Surprise medical billing legislation threatened by provider lobbying
Skip to main content
MDHC_Logotype_white
Subscribe
  • My Account
  • Login
  • Subscribe
  • News
    • This Week's News
    • COVID-19
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • People
    • Regional News
    • Digital Edition
    • Healthcare construction primed to rebound faster than other sectors
      Drug executives: Big jump in vaccine supply is coming soon
      States rush to catch up on delayed vaccines, expand access
      Becerra supports access to care, provider funding during confirmation hearing
    • Drug executives: Big jump in vaccine supply is coming soon
      States rush to catch up on delayed vaccines, expand access
      White House promises vaccine help as states rush to catch up
      Michigan health aides to lose $2 raise without legislation
    • Dr. Imran Andrabi
      Q&A: ThedaCare CEO says lessons from COVID-19 will inform new approaches to population health management
      The Check Up: Dr. Imran Andrabi
      The Check Up: Dr. Imran Andrabi of ThedaCare
      Hospitals confront water shortages in winter storm aftermath
      beaumont-hospital-royal-oak_i_i_i.jpg
      Beaumont says nearly 2,000 second-shot vaccinations canceled due to vaccine shortage
    • Beyond the Byline: Insurers are betting on virtual-first plans as COVID-19 shifts care pathways
      Beyond the Byline: Insurers are betting on virtual-first plans as COVID-19 shifts care pathways - Transcript
      Health insurance execs' salaries grew faster than company revenue in 2020
      Five chronic conditions cost employers $2.5 billion over two years, study shows
    • States rush to catch up on delayed vaccines, expand access
      Becerra supports access to care, provider funding during confirmation hearing
      White House promises vaccine help as states rush to catch up
      Biden asks high court to drop two Trump-era Medicaid cases
    • deloitte GDP image chart graph going up
      Sponsored Content Provided By Deloitte
      Breaking the cost curve
      By the Numbers: Largest taxable not-for-profit bond issuances, 2021
      Dennis Dahlen
      Health systems aren't rushing to cut back on financial liquidity
      Modern Healthcare CEO Power Panel
      Providers focus on adding nurses, expanding outpatient care
    • man and woman looking at ipad wearing face masks stock image
      Sponsored Content Provided By Surescripts
      Improvements to benefits data can enhance ePrescribing and the patient experience
      Oscar Health's $1B IPO sets the stage for more health tech exits in 2021
      A map of the U.S. with images of the coronavirus.
      The digital divide becomes a new social determinant of health
      Google opens Rochester, Minn., office to be closer to Mayo Clinic
    • angela karpf headshot
      Sponsored Content Provided By B. Braun
      Making patient safety a policy priority
      Michigan Maze Woman-main_i.jpg
      State of confusion: Michigan's mental health system has many layers for those in need to navigate
      Next Up Podcast: Educating patients on the COVID-19 vaccine with Tanya Andreadis
      Next Up Podcast: Educating patients on the COVID-19 vaccine with Tanya Andreadis - Transcript
    • Michael Jordan, Novant team up to address health equity
      Former Ascension CEO, the first to lead the health system, passes away
      Biden's pick to head CMS would be first Black woman to hold post
      RAKESH SURI MD_i.jpg
      Cleveland Clinic creates president of international operations position
    • Midwest
    • Northeast
    • South
    • West
  • Insights
    • ACA 10 Years After
    • Best Practices
    • Special Reports
    • Innovations
    • The Affordable Care Act after 10 years
    • Dr. John Fischer
      Patient-reported outcomes tool for hernia surgery helps physicians improve care
      New care model helps primary-care practices treat obesity
      doctor with patient
      COVID-19 treatment protocol developed in the field helps patients recover
      Rachel Wyatt
      Project to curb pressure injuries in hospitals shows promise
    • What's next for on-demand telehealth companies?
      A CalOptima PACE vaccination clinic.
      Will COVID-19 be the catalyst for creating a more sustainable healthcare system?
      A map of the U.S. with images of the coronavirus.
      The digital divide becomes a new social determinant of health
      Ascension’s St. Mary’s Hospital Surgery Center at Towne Centre and Allegheny Health Network’s Bethel Park surgery center
      Hospitals see opportunity, risk in ambulatory surgery centers
    • Dr. Daniel Hall
      UPMC pilots machine learning, telehealth to inform patient transfers
      A woman being recorded using her inhaler on a smartphone.
      Digital check-ins, connected inhalers help control asthma
      A phone screen showing the question, "Mary we hope this information was helpful and we'd like to keep guiding you. Are you interested in knowing when it's your turn to receive the vaccine?"
      Chatbots, texting campaigns help manage influx of COVID vax questions
      A woman with a wearable sensor talking to her provider.
      Wearable sensors help diagnose heart rhythm problems in West Virginia
  • Transformation
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • What's next for on-demand telehealth companies?
      Rising prescription copays drop adherence, spike mortality, research shows
      Dr. John Fischer
      Patient-reported outcomes tool for hernia surgery helps physicians improve care
      Highmark Health inks six-year cloud, tech deal with Google
    • California hospitals prepare ethical protocol to prioritize lifesaving care
      Amazon, JPMorgan Chase, Berkshire Hathaway disband Haven
      Digital pathways poised to reshape healthcare continuum in 2021
      Healthcare was the hardest hit by supply shortages across all U.S. industries
    • Dr. Daniel Hall
      UPMC pilots machine learning, telehealth to inform patient transfers
      A woman being recorded using her inhaler on a smartphone.
      Digital check-ins, connected inhalers help control asthma
