Modern Healthcare: Senators seek industry data on surprise medical bills

As Congress ramps up its efforts to address high surprise medical bills, a bipartisan group of senators want hard data from insurers and hospitals on out-of-network billing practices.

In a letter sent Tuesday to a broad swath of insurers, employers and providers who have been part of legislative discussions, six senators asked insurers how their out-of-network payments compare to Medicare rates and provider charges. The senators also probed whether fixing one area could risk raising costs overall as they asked for data to show whether tying an insurance plan's out-of-network rate to an average of provider charges would actually drive up premiums.

Sen. Bill Cassidy (R-La.), who initiated the letter, launched a discussion draft of balance billing legislation last year. Fellow signer Sen. Maggie Hassan (D-N.H.) introduced a separate measure. The senators' two offices have been coordinating on the issue, and Cassidy's office has had discussions with the White House. President Donald Trump declared in January he wants to end the practice.

Sens. Michael Bennet (D-Colo.), Todd Young (R-Ind.), Tom Carper (D-Del.) and Lisa Murkowski (R-Alaska) also joined the request, sent hours before President Donald Trump's State of the Union address, seeking details that will help inform legislation. They asked hospitals to disclose the percentage of specialists they outsource. Specialists include emergency doctors, anesthesiologists, radiologists and pathologists. They wanted to know how many of these specialists are part of the hospital network.

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Hospitals were asked to show the percentage of their earnings from emergency care and specialty department treatment that comes from balance billing. The senators sought the percentage of specialty care given to patients at an in-network hospital that gets billed as out-of-network.

The letter also questioned the ongoing spike in patient spending on emergency care even as usage remained flat, citing a report from the Health Care Cost Institute that found per-person spending had increased 98% from 2009 to 2016 despite utilization staying the same.

Insurers have been asked to lay out what they pay for out-of-network care and to compare these costs to Medicare rates, provider charges and their average in-network rates.

They were also urged to weigh in on the debate over state decisions to tie out-of-network reimbursement to a percentile of average provider charges, such as New York has done. Analysts have warned that this could lead to an overall increase in costs and, subsequently, rising premiums.

Senators sought a state-by-state breakdown of data from Alaska, California, Colorado, Florida, Maryland, New York and Texas, where balance billing laws are in effect, and averages from the remaining states that don't have laws in effect.

The policymakers who signed onto the letter are each involved in pending legislation. Cassidy and Hassan have been working on separate bills, and Hassan is bringing a constituent hit by an unexpected $1,650 bill for an in-network emergency department visit to Tuesday night's State of the Union.

Murkowski is keenly interested in the issue because of the unintended consequences of a rule in her state of Alaska designed to curb costs. But the policy, which ties out-of-network payments to a percentile of provider charges and has no check in place to keep providers from hiking their rates, was found to actually run up costs and has led to $85 million in additional medical spending.

Hospitals and insurers have been lobbying Congress hard to make sure they're not the losers on any legislation addressing balance billing practices.

By:  Susannah Luthi
Source: Modern Healthcare