Rethinking the No Surprises Act: Advocacy from June to December of 2022

Advocacy for Physicians

Since the implementation of the No Surprises Act, a biased IDR process that favors insurers has brought about robust advocacy from a variety of physician organizations. Many also have filed amicus briefs in support of various lawsuits against health insurance companies.  Here are some examples of advocacy from the ASA, AHA, and AMA, among others, from July 2022 to the present. 

 

The Emergency Department Practice Management Association (EDPMA) continues to advocate for fair reimbursement for emergency physicians’ life-saving work as healthcare providers continue to misinterpret the problematic No Surprises Act – this letter, published July 29th, illustrates this advocacy.

The prioritization of profits over patient care has reached an ugly apex.

Some of the biggest health insurers including United Healthcare, Cigna, and Blue Cross Blue Shield are threatening to terminate long-standing physician contracts. The ransom: up to a 50% pay cut for emergency medicine physicians’ in-network rates.

What hangs in the balance is more than continued revenue loss—the impending repercussions are critical. These losses will lead to longer wait times for emergency services, potential staffing shortages, and more.

 

We support the American College of Emergency Physicians as they shed light on just one example of large insurance companies underpaying and refusing to pay healthcare providers for the life-saving care they provide.

Anthem Blue Cross has completely denied payments for the highest level of emergency care and has used this strategy to avoid paying smaller healthcare practices. Anthem primarily applies the strategy to higher forms of emergency care, citing “not enough evidence” as reason not to pay. 

ACEP has worked diligently to call out this behavior as clearly motivated to avoid reimbursing the most expensive form of care, needed in order to treat patients in severe, often life-threatening situations.

This is one of many practices that insurance companies use to underpay healthcare providers for their work. As a medical biller or provider, it is important to know where insurance companies cut provider revenue.

In an effort to establish a united front against unbalanced arbitration, the ACR, ACEP, and ASA filed a joint amicus brief on October 20th, in contention with the IDR process, which “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.”

These groups explain that providers have issues withstanding continued greed for profit from insurers. When these insurers lay down restrictions, all forms of care, including out-of-network care, are affected. They’ve proven that while care costs are down significantly, insurance premiums and company revenue continue to rise. It’s one of many reasons a united front is more important than ever.

 

On October 20th, The AHA and the AMA filed a “friend of the court” brief in support of the Texas Medical Administrative’s lawsuit which claimed the revised IDR process skews in favor of commercial insurers.

In this brief, the entities write “…the severe rate cuts enabled by the Departments’ insurer-friendly regulations threaten the viability of physician practices and the scope of medical services nationwide. Ultimately, the victims will be the patients who lose ready access to care.”

The QPA is an insurer-generated value and is therefore an unfair element for use in arbitration.
 

On October 20th, the Emergency Department Practice Management Association (EDPMA) filed an amicus brief in support of the TMA’s lawsuit against federal regulators.

There’s a lot on the line for the livelihood of emergency physicians. EDPMA Chair of the Board Don Powell, DO, FACEP, is quoted:

“…If the current final rule and de-facto benchmark standard goes unchecked, these practices go unchecked, emergency medicine physicians, their practices and their value as our nation’s healthcare safety net are in jeopardy. Access to emergency care – which was vital to assisting our country through the pandemic – will be compromised with fewer resources to emergency care while the health plans then and now continue to post record profit.”

We commend the EDPMA and its continued efforts to advocate for the fair reimbursement of emergency physicians. It’s a cause that inspires Allia Group’s work to recover underpaid claims, improving revenue for physicians groups and access to care.

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