      Humana partners with in-home provider for 24/7 care
      A phone screen showing the question, "Mary we hope this information was helpful and we'd like to keep guiding you. Are you interested in knowing when it's your turn to receive the vaccine?"
      Chatbots, texting campaigns help manage influx of COVID vax questions
    • Coordinated payment policies could speed transition to value, experts say
      CMMI's geographic direct contracting model needs an overhaul, experts say
      Hospitals fight UnitedHealthcare policies over lab test, specialty drug payments
      Cigna eliminates prior authorization for coronary CT scans
  • Data/Lists
    • Rankings/Lists
    • Interactive Databases
    • Data Points
    • Health Systems Financials
      Executive Compensation
      Physician Compensation
  • Op-Ed
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
    • Dr. Alan Kaplan
      The risks, rewards of taking organizations 'where they haven’t gone before'
      Wellstar CEO calls adapting for the pandemic her bold move
      Howard P. Kern
      Recognizing the value of telehealth in its infancy
      Dr. Stephen Markovich
      A bold move helped take him from family doctor to OhioHealth CEO
    • Dr. Stephen Markovich
      Making sure we're aligned along the path to achieving inclusion
      Barry Ostrowsky
      Ending racism is a journey taken together; the starting point must be now
      Laura Lee Hall and Gary Puckrein
      Increased flu vaccination has never been more important for communities of color
      John Daniels Jr.
      Health equity: Making the journey from buzzword to reality
    • In-person visitation must be part of the national COVID-19 response
      We've lost so much to the pandemic, but we've also made gains that will endure
      Medical groups key to meeting president's vaccine pledge
      We need a better social care referral loop, but it requires technology as well as the human touch
    • Letters: Eliminating bias in healthcare needs to be ‘deliberate and organic’
      Letters: Maybe dropping out of ACOs is a good thing for patients
      Letters: White House and Congress share blame for lack of national COVID strategy
      Letters: VA making strides to improve state veterans home inspections
    • Sponsored Content Provided By Optum
      How blockchain could ease frustration with the payment process
      Sponsored Content Provided By Optum
      Three steps to better data-sharing for payer and provider CIOs
      Sponsored Content Provided By Optum
      Reduce total cost of care: 6 reasons why providers and payers should tackle the challenge together
      Sponsored Content Provided By Optum
      Why CIOs went from back-office operators to mission-critical innovators
  • Awards
    • Award Programs
    • Nominate
    • Previous Award Programs
    • Other Award Programs
    • Best Places to Work in Healthcare Logo for Navigation
      Nominations Open - Best Places to Work in Healthcare
      Nominations Open - 50 Most Influential Clinical Executives
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top 25 Innovators
    • Minorities in Healthcare
      • - Luminaries
      • - Top 25 Minority Leaders
      • - Minorities to Watch
    • Women in Healthcare
      • - Luminaries
      • - Top 25 Women Leaders
      • - Women to Watch
    • Excellence in Nursing Awards
    • Design Awards
    • Top 25 COOs in Healthcare
    • 100 Top Hospitals
    • ACHE Awards
  • Events
    • Conferences
    • Galas
    • Webinars
    • COVID-19 Event Tracker
    • podium march webinar logo lockup
      Sponsored Content Provided By Podium
      Webinar: Critical Touchpoints for Every Patient’s Journey — How Technology Plays an Important Role
      scp health logo lockup march 2021
      Sponsored Content Provided By SCP Health
      Webinar: COVID’s call to action — Reset for success in 2021
    • Women Leaders in Healthcare Conference
    • Social Determinants of Health Symposium
    • Healthcare Transformation Summit
    • Leadership Symposium
    • Virtual Briefings
      • - Hospital of the Future
      • - Mental Health
      • - Patient Safety & Quality
      • - Strategic Marketing
      • - Virtual Health
      • - Workplace of the Future
    • Best Places to Work Awards Gala
    • Health Care Hall of Fame Gala
    • Top 25 Minority Leaders Gala
    • Top 25 Women Leaders Gala
  • Listen
    • Podcast - Next Up
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
    • Next Up Podcast: Educating patients on the COVID-19 vaccine with Tanya Andreadis
      Dr. Joseph Cacchione
      Next Up Podcast: Educating patients on the COVID-19 vaccine with Dr. Joseph Cacchione
      Dr. Karen DeSalvo
      Next Up Podcast: What to expect with telehealth and healthcare technology in the next four years
      Carter Dredge
      Next Up Podcast: Ready, set, innovate! Innovation and disruption in healthcare
    • Beyond the Byline: Insurers are betting on virtual-first plans as COVID-19 shifts care pathways
      Beyond the Byline: How residents' stories shape our coverage of the vaccination rollout in nursing homes
      Beyond the Byline: Regulators aim to boost value push with fraud and abuse law updates
      An older man wearing a mask receiving a vaccine.
      Beyond the Byline: Verifying information on the chaotic COVID-19 vaccine rollout
    • Outreach during COVID-19
      Leading intention promote diversity and inclusion
      Introducing Healthcare Insider Podcast
    • The Check Up: Dr. Imran Andrabi
      The Check Up: Dr. Imran Andrabi of ThedaCare
      The Check Up: Tanya Blackmon
      The Check Up: Tanya Blackmon of Novant Health
      The Check Up: Dr. Patrick Hwu
      The Check Up: Dr. Patrick Hwu of the Moffitt Cancer Center
      The Check Up: Suresh Gunasekaran
      The Check Up: Suresh Gunasekaran of the University of Iowa Hospitals & Clinics
    • ivana naeymi-rad one on one intelligent medical objects
      Video: Ivana Naeymi Rad of Intelligent Medical Objects
  • MORE +
    • Advertise
    • Media Kit
    • Newsletters
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Breadcrumb
  1. Home
  2. Government
August 26, 2019 07:06 PM

