Congress must protect frontline emergency providers, not insurance companies

Published 3:52 pm Tuesday, September 8, 2020

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Doctors, nurses and clinicians across Tennessee risked their own health for months treating COVID-19 patients. I’ve been lucky to have a front row seat to the heroic work of my colleagues over the last six months.
These frontline heroes deserve our praise and respect, but lawmakers in Washington D.C. are again considering legislation that would make it harder for them to provide the care patients desperately need.
As the incoming president of the Tennessee Chapter of the American Academy of Emergency Medicine, it is my responsibility to advocate for the thousands of doctors and providers caring for patients across the Volunteer State. I will work to educate lawmakers on policies that protect patients and allow emergency medicine providers to do their jobs.
Lawmakers in Washington D.C. and in state Capitols across the country are rightfully addressing the issue of surprise medical billing. A 2018 survey found that more than half of American adults have received a surprise medical bill. This occurs when insurance companies refuse to cover costs of treatments that patients depend on or when insurance companies force patients to pay higher premiums, co-pays and deductibles.
I have spent my career working in emergency medicine. Emergency providers pride ourselves on being the safety net for the healthcare system. They are required by Federal laws to treat every patient who comes into the ER, regardless of their ability to pay.
Health insurance companies, however, aren’t required to reimburse emergency providers for the cost of the care we provide.
Large health insurance companies are the most profitable entities in the healthcare sector, yet many use their outsized negotiating power to force doctors to accept reimbursement cuts. If doctors refuse, they are kicked out of network.
When providers are pushed out of network, providers and patients both lose. Without enough revenue coming in, many emergency departments and health clinics will struggle to keep the doors open with potential closures driving up wait times and compromising care when and where it was needed most.
Earlier this month, my predecessor, Dr. Mary Jane Brown, sent a letter to our colleagues urging emergency medicine providers across Tennessee to contact our senators and representatives to solve the surprise medical billing issue.
However, Tennessee Senator Lamar Alexander’s proposed solution would give more power to insurance companies at the expense of patients and emergency medicine providers.
Senator Alexander’s legislation would allow insurance companies to arbitrarily set the reimbursement rate for the cost of treatment. The bill effectively imposes a 20% pay cut on frontline medical personnel in the middle of a pandemic, risking hospital closures in rural and underserved communities.
Major organizations representing doctors and hospitals have opposed Senator Alexander’s legislation because of its potentially crippling effects, including the American Medical Association, American Hospital Association, and the Federation of American Hospitals.
Fortunately, patients and emergency providers have a champion in Senator Bill Cassidy (R-LA), who is proposing a bipartisan solution to surprise medical billing centered on an independent dispute resolution process (IDR).
IDR takes patients out of the middle of billing disputes by bringing health insurance companies and providers to the table to negotiate a fair solution. This system has been implemented successfully at the state level in both Texas and New York.
Tennessee Congressman Phil Roe (R-Clarksville), a doctor, has also introduced IDR-based legislation in the House of Representatives, which has more than 110 bipartisan co-sponsors.
Together, Senator Cassidy and Representative Roe’s bills are the best chance to end the problem of surprise medical billing without empowering insurance companies at the expense of providers and patients.
Members of Congress are currently debating another COVID-19 relief bill to provide support to frontline providers, patients and businesses struggling during the pandemic.
Senators Cassidy and Alexander are reportedly negotiating a compromise solution to surprise medical billing.
Emergency medical providers and their patients in Tennessee must work together to urge Senator Cassidy to stick to the IDR-based solution that protects patients and providers, not big health insurance companies.
(Dr. James Parnell is an emergency medicine physician and incoming president-elect for the Tennessee Chapter of the American Academy of Emergency Medicine.)

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