The American College of Radiology is again linking arms with the American College of Emergency Physicians (ACEP) and American Society of Anesthesiologists (ASA) in a lawyer-guided effort to iron out an abrading wrinkle in the No Surprises Act.
The latest action involves the trio’s Oct. 19 filing of a joint amicus brief with a federal court in Texas.
The brief voices the groups’ support of a new, second suit filed Sept. 22 by the Texas Medical Association against HHS, et al.
The fresh suit’s beef is with the independent dispute resolution (IDR) process codified in the Surprise Billing Final Rule issued this past August.
In the suit the TMA charges—and the three groups emphatically agree—that the IDR prescription is out of compliance with statutory text in the No Surprises Act.
In a news release recapping and updating the protracted legal struggle, ACR, ASA and ACEP state their interest in remaining involved is in “work[ing] to protect patient access to care and stop insurer profit grab at patient and provider expense.”
United Front Against Unbalanced Arbitration
As tipped by that language, the three groups’ main bone of contention with the standing IDR policy is that it bucks Congressionally set priorities for respecting the interests of all key parties—patients, providers and payers.
Specifically, the groups state, the final rule “skews the IDR process to favor the insurer-calculated Qualifying Payment Amount (QPA) over other factors Congress specifically directed IDR arbitrators to consider equally with the QPA.”
More pointedly, they write:
Insurers are using the new law to raise profits by initiating reductions in contracted fee schedules and narrowing medical networks, which denies patients their choice of providers and can delay diagnosis and treatment of illness and injury.”
En route to pursuing their present path, the ACR, ASA and ACEP will drop a joint lawsuit they filed in Illinois. That suit involved an interim final IDR rule that became moot with the publication of the final rule.
However, the groups state they will monitor the TMA suit and “stand ready to challenge the final rule in the Northern District of Illinois if necessary.”
Seeking a Legal Remedy to a Medical and Financial Fix
The groups underscore that the present TMA suit, now as earlier, is concerned only with the IDR process as applied to setting provider pay rates for out-of-network care.
“The suit does not impact No Surprises Act patient protections, which ACEP, ACR and ASA continue to fully support, nor raise patient out-of-pocket costs,” the groups state.
At the same time, they point out, the IDR final rule has landed at a time when many providers are still recovering from the pandemic’s financial punches.
These providers “cannot withstand this [present] insurer multi-edged profit grab and may be dropped from networks,” they write. “These insurer restrictions impact all care (not just out-of-network care), including cancer screenings, which plummeted during the pandemic and may yet lead to more cancer deaths.”
More:
There is no evidence that insurers use profit margin increases, obtained at patient and provider expense, to lower beneficiary costs.”
There’s more detail plus links to clarifying content in the full release. Read the whole thing
Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.