S.C. Rep. Russell Ott, special to Statehouse Report | For too many South Carolinians, and truly all Americans, the cost of health care is quickly becoming prohibitively high. Congress must work to address these spiraling costs in order to ensure vulnerable patients can afford to access the vital medical services they so desperately need. One way federal legislators could help to address this issue is by eliminating the unfair practice of surprise medical billing.
It is encouraging to see legislators taking this issue seriously. However, their efforts will be in vain if Congress ends up rushing this issue through the process by attaching it to a year-end legislative package that includes a short-sighted solution to this national problem.
Congress must solve this problem with the right solution—and so far, there is only one proposal that fits the bill. A process known as Independent Dispute Resolution (IDR) is the surest way to end surprise medical billing without undermining access or affordability for anyone. Unfortunately, the same cannot be said about another purported solution that has been recommended, known as benchmarking.
A benchmarking approach would set artificially and arbitrarily low out-of-network rates for physicians. By essentially giving insurers the power to slash physician reimbursements, a benchmarking-based solution would transfer enormous losses onto local hospitals and emergency rooms, many of which are already contending with their own financial woes—especially in rural communities throughout South Carolina and across the country.
In fact, benchmarking could exacerbate two problems facing rural communities when it comes to health care access: a widespread physician shortage and high rate of provider closure or consolidation. If Congress passes a benchmarking solution to solve surprise medical billing, at-risk hospitals serving our rural communities could face some hard decisions, including laying off much-needed staff, scaling back services, or closing their doors altogether. Any of these outcomes would only further reduce options, undermine access, and raise prices for rural patients who already face such high barriers to care.
That is why I firmly believe Congress must stay focused on passing legislation that includes the far superior, much less disruptive IDR process. IDR would provide a balanced approach in which both insurers and providers would be able to submit their best out-of-network payment offers through a simple, transparent online platform. Within 30 days, an independent mediator would determine a final amount based on these offers as well as a host of third-party data in order to ensure payments are fair and reflect the true cost of providing clinical care in a given location, setting, or facility type.
Moreover, under IDR, health care providers would receive interim, market-based payments that would provide some much-needed financial strength and stability for rural and at-risk hospitals. That would help ensure particularly vulnerable patients living in rural and medically underserved communities would not see their access to care eroded even further. IDR is quite simply the only proposed solution for surprise medical billing that would not have an adverse impact on rural health care.
IDR is also the only approach that has been introduced in Congress with a proven track record of success. In New York, where an IDR-focused law went into effect in 2015, the process has helped lower out-of-network billing rates by 34 percent while emergency care costs have dropped by 9 percent, saving New Yorker $400 million. This approach treats both sides equally, which is why it has the support of New York’s medical community as well as the New York Health Plan Association.
As Congress continues to weigh its options, legislation that has been introduced must be improved to include a meaningful, accessible IDR process if we are going to solve the problem of surprise medical billing in a comprehensive, responsible way. If such a process is not included, Congress should continue debating and working to find a true solution to protect patients from the burden of surprise medical bills once and for all. This issue is simply too important to rush through or get wrong.
When all is said and done, only the IDR process will separate patients from the out-of-network billing disputes between providers and insurers that result in surprise medical bills. That is the solution Congress must work to pass in order to protect vulnerable patients in South Carolina and throughout the nation.
State Rep. Russell Ott, a Democrat from St. Matthews, first was elected in 2013.
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