Benchmarking to end surprise billing would hurt senior healthcare

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O P I N I O N

THE SOAPBOX

Stand up. Speak up. It’s your turn.


Keeping up with the rising costs of medical care can be hard enough as it is for seniors living on limited incomes. One thing that certainly doesn’t help the situation is getting hit with a surprise medical bill weeks after receiving care because of ridiculously high out-of-network fees that weren’t explained to a patient from the get-go.

As someone who talks every day with fellow seniors about issues impacting us here in the Granite State, I have heard too many stories about how surprise billing can impact vulnerable patients and their families. Stories about having to choose between paying for groceries, utilities, and other necessities or paying off an inordinately high surprise bill. No one should have to make that decision.

Congress is finally considering legislation to address this issue and prevent more patients from being stuck in the middle of billing disputes between their healthcare provider and insurer. As Democrats, New Hampshire’s entire congressional delegation should help lead on this issue and make certain Congress passes a bill that protects patients from surprise billing. However, just as importantly, the solution they pass must be one that does not further jeopardize patient access or affordability—especially for those who can least afford it.

That’s why it’s so important that Congress avoid any approach that would call for benchmarking to resolve payment issues between insurers and providers. While it might stop surprise billing, benchmarking would only create a set of entirely new—and much worse—issues that would hurt senior healthcare in New Hampshire and throughout the country. This is not sound policy and should be a non-starter for Democratic members of Congress.

Benchmarking would basically call for the government to set payment rates for physicians who provide out-of-network care. Without taking into account the various factors that impact price and difficulty—such as location and facility type—a benchmarking approach will most likely mean many doctors would not be compensated adequately for the services they provide in the setting they provide them. Over time, that will translate to more than significant losses being transferred to America’s hospitals, ERs, urgent care clinics, and other facilities that provide care for our communities.

All this will do is contribute to America’s doctor shortage and already high rate of hospital consolidation. This, in turn, means fewer choices, less access, and reduced quality of care for patients—all while increasing costs and wait times. Once again, senior patients would be disproportionately impacted as they already face barriers to care as it is. Finding and accessing new options would be particularly difficult for seniors living with mobility issues. Benchmarking simply poses too large a threat to too many of our most at-risk fellow citizens.

Fortunately for Granite Staters concerned about this issue, there is another solution that has been introduced in Congress that would not adversely impact senior healthcare. Independent Dispute Resolution—as outlined in another bill—would protect patients from surprise billing by creating a transparent negotiation process between insurance companies and healthcare providers, creating an environment that incentivizes both parties to put forth their most reasonable offers for payment.

The entire IDR process would happen online and a final payment amount would be set by an impartial mediator. Until that time, providers would receive interim payments that would help keep rural hospitals in particular financially secure so they may continue providing quality care. IDR has worked well in New York since 2015, helping protect patients, increase transparency among insurers, improve network participation, and decrease out-of-network rates. On top of that, emergency care costs have remained stable.

It is time to protect patients, especially seniors, from the hardships that come with surprise billing—and it’s important that Congress get the job done right. New Hampshire’s entire congressional delegation should work together with other Democrats in Congress to support IDR and incorporate it into the final version of legislation Congress passes to resolve this matter once and for all.


Beg to differ? Agree to disagree? We welcome thoughtful prose on all topics of interest here. Send submissions to carolrobidoux@manchesterinklink.com, subject line: The Soapbox.


Garry Haworth is a healthcare advocate from Manchester, NH.