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February 29, 2020 01:00 AM

Letters: Arbitration is better approach to end balance billing

Modern Healthcare
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    Pile of medical bills
    Modern Healthcare Illustration / Getty Images

    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
    Lebanon, N.H.

    Physician assistants help improve access to primary care

    The recent letter from AANP CEO David Hebert identifies NPs as a solution to this country’s primary-care physician shortage. But his comments overlook another vibrant solution to this healthcare crisis: the 139,000+ physician assistants currently practicing in America.

    PAs are one of the fastest-growing professions in healthcare. A recent report by the National Commission on Certification of Physician Assistants shows that the PA workforce grew by 6.6% between 2017 and 2018. Almost every state saw an increase, some in the double digits: Rhode Island (13.7%), Arkansas (11.4%), and Nevada (11.3%).

    This is good news for American patients and our healthcare system. The Association of American Medical Colleges’ 2019 data reaffirmed a shortage of up to 122,000 physicians by 2032. With 25% of PAs in primary care, PAs are well positioned to continue meeting patient needs as physician populations dwindle. In four states with more rural populations, almost half of PAs are in primary care: Alaska (50.4%), North Dakota (47.6%), Wyoming (44.9%), South Dakota (42.5%). PAs also meet surgical and emergency medicine needs, with over 40% working in hospitals.

    Dawn Morton-Rias, Ed.D.
    President and CEO
    National Commission on Certification of Physician Assistants

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