Perceived Results of the No Surprises Act

nsa idr process flaw

The impact of the No Surprises Act can already be felt in emergency rooms and specialty practices across the country, as physician groups must deal with the way the NSA affects their practices’ revenue streams. From bankruptcy risk to emergency service closures, here are some examples of the serious outcomes of a flawed NSA and IDR process. 

The problematic No Surprises Act may create overcrowded and understaffed emergency departments.

According to a study from the Agency for Healthcare Research and Quality from September of 2022, the No Surprises Act could lead to an increase in emergency department, or ED, visits.

By comparing ED visit rates in states with bans on balance billing and those without, the study found these bans reduced spending per visit, but actually increased the total amount of visits. 

Providing life-saving services should not become a burden for emergency department physicians. Patient care must also remain paramount. 

Recovering underpayments from insurance companies in a reliable, lawful way is the next vital step, with which Allia Group can help.

In August of 2022, Air Methods of LifeNet Helicopter Services announced the closure of several of their bases, showing early reverberation of the No Surprises Act’s impact throughout hospitals and healthcare institutions across the country.

The group cited “tremendous pressures from the No Surprises Act (NSA), unprecedented inflation, and significant under-reimbursement from Medicare, which the government hasn’t updated in nearly 20 years” as reasons for scaling back.

In fact, according to this article, the nation’s air ambulance industry is facing the “dire consequences” of the No Surprises Act. According to the Association of Air Medical Services, this is a “license to steal.”

Their Vice President for Public Affairs, Christopher Eastlee, warns “the entire healthcare structure is at risk.”

More specifically, for emergency air medical companies, the median in-network rates used in reimbursement do not adequately compensate for their services. This could force closures for air ambulance services.

The No Surprises Act also does not address a scenario where the payer deems air ambulance transport medically unnecessary, leaving a cost that would have been the patients’ responsibility in the hands of providers.

Another casualty of profit decline and weak liquidity from forces including the No Surprises Act is Envision Healthcare, which was at high risk for bankruptcy as of September 2022.

The physician staffing firm’s contract disputes with UnitedHealthcare include back-and-forth lawsuits over United routinely denying claims for emergency services and Envision’s alleged upcoding of claims.

It’s no surprise that tensions are nearing their boiling point as the battle escalates. When physician groups are a casualty, we risk access to affordable, life-saving services.

This fantastic OpEd piece from Tennessee physician Michael Corvini, MD, MBA illustrates the harm patients and providers face when payer profit is put first.

Corvini is TeamHealth’s Southeast Group President and has been a dynamic healthcare leader and board-certified physician for over 20 years, overseeing Emergency Medicine and Hospital Medicine.

Despite TeamHealth and BCBS Tennessee working “in harmony” for 25 years, things have taken a turn for the worst.

By taking advantage of the No Surprises Act, BCBSTN attempts to cut physician pay by threatening contract termination.

As of September 2022, BCBSTN demanded that TeamHealth accept an immediate 60% rate reduction without warning or justification. Corvini says, “A 60% rate cut would be financially unsustainable for physicians, nurse practitioners and physician assistants, making it harder for patients to find care when needed.”

The nation’s air ambulance industry is facing the “dire consequences” of the No Surprises Act, which has been called a “license to steal,” according to the Association of Air Medical Services.

Their Vice President for Public Affairs, Christopher Eastlee, warns “the entire healthcare structure is at risk.”

More specifically, for emergency air medical companies, the median in-network rates used in reimbursement do not adequately compensate for their services. This could force closures for air ambulance services.

The No Surprises Act also does not address a scenario where the payer deems air ambulance transport medically unnecessary, leaving a cost that would have been the patients’ responsibility in the hands of providers.

 

UVM Health Network, Vermont’s largest healthcare provider, announced that it is being dropped from UnitedHealthcare on April 1.

For some Vermonters, UnitedHealthcare is their only choice in payer.

While patients see the disagreement as a “two-way street” and feel neglected as neither group backs down in negotiations, it’s important to note the financial strain the past year has put on providers:

UVM Health Network reported $90 million in losses in 2022.

Conversely, UnitedHealthcare reported a $14.4 billion profit for 2022.

If UVM Health Network and UnitedHealthcare cannot reach an agreement, Vermonters will lose their in-network healthcare coverage on April 1 and New Yorkers on June 1 – ultimately, increasing their costs and leaving some hours away from the care they need.

 

On March 9th, the shut down of another LifeNet air ambulance base was announced.

Following a group of closures around 5 months ago, the Michigan base is the next casualty.

Air Methods – our parent company – made the difficult decision of closing our base due to the tremendous pressure from the No Surprises Act and the government’s failure to update medicare reimbursement in nearly 20 years. After exploring every option available, it was determined that it was simply unsustainable to keep our LifeNet of Michigan open,” the company stated in a Facebook post.

Things don’t seem to be getting any better as NSA policies and procedures continue, jeopardizing the availability of #EmergencyCare and services.

 

According to this article, the No Surprises Act will lead to losses of nearly $1 billion by emergency medicine physician groups, threatening patient access to emergency care.

Emergency departments have experienced a 32% decrease in out-of-network payments from health plans since the implementation of the NSA, according to a new study from the EDPMA.

While the NSA has effectively protected patients, its flawed implementation threatens both the quality and accessibility of emergency care, as well as emergency room staffing.

Allia Group can improve your emergency department’s revenue cycle – contact us to get started.

 

 

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