Jun 21, 2019 - Health

How surprise billing proposals actually affect health care providers

Hospital and provider groups may hate the leading House and Senate proposals for ending surprise medical bills, but the largest providers will likely be least affected, according to a Moody's analysis.

Driving the news: The Federation of American Hospitals, the American Hospital Association and the American Medical Association all oppose tying payments for out-of-network care to the median in-network rate for the service.

  • "That approach would eliminate incentives for plans to contract — and likely encourage plans to drop contracts — with providers who are currently above that amount," the AMA said in a statement.

What they're saying: This wouldn't be bad for all providers, according to Moody's — just the ones that collect higher-than-average payments.

  • If median rates are low, insurers may not have as much incentive to build provider networks, as they may end up paying less for an out-of-network claim than an in-network one.
  • Large providers, thanks to their scale and negotiating leverage, are already more likely to be in-network than smaller providers.

Overall, resolving surprise medical bills for patients is "mostly credit negative" for the industry, according to Moody's — which implies that the industry benefits from the ability to balance bill patients.

What we're watching: The change could lead to further provider consolidation, Moody's predicts.

  • The proposal "would make it more attractive for smaller group providers of anesthesia, emergency and other services to be part of a larger, in-network group," the authors write.

Go deeper: Surprise billing proposals don't address ambulances

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