Thread by @MarilynHeineMD

@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.

@JonnyJenk 4/ The IDR in the proposal is set up to always favor low-offers by plans that incorporate Medicare and Medicaid payments in the calculation. The IDR becomes cost-prohibitive for practices who base their offers on fair rates since they will lose and have to pay the costs of IDR.

@JonnyJenk 5/ The proposal will eventually undercut fair contracting efforts as insurers are not incented to negotiate fair rates or keep their networks adequate.

Independent/smaller practices are vs. plans w/massive market concentration & the negotiation process is skewed in plans’ favor.

@JonnyJenk 6/ Additionally, there are provisions in the bill that seem to require physicians to post and provide information to patients that the plans would more easily have access to (e.g medical care management requirements) prior to care.