Surprise medical billing legislation threatened by provider lobbying

Susannah Luthi
  • Tweet
  • Share
  • Share
  • Email
  • More
    Print

    Physician groups' public relations, advertising and lobbying blitz against Congress' front-line proposals to end surprise medical bills reached such a pitch this month that congressional staff worry the entire effort will collapse.

    A dark-money group is spending millions on an ad campaign targeting vulnerable senators. State and national hospital and physician groups are working their delegations.

    And all the opposition is jeopardizing Congress' ability to get anything done this year. Some on Capitol Hill are convinced that's exactly the lobbying groups' goal.

    "It's not a matter of tweaks to get providers to stand down, it's that provider groups don't want to see a solution here," said one congressional aide close to negotiations, who requested anonymity to speak freely. "They want the status quo. They've charted out where Congress could end up, and they are ready for the whole thing to come down. For them, surprise billing can stay in the mix."

    Another staffer said the aggressive campaigning has left policy aides skeptical that the groups actually do want to get patients "out of the middle."

    "Our question is, what happened to their commitment to protecting the patients?" that aide said, adding: "It shows just how big of a cash cow this practice is, that they're willing to pour millions of dollars into fighting these bills."

    Shawn Gremminger, senior director of federal relations for the consumer advocacy group Families USA, concurred. "Both sides (insurers and providers) are looking at this from a risk-reward perspective of: What makes the most sense?" Gremminger said. "For them, doing nothing is the best solution, which pretty much tells you why we're seeing what we're seeing, although they won't publicly say it."

    Provider groups are adamant this isn't the case.

    "We want to see legislation," said Chip Kahn, CEO of the Federation of American Hospitals, which represents for-profit hospitals. "It's a problem we can't solve ourselves—I wish we could—and we need legislation to ensure patients don't suffer from sticker shock, that their copayments are reasonable and within the bounds of their coverage."

