Sep 16, 2019

Physician staffing groups are behind the surprise medical bills ad blitz

Physician staffing groups that generate large amounts of surprise medical bills are behind Doctor Patient Unity, the dark-money group running $28 million in ads against Congress' effort to crack down on surprise bills, the New York Times reports.

The two staffing groups, TeamHealth and Envision Healthcare, supply emergency room doctors, radiologists and anesthesiologists to hospitals — specialties that are among the most likely to be out-of-network for patients. Both groups are backed by private equity.

Between the lines: Envision and TeamHealth have a lot to lose from a ban on surprise billing, as it's a lucrative practice for them.

  • The kinds of physicians they employ have a steady patient supply regardless of whether they're in those patients' insurance network. That creates the opportunity for them to charge sky-high rates and then bill patients for what their insurer won't cover.
  • The threat of going out-of-network also gives these providers leverage in their negotiations with insurers, causing in-network rates — and thus premiums — to rise.
  • Congress' leading solution to surprise billing would likely decrease this leverage and thus lead to lower in-network rates for these doctors.

My thought bubble: The choice before lawmakers now could not be more Washington-in-2019: Side with voters getting slammed by these bills, or side with the private equity-backed groups profiting from them.

Go deeper: We all pay for surprise emergency room bills

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The effects of California's surprise medical billing law

Illustration: Sarah Grillo/Axios

California's law prohibiting surprise billing has led to an increase in care delivered by in-network providers, according to a new analysis by the USC-Brookings Schaeffer on Health Policy initiative.

The big picture: The leading federal surprise billing solution is similar to the California bill in that it creates a benchmark payment rate for out-of-network care. Providers have lobbied fiercely against the approach.

Go deeperArrowSep 27, 2019

House committee floats new proposal to ban surprise medical billing

Illustration: Aïda Amer/Axios

The House Ways and Means Committee is considering banning surprise medical bills and forcing the administration to decide how providers get paid for out-of-network care, according to a letter sent by Chairman Richard Neal to Democratic members.

The big picture: Payment resolution has sparked an intense fighting among insurers, hospitals and doctors.

Go deeperArrowOct 2, 2019

Arbitration for surprise medical billing may favor doctors

More evidence is piling up that when doctors and insurers sit at a table with a third-party arbiter to solve billing disputes, the outcome could benefit the doctors.

Driving the news: 2 new government reports show how arbitration, one of the solutions being considered by Congress, works in theory and in the real world.

Go deeperArrowSep 20, 2019