute broader liability protection for physicians on front-line fight against #COVID19
Read 5 tweets
1 Jun
1/ Action Item for relief funds: As ⁦@AmerMedicalAssn⁩ reported, #HHS announced that providers need to take action by June 3, 2020 regarding CARES Act Provider Relief Fund distribution of the first $50 billion referred to as the General Distribution: tinyurl.com/y78swuda
2/ Specifically, @HHSGov indicated that by June 3, those who had received funds need to accept the #HHS Terms and Conditions and submit revenue information to be considered for an additional General Allocation payment.
3/ Subsequently, HHS announced that it had extended the attestation deadline for an additional 45 days, but the June 3 deadline has remained on the Provider Relief Fund website: tinyurl.com/yat69ao8
Read 8 tweets
13 May
Especially now as we fight the #pandemic is not the time to make sweeping, detrimental policy changes. Yet the Alexander-Walden-Pallone plan for out-of-network bills AKA “#surprisebills” is being considered. The proposal is deeply flawed. Here’s why:


1/x
Others say flawed plan is NOT the remedy for this important issue.

“This policy would likely lead to physician shortages & even facility closures in many vulnerable & underserved communities, just as these critical providers are desperately needed.” tinyurl.com/y9fwflhj 2/x
“IDR is a proven solution and has worked at the state level in NY & other states. NY’s experience shows that an IDR process can work to the benefit of patients while lowering overall costs.“ - Nat Coalition on Healthcare, represents >100 mil Americans tinyurl.com/ybpun6yw. 3/x
Read 5 tweets

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