President's Letter
Charles C. Scott, MD, Phd, FACEP
So far, this year seen changes and negative pressure in the way Emergency Physicians are getting compensated, increased regulatory and legislative requirements to continue performing the job, and a terrible reimbursement environment in the state of Arkansas. Having been in Arkansas, none of this seems new to me. However, ACEP has been and continually will work on making our jobs better and sustainable. Having recently attended the Leadership & Advocacy Conference in DC. I met with our Senators and talked with the Chief of Staff of Representative French Hill with a UAMS ED resident, Alisa Fujihashi MD, and medical student working on matching in Emergency Medicine, Kylie Hayes. The main issues we were discussing: a) mental health patient advocacy and b) “surprise billing”.
Just the name surprise billing means we lost the PR battle long ago. The surprise bills are a direct result of high deductible insurance plans, which were offered because the insurance companies know the only thing people notice when signing up for a plan is the monthly cost. The other reason for these bills are the insurance companies long history of requiring higher and higher bills, so they can take credit for the false discount that patients see when they receive their bill. Further, emergency departments should all be compensated as in network since the third insurance company strategy has been keeping networks as narrow as possible in an effort to shift cost onto patients. All of this occurs as the health insurance companies post billions of dollars in record profits.
We were at the table and though we are unable to back the current form of the Cassidy bill (which mainly addresses another behemoth industry, the pharmaceutical companies), it does address the out of network billing issue. From Laura Wooster, ACEP public affairs:”The bill has an interim payment of the median in-network rate that the insurer is required to pay directly to the provider, and then if either side is unhappy with that, they can initiate arbitration. Unfortunately, it directs the arbiter to consider *only* the commercial in-network rate in making a decision, and directly specifies the arbiter cannot look at charges. It also allows the insurer to write off the administrative costs of arbitration under the medical care portion of the MLR-leaving them able to basically take every single claim to arbitration, if they wanted, without cutting into their profits (it also has a rather inflammatory title and starts with three pages of pro insurer/antiprovider "findings").
That being said, on the positive side, they've incorporated ACEP's language for leveling deductibles for emergency care, has assignment of benefits to the provider, and also uses ACEP's language requiring insurers to print deductibles on insurance cards.”While this is just the beginning of the discussion, it will hopefully get our careers some consideration even in the face of massive lobbying efforts that are against us. I would like to work on a mission statement with anyone interested for our specific Arkansas chapter. I would appreciate any specific goals from which to build our mission and our vision. Some specific plans that I would consider very helpful to our patients include capping the deductible amount on any plan offered at 15% of that patient’s income, requiring insurance companies to use fair reimbursement databases (not the ones they have contrived), and making the cost of all healthcare and pharmaceuticals completely transparent (from clinics, hospitals, pharmacies, pharmaceutical companies, insurance plans, and any entity in the middle, such as PBMs). The last idea is moving forward in a small fashion, but if price and reimbursement are the same and published, the transformation of our industry would at least begin on a fair footing.
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