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Members Congress clinb the steps of the House of Representatives for final votes, at the Capitol in Washington D.C. © J. Scott Applewhite

American College of Surgeons Opposes the Lower Health Care Costs Act

Proposed pro-health plan legislation imposes federal payment rate setting on physicians, leading to serious consequences to the entire health care system for years to come

Published on June 21, 2019

The American College of Surgeons (ACS) opposes the Lower Health Care Costs Act of 2019, introduced by Senate Health, Education, Labor, and Pensions Committee Chairman Lamar Alexander (R-TN) and Ranking Member Patty Murray (D-WA). This legislation would utilize insurer-dictated federal payment rate setting as a go-around to addressing the root cause of surprise medical billing.

The ACS continues to support efforts to prevent patients from receiving surprise medical bills and keeping patients out of the middle.

“Surgeons do not want their patients to bear the consequences of the narrowing of networks and other gaps in insurance coverage that lead to surprise medical bills. However, the solutions should not come on the backs of the physicians caring for the patients,” said David B. Hoyt, MD, FACS, Executive Director of the American College of Surgeons.

Throughout this process, the ACS has expressed major concerns with federal rate setting as a default payment for out-of-network physicians that is benchmarked to the median in-network payment rate as included in this bill. There are various ways this idea is being applied, but no matter how it is being used, accepting an insurer-dictated, federally benchmarked rate to resolve the issue of surprise medical billing could have a profound long-term effect on all physician payment, for both in-network and out-of-network physicians.

The ACS is also troubled by the fact that the Lower Health Care Costs Act bypasses an independent dispute resolution (IDR) process to avoid the associated costs. The ACS believes that a viable solution to the issue of surprise billing must strike a careful balance, allowing physicians and insurers to negotiate a final payment through an IDR, while completely protecting patients from unanticipated medical bills. IDR brings both parties to the table equally. Avoiding IDR provides unfair power to the insurers. The use of IDR has proven effective in the states, particularly the New York model serving as the prime example.

The ACS believes that Congress needs to continue to work with all stakeholders to resolve the issue of surprise medical billing in a way that does not hold patients accountable.

“The ACS is asking that members of Congress carefully think through solutions like rate setting which will open the door to large scale health care reform discussions in a way that warrants much further debate. Congress should consider the large-scale consequences for the U.S. health care system as a whole before applying such sweeping solutions,” said Dr. Hoyt.

SOURCE American College of Surgeons
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