Sep 20, 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.

  • New York created an arbitration process a few years ago, and doctors on average have been paid well above 80% of their billed charges in emergencies, according to an analysis of the state's report by Loren Adler of the Brookings Institution and the USC-Brookings Schaeffer Initiative. Charges are made-up figures with no relation to costs or quality.
  • Separately, creating a federal arbitration process "would be likely to result in larger payment rates to providers," especially for doctors who are already paid at higher-than-average rates, the wonks at the Congressional Budget Office said.

The bottom line: Washington has not settled on a single surprise billing solution. It’s not difficult to see why providers are pushing for a process that pays them many multiples above Medicare and average in-network rates.

Go deeper: Hospitals' dog in the surprise billing fight

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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

Big Pharma's giant promotional payouts to doctors

More than 700 doctors were paid at least $1 million by drug and medical device companies between 2014 and 2018, ProPublica reports. More than 2,500 received at least half a million dollars.

Why it matters: Many drugs that are heavily promoted have strong competition. "Promotional spending is a major way that manufacturers in these situations distinguish themselves from each other — not by conducting comparative studies or by engaging in substantial price reductions," said Aaron Kesselheim, a professor of medicine at Harvard Medical School.

Go deeperArrowOct 18, 2019