This letter requests that Congress work to resolve issues in Surprise Billing legislation before it is voted on in either chamber.
A copy of the letter is below:
December 16, 2020
The Honorable Nancy Pelosi
Speaker of the House of Representatives
U.S. Capitol Building, H-222
Washington, DC 20515
The Honorable Kevin McCarthy
House Republican Leader
U.S. Capitol Building, H-204
Washington, DC 20515
The Honorable Mitch McConnell Majority Leader
United States Senate
317 Russell Senate Office Building
Washington, DC 20510
The Honorable Charles Schumer Minority Leader
United States Senate
322 Hart Senate Office Building
Washington, DC 20510
Dear Speaker Pelosi, Minority Leader McCarthy, Majority Leader McConnell, and Minority Leader Schumer:
On behalf of the American Osteopathic Association (AOA) and the more than 151,000 osteopathic physicians (DOs) and medical students we represent, we write to express our appreciation for Congress’ efforts to safeguard the health and well-being of all Americans, support our healthcare system, and protect people from surprise medical bills. During this unprecedented time, DOs and all physicians have remained steadfast in delivering healthcare on the frontlines caring for patients across all medical specialty settings in every state and will continue to do so when the pandemic is over. It is imperative that any policies signed into law support patients and the healthcare professionals providing their care.
We recognize that members of Congress and committees with healthcare jurisdiction have been working hard to address a myriad of issues before the end of the year, and we recognize that much progress has been made. However, we are deeply concerned that if essential outstanding issues are left unresolved, much of what Congress has already done to support our healthcare system during the COVID-19 pandemic will be undermined.
Surprise Medical Billing
The AOA appreciates much of the work that has been done to improve the No Surprises Act. While the bill takes steps to improve transparency for patients by strengthening requirements for provider directories and advance explanation of benefits for scheduled services and improving state claims databases, we remain concerned that the No Surprises Act will harm physicians in small practices and ultimately patient access to care. There are several important issues that we strongly request be addressed before surprise medical billing legislation is voted on in either chamber.
We recognize that the No Surprises Act is the byproduct of bipartisan, bicameral negotiation and that the immediate opportunity for changes is likely limited. For that reason, our comments are limited to three specific changes that we believe are critical to ensuring that all patients have access to the highest quality physician-led care, removes patients from the middle of any payment negotiations, and allows for a fair, transparent, and timely dispute resolution process between physicians and insurers.
1. Accessing Independent Dispute Resolution Process in Case of Failed Negotiations
Section 103 of the bill lays out how out-of-network rates paid by health plans will be determined as well as the process of independent dispute resolution (IDR). Under §103(a), nonparticipating providers and facilities have a 30-day period for open negotiation to resolve payment for services. Under paragraph (B) Accessing Independent Dispute Resolution Process In Case Of Failed Negotiations, if a determination of payment for the item or service is not reached by the end of the 30-day open negotiation period, the parties only have two days to initiate the IDR process. While this short turnaround may not be burdensome for many insurance companies, or even some large hospitals, this timeframe could be extremely challenging for physicians in small and medium practices, and drastically limit their ability to participate in the IDR process. Our ask is that the number of days required to initiate IDR be increased from “two days”, to that of five business days.
2. Suspension of Certain Subsequent IDR Requests
Under section 103, when two parties are involved in IDR, the requesting party is prohibited from initiating a new IDR notification with the same party for an item or service that is the subject of the initial IDR notification for 90 days following a determination of the initial IDR notification. This restriction could unnecessarily delay adequate payment for small physician practices, limiting their ability to pay staff and eroding their ability to negotiate with insurers. We request that the suspension of subsequent IDR requests be shortened to no more than 30 days.
3. Report on Impact of Legislation within Four Years of Implementation
The bill requires the Secretaries of Labor and Treasury to submit a report to Congress within four years of enactment that details its impact. Specifically, the report will detail whether any insurers or health insurance plans have a pattern or practice of routine denial, low payment, or downcoding of claims, or otherwise abuse the 90-day period.
We are grateful that the legislation requires this report. However, we would strongly encourage the required timeline be changed to one year. If the practices described above are occurring routinely, many physicians may not be able to wait four years for the practices to be documented and corrective action to be recommended. If abuses are bad enough, practices could be forced to close and physicians may have to change their practice setting long before a report is issued. To maximize efficacy and provide greater accountability, we recommend that the first report be required one year following the implementation, and on a biennial basis for subsequent years.
Preventing 2021 Medicare Payment Cuts
The AOA represents the interests of all osteopathic physicians, regardless of specialty, and is supportive of many of the policies in the CY 2021 Medicare Physician Fee Schedule (PFS). However, while many of the policies in the 2021 PFS will support physicians and patient access to care, some will have harmful unintended consequences. As you know, the Centers for Medicare & Medicaid Services (CMS) is required to apply an across-the-board cut to payment rates to offset rate increases to balance the fee schedule when expenditures exceed a certain threshold. As a result, while some specialties will experience a revenue increase in 2021, physicians in other specialties, particularly emergency physicians, radiologists, pathologists, and anesthesiologists, will face significant cuts to their Medicare payments in 2021. Many of these physicians are literally caring for patients on the frontlines of the pandemic and are also potentially impacted by the No Surprise Act.
Amid a national public health emergency, when physicians are caring for patients in unprecedented conditions, while facing clinical challenges, increased practice expenses, and reduced revenue, physicians need more support not less. The work that Congress has done to support our country’s healthcare system during the COVID-19 pandemic is critically important, but those efforts will be undermined if the harm that will be caused by the PFS budget neutrality cuts is not addressed. Leaving these cuts in place also puts our already strained healthcare safety net at further risk of collapse. We strongly urge you to ensure that no physician has their payment rates cut under the 2021 Medicare PFS.
Thank you for your continued leadership and consideration of the AOA’s recommendations. If you have any questions regarding the recommendations outlined above, please reach out to David Pugach, JD, AOA Senior Vice President of Public Policy, at DPugach@osteopathic.org or (202) 349-8753 if you have any questions, or if the AOA can be a resource in any way.
Sincerely,
Thomas L. Ely, DO
President, AOA
Kevin M. Klauer, DO, EJD
Chief Executive Officer, AOA
CC:
The Honorable Richard E. Neal
Chairman
Ways & Means Committee
United States House of Representatives
The Honorable Kevin Brady
Ranking Member
Ways & Means Committee
United States House of Representatives
The Honorable Frank Pallone, Jr.
Chairman
Energy & Commerce Committee
United States House of Representatives
The Honorable Greg Walden
Ranking Member
Energy & Commerce Committee
United States House of Representatives
The Honorable Robert C. “Bobby” Scott
Chairman
Education & Labor Committee
United States House of Representatives
The Honorable Virginia Foxx
Ranking Member
Education & Labor Committee
United States House of Representatives
The Honorable Lamar Alexander
Chairman
Health, Education, Labor & Pensions Committee
United States Senate
The Honorable Patty Murray
Ranking Member
Health, Education, Labor & Pensions Committee
United States Senate