Surprise medical billing proposals could have ‘devastating unintended consequences’ on small radiology practices
Hundreds of small and independent physician practices are concerned that congressional proposals to address surprise medical bills could have other “devastating unintended consequences” on radiology and other specialties.
Almost 900 docs spelled out those qualms in a sharply worded letter to U.S. House and Senate leaders sent Thursday, Dec. 5. Adopting too rigid of guidelines for payment could unintentionally arm insurers that already are using a “take-it-or-leave-it” approach to negotiations with independent practices, they wrote.
The physicians want Congress, in particular, to steer away from any mechanism that would tie out-of-network payment to median, in-network benchmark pricing that could “allow insurers to forego entirely contracting with physicians.”
“We strongly urge you to consider how these federal policies currently under consideration may disproportionally impact small physician groups and the care we provide to your constituents,” wrote the coalition, which includes a dozen-plus radiology practices, alongside surgeons, dermatologists and other specialties. “We are deeply concerned that the wrong approach will ultimately drive many of us out of the market entirely, which will drive up healthcare costs as more smaller practices will be purchased by hospital systems and others, leading to increased consolidation.”
The group is pushing Congress to adopt “enforceable network adequacy protections” for federally regulated plans to help safeguard independent practices. They “strongly” urge the adoption of independent dispute resolution (IDR) process to help settle disagreements between radiologists and insurers. The state of New York has already tried a similar approach, which helped save consumers $400 million while reducing out-of-network billing by 34%, the group noted.
Absent an independent means to settle disputes, they’re predicting further consolidation and price pressure.
“An appropriate policy must be crafted that keeps costs contained, preserves access to care for patients, and will not disrupt contracting dynamics between physicians and insurers who attempt to negotiate in good faith,” they concluded.
Out of the Middle—a coalition of physicians that includes the American College of Radiology (ACR) and other trade groups—applauded the letter and its message on Friday, Dec. 6. “Patients need a cure for surprise bills, not a short-term Band-Aid,” the group said in a statement. In its own letter to lawmakers in September, the ACR and other prominent healthcare organizations advocated for the adoption of a robust IDR to help settle disputes, Radiology Business reported.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.