The editorial “Time for compromise on balance billing” endorses a benchmark payment rate to curb the practice of surprise billing. If passed, such legislation will squeeze hospital emergency departments to a dangerous level.
In an emergency, patients don’t question whether their physician is “in-network” or “out-of-network,” and they shouldn’t. The Emergency Medical Treatment and Active Labor Act ensures that patients receive appropriate medical screenings and stabilization in an emergency department, regardless of ability to pay. This unfunded mandate of emergency providers and hospitals is unique to the ED setting, and does not apply to other outpatient clinics and medical offices.
Emergency physicians and hospitals understand that some treatment will go uncompensated. It’s part of the business of ethically providing care to all emergency department patients, and a natural consequence of the unfunded EMTALA mandate.
But the financial burden is real. Hospitals have provided an excess of $660 billion of uncompensated care over the past 20 years, according to the American Hospital Association, absorbing a notable payment gap between cost of care rendered and payments received.
Rather than projections, a real-life example of a better solution to surprise billing is an arbitration system that has been in effect in New York state since 2015. Contrary to claims that arbitration will balloon spending, the New York State Department of Financial Services reported that the surprise billing law has saved consumers over $400 million between March of 2015 and the close of 2018. Furthermore, out-of-network billing was reduced by 34%.
Dr. Aida Cerundolo
Emergency medicine physician