    Tom Nickels, executive vice president for the American Hospital Association, said that while the group is working with Congress on a compromise, an "up-or-down vote on either the Senate HELP or House Energy and Commerce Committee proposal is unlikely to be the choice Congress will face on this matter."

    Hospitals and physician groups are each waging war on the issue, but they aren't necessarily on the same page about what a policy fix should look like—beyond the fact that they oppose the proposals that set a "benchmark" rate cap of charges for all out-of-network treatment proposed by Senate and House health committee leaders.

    These measures would use a typical insurer-negotiated rate as the benchmark for what insurers would pay for out-of-network treatment. Senate health committee Chair Lamar Alexander (R-Tenn.) and ranking member Patty Murray (D-Wash.) co-sponsored the policy in the upper chamber and Energy and Commerce Chair Frank Pallone (D-N.J.) and ranking member Greg Walden (R-Ore.) led the effort in the House.

    Pallone and Walden added a limited arbitration option for certain specialty cases, and Alexander has signaled he's open to tweaks to his proposal as well.

    But that hasn't softened the opposition from either doctors or hospitals. The growing perception on Capitol Hill is that balance billing, reportedly isolated to bad actors, has trickled into the provider business model as leverage for higher rates—particularly with the rise of physician staffing companies. Provider groups counter this by saying they want to contract with networks. But they also want leverage with insurers.

    Meanwhile, they have accelerated efforts to prevent a vote on the benchmark proposal since lawmakers left Washington for their home states for the August recess. One aide described the past month as a "pummeling" of lawmakers—in district meetings, in local newspapers and on TV. The most visible opposition came from physician groups and their coalitions.

    In Alexander's home state of Tennessee, a series of op-eds coordinated by the Tennessee Medical Association has gone after his legislation. TMA Vice President Dave Chaney said the group decided on an opinion campaign shortly after discussing the health committee bill with Alexander.

    Chaney said the TMA is lobbying the state's delegation around a provider-friendly arbitration proposal by Reps. Raul Ruiz (D-Calif.) and Phil Roe (R-Tenn.), both physicians.

    The organization has also coordinated with a separate coalition called Out of the Middle. The Out of the Middle website lists the American College of Emergency Physicians, American Society of Anesthesiologists, College of American Pathologists, the American College of Radiology, specialty surgeon groups and others as its members, but has no contact information.

    Lawmakers aren't just facing physician groups and their medical associations. The AHA has also asked its member hospitals to go directly to their representatives and senators to lobby against the benchmark proposal.

    Meanwhile, opinion-writing campaigns similar to what's running in Tennessee have sprung up around the country, with messages tailored to regional politics. To win over conservatives, these op-eds refer to the benchmarking proposal as rate-setting.

    "Giving the government greater control over our health care is a treacherous road," said one op-ed in North Carolina's Jacksonville Daily News. The author, Jay Reinstein, is a local community leader recently diagnosed with Alzheimer's disease.

    His argument appeared tailored for North Carolina Sen. Thom Tillis, a vulnerable Republican. A similar point was made by a Scottsdale, Ariz., city councilwoman in the Scottsdale Independent. GOP Sen. Martha McSally faces a potentially tough race in 2020.

    To appeal to Democrats, editorials say benchmarking threatens rural hospitals and could undercut the healthcare safety net—as was opined in Minnesota's Post-Bulletin in late July by Dr. Timothy Johnson, president-elect of Minnesota's ACEP chapter.

    Even more ubiquitous are dark money-funded TV ads, targeting senators everywhere but especially vulnerable ones.

    The Center for Responsive Politics first reported the August blitz from the obscure group Doctor Patient Unity. Its website doesn't publish any affiliations, and the physical address listed belongs to the law firm Holtzman Vogel Josefiak Torchinsky. The firm declined to give any information about the group, citing client confidentiality.

    Doctor Patient Unity has spent about $13 million on TV ads, Bloomberg Government found in its own investigation. The ads attack the Senate and House "rate-setting" policy.

    Most of the spending has targeted Tillis and GOP Sens. David Perdue of Georgia, Cory Gardner of Colorado and McSally of Arizona.

