HHS Secretary Xavier Becerra said doctors in Congress are not following the “No Surprises Act” rules of not looking for patients. “I don’t think when someone overcharges it hurts the overcharger to now have to [accept] Becerra said. The Congressional Budget Office estimates the Biden team’s rules will push the premium down between 0.5% and 1%.
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HHS Secretary Xavier Becerra said doctors in Congress are not following the “No Surprises Act” rules of not looking for patients. “I don’t think when someone overcharges it hurts the overcharger to now have to [accept] Becerra said. The Congressional Budget Office estimates the Biden team’s rules will push the premium down between 0.5% and 1%.
BRYAN R. SMITH / FP via Getty Images
Health and Human Services Secretary Xavier Becerra said: in defending regulations.
The proposed rules represent the Biden administration’s plan to implement The Act has no surprises, Congress passed to relieve patients of the shockingly high bills they receive when one or more of their providers unexpectedly isn’t out of their insurance plan’s network.
The law – effective January 1, 2022 – shield patients from those bills, requiring providers and insurance companies to figure out how much a doctor or hospital should pay, first through negotiation and then, if they don’t may agree, will arbitrate.
However, groups of doctors and some medical associations have lashed out Final Rule that HHS disclosed last month, saying it favors insurers during the arbitration phase. That’s because, although the rules require arbitrators to take many factors into account, they are instructed to start with a benchmark largely determined by insurers: the average percentage traded for similar services between network providers.
The bottom line is to protect the patient
Physician groups say giving the upper hand to insurers will cause them to lower payout rates and potentially force doctors out of networks or even out of business, reducing access health care service.
Becerra says the department has heard of those concerns, but the bottom line is to protect patients. Health providers that have taken advantage of a complicated system to charge exorbitant prices will have to bear their share of the cost, he said, or shut down if they can’t.
“I don’t think when someone overcharges it hurts the overcharger to now have to [accept] “Those who overspend either have to tighten their belts and do better, or they don’t last long in the business,” says Becerra.
“It’s not fair to say we have to let someone hack us so they can do business,” he added.
However, Becerra said he does not anticipate a wave of closures or reduced consumer access. Instead, he suggests, a competitive, market-based process will find a balance, especially when consumers know better what they’re paying for.
“We’re willing to pay a fair price,” he says, but insists, “I’ll pay for the best, but I don’t want to pay for the best and then triple it on top of that.” and covered by the bill.”
The bottom line: High levels of bills negotiated and arbitrated
Becerra also pointed to a report on unexpected medical bills that HHS will issue on Monday and which was made available in advance to Kaiser Health News, highlighting the impact of arbitration and negotiation laws already in effect in 18 states.
The report, which aggregates previous studies, found that people were affected by unexpected bills averaging $1,219 for anesthesiologists, $2,633 for surgical assistants, $744 for childbirth and north is $24,000 for air ambulance.
In states that use benchmarks similar to what doctors recommend using HHS instead of the agency’s current recommendation – such as New York and New Jersey – the report shows increased costs. For example, New York has a “baseball-style” system in which the referee chooses between offers made by a supplier and an insurance company, although the referee is required to consider the offer closest to 80th percentile of charge. “Since the amount that vendors charge is often much higher than the actual negotiated rate, this approach risks resulting in significantly higher overall costs,” the report found. In New Jersey, billed fees or “usual and customary” rates are considered.
“When arbitration is broad, borderless, at the end of the day, healthcare costs go up, not down,” says Becerra. “We wanted costs down. So we wanted to set up a system to help provide guidelines to keep us efficient, transparent and cost-effective.”
According to estimates by the Congressional Budget Office, the system chosen by the Biden administration is expected to push premiums down between 0.5% and 1%.
“Everybody has to give a little to get to a good place,” says Becerra. “I hope that sweet spot is where the patients … are taken out of that food war. And if the food war continues, the arbitration process will help to resolve it in a way efficiency, but it will also lead to lower costs.”
While the administration has chosen a benchmark that groups of doctors and hospitals do not like, the law makes clear that other factors should be considered when setting a price for a medical procedure or service, such as supplier experience, the market, and the complexity of a case. Those factors help ensure fair arbitration, Becerra said.
“What we do is simply set up a rule that says: ‘Give evidence. “It has to be relevant, physical evidence. And let the best win that fight in arbitration.”
The interim final rules were published on October 7, giving stakeholders 60 days to comment and look for changes. More 150 members of the National Assembly, many of them doctors, asked HHS and other relevant federal agencies to reconsider before the law took effect on January 1. These lawmakers allege that the administration failed adhere to the spirit of the compromises that Congress made when it passed the law.
The rules so far tend to go into effect with little or no change, but Becerra says his department is still listening. “If we think any changes need to be made, we are prepared to do so,” the secretary said.
The HHS report also notes that the law requires extensive monthly and annual reporting to regulators and Congress, when it goes into effect, to determine if the regulations are flawed or have consequences. Undesirable as what the doctors are warning or not.
Becerra says he thinks the rules strike the right balance, not favoring insurance companies or doctors, but those in need of medical care.
“We want it to be transparent, so that we can lead to more competition and keep costs low. Not just for payers, insurers; not just for providers, hospitals or doctors; especially especially for the patient,” he said.
Health News Kaiser is a national, editorially independent program and newsroom of the Kaiser Family Foundation. KHN is not affiliated with Kaiser Permanente.
