Considerable Surprises May Lurk in ‘No Surprises’ Legislation By DENISE BURKE, JD
The term “surprise billing” is used to describe the situation when a patient receives a bill for the difference between the out-of-network provider’s fee and the amount covered by the patient’s health insurance, after co-pays and deductible. Patients often assume that providers such as radiologists, pathologists, physician anesthesiologists, emergency physicians and trauma surgeons are in-network because the treating hospital is in-network, thus they are “surprised” that the charges are not covered by their insurance. The issue of surprise billing has been hotly debated by the 116th Congress as an estimated 40 percent of patients received a surprise bill in 2018. Multiple pieces of legislation have been proposed and it seems likely that legislation will be passed, although the exact substance is yet to be determined. There is considerable agreement between the proposals on protecting patients in emergency situations, but there are notable and important differences beyond that agreement. For example, the Cassidy Senate Bill (“Protecting People from Surprise Medical Bills Act”) prohibits surprise billing when a patient is seeking non-emergency care by an out-of-network provider at an in-network facility. The version from the Energy and Commerce committee, (the “No Surprises Act”) would allow such billing if the patient is provided with written and oral notice and consent. The “Protecting People from Surprise Medical Bills Act” (HR 3502), would prohibit surprise billing for out-of-network after-emergency care when a patient cannot travel without medical transport, as well as for out-of-network imaging or lab services when ordered by an in-network provider. The Senate HELP Bill would require that patients receiving out-of-network ancillary services only pay the in-network cost-sharing amount and unstable patients who receive services emergency services would be responsible only for the amount
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About the Writer Denise Burke is an accomplished healthcare attorney providing special regulatory counsel to private equity companies, hospitals, physicians, medical device companies and other healthcare clients on a wide range of complex regulatory/compliance, operations and transactional issues. She is a prior Chair of the Tennessee Bar Association Health Law Section and was named a Fellow of the Nashville Health Care Council in 2016. Burke has been consistently recognized by Best Lawyers for the past decade, including 2012’s “Lawyer of the Year” in healthcare law for the Memphis and West Tennessee area and as a “Woman of Influence” in 2017. She is also ranked in Healthcare by Mid-South Super Lawyers ®. She serves as a member of the Advisory Board of the Institute for Health Law & Policy at the University of Memphis Cecil C. Humphreys School of Law and the Common Table Health Alliance.
they would have paid in-network. The Senate HELP Bill would also require that patients be given advance notice of any outof-network care, an estimate of the costs, and referrals for alternative options for innetwork care. If a patient is not provided the required notice, the patient would not be responsible for the out-of-network cost. The Senate HELP Bill proposes to set rates for practitioner or facility based on the median in-network contracted rate for services in that geographic area and does not include arbitration style provisions. The (CONTINUED ON PAGE 8)
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A revolutionary type of minimally-invasive spine surgery offered at Campbell Clinic is benefiting patients around the Mid-South. Endoscopic spine surgery is a groundbreaking procedure that allows a surgeon to access the spine through a small port placed through an incision less than one centimeter in length. Through the port, a physician uses small tools to resect disc herniation, facet cysts and decompress neural elements. An endoscope allows direct light-based visualization of the anatomy as well as the tissue being removed. The physician also uses fluoroscopy to guide precise placement of the port and instruments to ensure the appropriate level and corresponding diseased area will be accessed. Dr. Gardocki currently performs discectomies, facet cyst resections, foraminotomies, and transforaminal and interlaminar decompressions using this approach in the lumbar, thoracic and cervical spine. The results thus far have been nothing short of amazing.
Dr. Raymond J. Gardocki Campbell Clinic Spine Center
As with any procedure performed in an outpatient ambulatory surgery setting, endoscopic spine surgery carries with it a host of clinical benefits for the patient. Those include: • a much smaller incision than normal, resulting in fewer limitations after surgery • limited amount of blood loss as compared to lengthier, inpatient procedures • better management of intra-operative and post-operative pain • preservation of spinal mobility • significantly lower risk of deep tissue infection and readmission • less disruption of surrounding muscle and tissue • and of course, the convenience of same-day surgery! During the procedure, patients are consciously sedated to ensure their comfort and to assist the surgeon with guidance around local nerve tissue based on immediate sensation. After the surgery, low-dosage Versed is administered to aid in pain control and to eliminate any recall of the procedure. While not all patients are candidates for conscious sedation surgery, many are eligible to have same-day surgery so that they may recover in the privacy and comfort of their own home. Despite the normal soreness associated with surgery, patients typically report immediate relief postoperatively from the symptoms associated with herniated discs such as weakness, numbness and pain. Most patients return home with no bandage that needs to be changed and no sutures that need to be removed. Typically, post-operative pain is controlled with NSAIDs and there is no need for narcotics. Dr. Ray Gardocki is a spine surgeon at Campbell Clinic Spine Center in Cordova. He is the first and only physician in the region to be trained in the endoscopic spine approach. Dr. Gardocki graduated from the University of Southern California School of Medicine in 1997 and completed his residency at the Los Angeles County/USC Medical Center in 2002. For more information about endoscopic spine surgery, or to schedule an appointment, call 901.507.7656.
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Endoscopic Spine Procedure Provides Quick Relief for Local Patients
To find out if you or one of your patients may be a candidate for this new spine procedure, visit www.campbellclinic.com to learn more, or call 901.507.7656 to schedule an appointment. John Pantall, Microsoft Certified 901.466.6358
Memphis Medical News August 2019