    Physicians for Fair Coverage, yet another tax-exempt group that represents specialty physician companies including US Acute Care Solutions and Radiology Partners, is running similar ads and working on "grass-roots" state campaigns against the benchmark policy. A spokeswoman for the group, Megan Taylor, says its membership wants the billing problem resolved. "PFC supports legislation that protects patients from balance bills and addresses bad behavior because we value our relationships with health plans and have negotiated very productive arrangements, including value-based contracts," Taylor wrote in a statement.

    Then there's the lobbying money at the federal level. According to the Center for Responsive Politics' latest 2019 tallies, the AHA has spent $10.2 million and the American Medical Association has spent $11.5 million. Only a portion of the money may be going toward balance billing.

    BGR Group spent about $220,000 representing Physicians for Fair Coverage, which separately spent $145,000. The American College of Emergency Physicians has spent $1.2 million, American Society of Anesthesiologists has spent $500,000 and College of American Pathologists has spent nearly $770,000.

    Amid the PR and policy battle, even lobbyists are divided about where the debate is going wrong.

    "The fact that industry on both sides could scare Congress into inaction on an issue that is financially ruining Americans through no fault of their own is unconscionable," said one provider lobbyist, who wants a "split the baby" policy that "doesn't destabilize the relationship between providers and payers."

    Another healthcare lobbyist complained that the Senate health committee early on "turned the hearing aids off" to provider groups.

    "We just don't want rate regulation, and (Sen. Alexander) is headed in that direction, which frankly has nothing to do with the problem," that lobbyist said.

    A third lobbyist for physicians posited that the thought of losing leverage to insurers has further ratcheted up tension for the doctors.

    "When you do see somebody advocating for their sector and they're saying something that isn't favorable about the other side, you get defensive about it," the lobbyist said. "And it detracts from the common goal, which you forget—we've all basically agreed we want to protect patients and get them out of the middle."

    It's unclear now exactly how the debate will move forward once Congress is back.

    "That groups are trying to kill (the policy) entirely cuts against what they are saying publicly—which is that they agree this is a problem, that they only disagree on how to solve it," one Senate aide said.

    Gremminger put it this way: "What we've seen (from industry) is, 'First, protect me financially. And to the extent we can then take patients out of the middle, that's great.' "

    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    States rush to catch up on delayed vaccines, expand access
    States rush to catch up on delayed vaccines, expand access
    Feds OK’d export of millions of N95 masks as U.S. workers cried for more
    Feds OK’d export of millions of N95 masks as U.S. workers cried for more
    Sponsored Content
    Get Free Newsletters

    Sign up for free enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today

    The weekly magazine, websites, research and databases provide a powerful and all-encompassing industry presence. We help you make informed business decisions and lead your organizations to success.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS
    • Instagram

    Stay Connected

    Join the conversation with Modern Healthcare through our social media pages

    MDHC_Logotype_white
    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2021. Crain Communications, Inc. All Rights Reserved.
    • News
      • This Week's News
      • COVID-19
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition
    • Insights
      • ACA 10 Years After
      • Best Practices
      • Special Reports
      • Innovations
    • Transformation
      • Patients
      • Operations
      • Care Delivery
      • Payment
    • Data/Lists
      • Rankings/Lists
      • Interactive Databases
      • Data Points
    • Op-Ed
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Awards
      • Award Programs
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top 25 Innovators
        • Minorities in Healthcare
          • - Luminaries
          • - Top 25 Minority Leaders
          • - Minorities to Watch
        • Women in Healthcare
          • - Luminaries
          • - Top 25 Women Leaders
          • - Women to Watch
      • Nominate
      • Previous Award Programs
        • Excellence in Nursing Awards
        • Design Awards
        • Top 25 COOs in Healthcare
      • Other Award Programs
        • 100 Top Hospitals
        • ACHE Awards
    • Events
      • Conferences
        • Women Leaders in Healthcare Conference
        • Social Determinants of Health Symposium
        • Healthcare Transformation Summit
        • Leadership Symposium
        • Virtual Briefings
          • - Hospital of the Future
          • - Mental Health
          • - Patient Safety & Quality
          • - Strategic Marketing
          • - Virtual Health
          • - Workplace of the Future
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Minority Leaders Gala
        • Top 25 Women Leaders Gala
      • Webinars
      • COVID-19 Event Tracker
    • Listen
      • Podcast - Next Up
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • MORE +
      • Advertise
      • Media Kit
      • Newsletters
      • Jobs
      • People on the Move
      • Reprints & Licensing