How surprise billing proposals actually affect health care providers
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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
