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Protecting patients, preserving access to emergency care

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Dr. Timothy Johnson

As an emergency room physician, serving my patients and maintaining the highest standard of excellence in emergency care is at the heart of everything I do.

That is why I believe it is long past time for Congress to address one of the many factors that contribute to the rising cost of health care in the United States — surprise medical billing.

It is critical, however, that lawmakers solve the problem without threatening the ability of local hospitals and emergency rooms to provide patients with the highest quality of care possible.

According to a study by the University of Chicago, 57 percent of Americans have been affected by a surprise medical bill at some point in their lives — most commonly in the event of unplanned or emergency care. Patients are left with astronomically high bills for the cost of care not covered by their insurer, and are put in the most unwelcome position of being caught in a billing dispute between their health care provider and their insurance plan.

There is a near consensus among physicians, insurers and lawmakers that patients should not have to face this unplanned financial burden. However, what is up for debate is how to best separate patients from the billing dispute process without impacting the quality of or access to health care for anyone.

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One solution introduced in the Senate, S.1895, the Lower Health Care Costs Act, takes a woefully misguided approach that would undermine the efficacy of local hospitals and emergency rooms, here in Minnesota and across the country.

If passed as currently written, S.1895 would implement a benchmarking approach to settling these kinds of payment disputes. That would mean the federal government would determine rates paid by insurers to physicians in the case of out-of-network care. Setting arbitrary and in many cases under-market rates for the services provided at hospitals and emergency rooms not only ignores the varying costs associated with providing care in differing regions and among different types of facilities, but would give insurers the power to dictate care for patients, leading to a host of unforeseen, undesirable consequences.

For one thing, government rate-setting would translate to billions of dollars in losses for hospitals and emergency rooms, which would be especially disastrous in rural parts of the state. As many of these facilities operate on incredibly tight budgets as it is, a benchmarking approach to ending surprise medical bills could inadvertently contribute to the growing rate of provider consolidation, eliminating choice and threatening access to vital care for many patients. This would especially those who are uninsured or on Medicaid or Medicare, who rely more heavily on emergency care.

There is a better solution also being considered by Congress. It is the Independent Dispute Resolution (IDR) process outlined in S.1531, the STOP Surprise Medical Bills Act. IDR effectively removes the patient from payment disputes while ensuring both providers and insurers negotiate payments in a fair, open and transparent manner.

Unlike benchmarking, this IDR approach ensures financial stability for rural hospitals and emergency rooms, protecting patient choice and access to care.

Sen. Amy Klobuchar and Sen. Tina Smith, should both be commended for their support of S.1531 and the IDR mechanism to protect Minnesota’s patients and emergency health care facilities alike. We now need the rest of Congress to get on board to ensure that any legislation passed by Congress to address surprise medical billing utilizes this tried-and-true approach.

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