CEO Report - Protecting Patients from Surprise Medical Bills
Posted on November 07, 2019
“The employer does not pay the wages. The employer only handles the money. The customer pays the wages.” - Henry Ford
For some time now, we have been expressing our belief that Michigan healthcare is becoming more integrated, more value-driven and more transparent. Under the banner of transparency, the patients we serve – and the families and companies who ultimately foot the bill – are demanding more detailed, comprehensive and timely information about the quality and cost of the care they receive. At the same time, we have also been lifting up the importance of patient-centered care and ensuring that everything we do puts the patient – the customer – first. The rise of patient-family advisory councils is but one example of this trend.
The issue of surprise medical billing resides at the intersection of this demand for greater transparency and the focus on patient-centered care. In 2019, surprise billing has dominated headlines and sparked activity by state and federal policymakers. There are three situations where a patient typically receives a surprise or balanced bill:
1) A patient receives emergency treatment from an out-of-network provider.
2) A patient receives care from an in-network hospital; however, an out-of-network physician is involved in the care, unbeknownst to the patient.
3) A health plan denies coverage by deeming the services provided were unnecessary.
In each case, these billing scenarios place a considerable burden on Michigan patients and their families and cause undue mental, physical and financial stress at a time when recovery should be at the forefront of their minds. Thus, regardless of how a surprise bill occurs, the MHA supports efforts to protect patients from any balanced billing scenario and take them out of the middle of any payment negotiation between the provider and the payer. In cases where a patient is seen by an out-of-network provider, we strongly believe that the maximum a patient should pay for the procedure would be whatever their deductible, co-pay or coinsurance is for an in-network services. The remainder would be negotiated between the provider and the payer.
Well before this issue was publicized, hospitals have actively tried to address surprise billing. Prior to the MHA advocating on the issue, our members have sought to have specialty physician groups contract with the same insurer networks as the hospital, maintaining continuity of coverage for every patient.
While we support legislative efforts to address balance billing, the MHA opposes legislatively setting rates due to the negative effects it can have on patients. Currently, the MHA has taken a neutral position on two bills in the Michigan House that seek to address surprise billing (House Bills 4459 and 4460). Through MHA advocacy efforts, we have successfully pursued changes to the bill package that maintain hospitals’ ability to negotiate insurer contracts while removing the patient from billing negotiations. Assisting our efforts was the creation of an MHA infographic to help inform state legislators on the issue and how surprise billing may occur.
We have also been collaborating at the federal level with the American Hospital Association (AHA), which earlier this year submitted a letter to Congress and committee leadership on behalf of hospitals, health systems and other healthcare organizations expressing their full commitment to protecting patients from surprise bills. At the same time, the AHA released surprise billing principles that effectively summarize the position of the hospital field.
Finally, MHA Board Chairman John Fox of Beaumont Health had a recent op-ed published by Crain’s Detroit Business that details the efforts Beaumont has taken to address the issue. Hospitals across Michigan have undertaken similar steps, and all believe that eliminating surprise billing helps our patients and fulfills the MHA’s mission of advancing the health of individuals and communities. By protecting our patients as much as possible, we can create healthier communities across our state.
As always, I welcome your thoughts.
Posted in: MHA Rounds