By Roger Allbee
Congress is finally taking steps to end surprise medical billing, a longstanding issue that for years has caused needless stress and financial woes for Vermont patients as well as patients across the country.
No one should be subjected to the pain and hardship that comes with surprise billing. Yet, due to a number of factors—including insurance companies that continue to shrink their provider networks—more and more patients find themselves stuck with exceedingly high bills for treatments and services they assumed would be covered by their health care plans.
While federal action is long overdue, legislators in Washington must be sure they are implementing the right solution—one that protects patients from surprise billing while also preserving their access to reliable, affordable health care. Not all solutions currently being considered in Congress would do that.
An especially risky proposal being floated on Capitol Hill called benchmarking would have dire consequences for patients and hospitals alike—particularly in rural parts of Vermont. This approach would rely on a government-mandated benchmark to set payments for out-of-network providers across the country. By using insurance companies’ in-network averages for equivalent procedures—figures that are decisively not transparent—a benchmarking approach would severely slash reimbursements to doctors, both in and out-of-network.
In doing so, benchmarking as a solution to surprise billing would force our nation’s hospitals, emergency rooms, and other vital health care institutions to incur billions of dollars in financial losses. While some larger, metropolitan hospital systems may be able to absorb these losses, our nation’s smaller, more rural hospitals would not.
As former CEO of Grace Cottage Hospital in Townsend, I can attest to the fact that the challenges facing rural health care providers are steep enough as it is without threatening their bottom lines. If a benchmarking solution were to become law, it would only serve to undermine rural hospitals, threaten patient access to care, and increase costs by forcing smaller hospitals to make cutbacks or possibly even increase the rate of provider consolidation and closure that has already devastated access in too many rural communities.
Rather than taking us down this perilous road, Congress ought to pass a more balanced, commonsense approach—and fortunately, one has already been introduced. Legislation that seeks to end surprise billing by enabling health insurers and providers to enter into a fair negotiation process known as Independent Dispute Resolution would provide a far better path forward.
Essentially, IDR would incentivize both insurers and providers to submit their most reasonable offers for payment through a simple online process overseen by an independent, third-party mediator. Until such a time that the mediator determines a final payment, providers would be paid temporary reimbursements based on the fair market value of their services. This would go a long way in providing the financial security needed to protect rural hospitals’ bottom lines so that patient access to care, affordability, and quality are never in question.
Senator Patrick Leahy and Vermont’s entire congressional delegation should continue to protect rural health care in our state and throughout the nation by supporting IDR and working to include it in any legislative solution passed to put the matter of surprise billing to bed once and for all.
Roger Allbee is the former Secretary of Agriculture and former CEO of Grace Cottage Rural Health Center and Hospital in Townsend, Vermont.
