COMMITTEE REPORTS: GOV'T AFFAIRS
By Damian Caraballo, MD, FACEP
Government Affairs Committee Chair FCEP Vice President
IT’S TIME TO
SPEAK UP
BALANCE BILLING LEGISLATION IS THE BIGGEST THREAT TO EM Imagine if someone told you certain groups were lobbying in Washington D.C. to cut your salary 30-40% in order to pad health insurance company income statements. Would it motivate you to do something to stop it? In an effort to end balance billing (now called “surprise billing”), Congress is currently working on this exact scenario by proposing legislation that would let health insurance companies “benchmark” out-of-network (OON) bills at 125% of their median in-network rates. In June, the Senate HELP Committee was ready to rubberstamp a plan that would have placed a price ceiling fee-schedule on OON charges. This essentially would max out all emergency physician reimbursement at median levels provided by insurance companies. The Congressional Budget Office estimates this would lead to 20% pay-cuts to hospital-based “PEAR” physicians (pathology, EM, anesthesia, radiology) over the next 10 years. Given EM physicians’ reliance on commercial payors to offset non-reimbursing, uninsured EMTALA care, ACEP estimates the revenue cuts for EM physicians—after Insurers 6
undoubtedly renegotiate current in-network contracts—would be closer to 30-40%. This is essentially SGR Armageddon 2.0, this time targeting PEAR physicians.
ogist) is working on an amendment that would add IDR to the Senate surprise-billing bill S.1895 mentioned above, making it much more fair to physicians.
Fortunately, through the efforts of nationally organized medicine groups such as ACEP and grassroots efforts by individual doctors linked through emails and social media, we were able to hold off a final vote in the Senate. Further, on the House side, thanks to fellow emergency physician and Congressman Raul Ruiz (D–CA), we were able to get the House to approve an amendment on HR 3630 (Pallone, No Surprises ACT), which uses an Individual Dispute Resolution (IDR) as a way of settling OON rates. This solution will be much less disruptive to our practices and will allow some form of negotiation between EM physicians and insurance companies without drastically cutting our reimbursement. Senator Dr. Cassidy (R–LA, a gastroenterol-
We are being told that Congress will definitely pass something this year that will end balance billing. The method they choose will have enormous ramifications affecting our practice for years to come. This is currently our biggest threat in EM. We need all EM physicians in Florida to come together now to pressure local representatives, as well as Senators Scott and Rubio, to make sure the right solution to end surprise billing is chosen.
EMpulse Fall 2019
We need local doctors calling or emailing their legislators. The short version is we need them to co-sponsor or vote in favor of an IDP solution on the House side, and add the Cassidy workgroup amendment (S. 1531) on the Senate side. We need to
