Salem, OR – April 27, 2017 – In testimony before the Senate Healthcare Committee, the president of the Oregon Chapter of the American College of Emergency Physicians (OR-ACEP) urged the Oregon Senate to amend a House-passed bill to ban balance billing so it doesn’t compromise access to care especially in rural regions of the state by adopting a fair reimbursement system for out-of-network care based on an independent, non-profit and transparent database.
The House-passed bill, HB 2339 A-eng. sets up two tiers for provider reimbursement. For non-emergency services, the bill uses 175 percent of Medicare as the benchmark. For emergency services, reimbursement rates are tied to a complicated “greatest of three” rule: 1) the median amount, less co-pays and deductibles negotiated for in-network providers; 2) the median negotiated for out-of-network providers; or 3) the amount paid by Medicare for the same or similar service in a geographic area.
Hans Notenboom, MD, told the Senate Healthcare Committee: “the greatest of three rule forces out-of-network providers to accept below market rates, and may mean that many specialists – including surgeons, neurosurgeons and cardiologists – will stop taking emergency calls creating a huge access problem, especially in rural Oregon.”
Additionally, Dr. Notenboom said that there should not be separate standards for emergency and non-emergency care, and that tying the rate of reimbursement for out-of-network providers to 175 percent of Medicare would “cut reimbursement to providers by over 50 percent. This would eliminate incentives for insurers to contract with providers and likely result in more out-of-network providers and less access to care for patients.”
Dr. Notenboom said OR-ACEP and six other physician organizations are joining forces to form Oregon’s End the Surprise Insurance Gap coalition. The coalition urges the Senate to amend HB 2339 A-eng. to a use a percentile of FAIR Health’s database as a benchmark for reimbursements. FAIR Health is an independent, national non-profit organization. Their database is used by Connecticut and New York to determine out-of-network physician reimbursement rates.
According to the End the Surprise Insurance Gap coalition, Medicare is not the right benchmarking standard since it was never intended for this purpose. In fact, Medicare amounts are politically derived for the purpose of reimbursing medical services for a specific population based on federal budgetary and regulatory constraints. Such a methodology is not based on the actual costs of providing care, especially in emergency and rural settings. Even the U.S. Government Accountability Office (GAO), the non-partisan investigative arm of Congress, says that Medicare significantly underpays some specialties.
The underlying cause of surprise medical bills is gaps in health insurance. Patients are facing higher premiums for health insurance and getting less coverage. In effect, insurance companies are shifting costs of medical care onto patients and the doctors who care for them. Moreover, insurers are hiding behind the Emergency Medical Treatment and Labor Act (EMTALA), which requires anyone coming to an emergency department to be stabilized and treated, regardless of their insurance status or ability to pay. Insurers are using EMTALA to force physicians to accept take-it-or-leave it reimbursement deals that can put them out of business or leave them practicing out-of-network. Unfortunately, the end result is a major cost shift from insurers to patients and physicians.
“Legislators in Oregon have recognized that surprise insurance gaps are leaving patients exposed,” said Michele Kimball, CEO, Physicians for Fair Coverage, a member of the coalition. “As they work to close these gaps caused by insurers narrowing physician networks, the FAIR Health database for out-of-network payments has shown to be the more comprehensive, transparent and inexpensive avenue for legislators compared to any other national or state database.”
The End the Surprise Insurance Gap coalition is comprised of the Oregon Chapter of the American College of Emergency Medicine, the Oregon Medical Association, Physicians for Fair Coverage, WVP Health Authority, the Oregon Association of Orthopaedic Surgeons, the Oregon Academy of Ophthalmology and the Oregon Society of Anesthesiologists.
