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 “The IFR established by the administration will
hit anesthesiology, radiology and emergency medicine hard across the
country, especially in small, rural or marginalized communities,”
said ASA President Randall M. Clark, M.D., FASA. “Some practices
will be forced to make difficult decisions on how to spread already
thin resources to continue to treat all patients safely.”
“The regulatory language guiding the implementation of this law is
fundamentally flawed and must be addressed,” said Gillian Schmitz,
MD, FACEP, president of ACEP. “Rather than the compromise
meticulously crafted to solve surprise bills as Congress intended,
the administration has turned this law into an open invitation for
insurance companies to strongarm physicians out of network.”
“Without regard for patient impact, insurers are using the federal
rule to narrow provider networks, which will deny patients’ access
to their chosen providers and inflate already record insurer
profits,” said Howard B. Fleishon, MD, MMM, FACR, chair of the
American College of Radiology Board of Chancellors. “Rural and
underserved communities may be hit hardest by this overreach that
can result in longer wait times for care, delayed diagnosis and
higher out of pocket costs to treat more advanced conditions. The
court can stop this now by granting our motion for summary judgement.“
The No Surprises Act gives patients financial protection against
surprise medical bills and prohibits balance billing for certain
out-of-network (OON) services or care. In the law, an independent
dispute resolution (IDR) entity is required to consider six factors
when determining the payment amount for OON bills: 1) the insurer’s
in-network rate, known as the qualifying payment amount; 2) the
provider’s training, experience, and quality of care; 3) the
provider’s and insurer’s market share; 4) the acuity and complexity
of the care; 5) the provider’s teaching status, case mix, and scope
of services; and 6) the good-faith efforts of the provider and
insurer to contract for in-network rates.
What the administration did instead was “set one factor—the
insurer’s in-network rate—as presumptive,” according to the motion
for summary judgement. “The IFR’s presumption in favor of insurers’
in-network rates will empower private health insurers to drive down
payment, imperiling physicians and their patients’ access to care.”
The motion for summary judgement states that the
IFR “violates the plain language of the No Surprises Act, exceeds
the department’s authority granted by Congress, thwarts the purpose
of the statute, is inconsistent with the legislative history of the
No Surprises Act, and was promulgated in violation of the
Administrative Procedure Act (APA).”
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In their filing, ASA, ACEP and ACR ask the court to find the
administration’s IFR “unlawful” because it is “arbitrary,
capricious, an abuse of discretion, or otherwise not in accordance
with law;” “without observance of procedure required by law;” and
“in excess of statutory jurisdiction, authority, or limitations, or
short of statutory right.”
Health insurers’ net incomes and profit margins have grown each year
since 2015 — including record profits in 2020 — even as their costs
dropped. Insurance premiums continue to rise. Record insurer profits
have not led to reduced premiums for beneficiaries. There is no
indication — nor proof — that insurer profit increases gained via No
Surprises Act-related network restrictions would result in lower
costs to patients. Neither the lawsuit nor the filing for summary
judgement impact patient protections in the new law nor increase
patient health care costs.
##
Founded in 1905, the American Society of Anesthesiologists (ASA) is
an educational, research and scientific society with more than
55,000 members organized to raise and maintain the standards of the
medical practice of anesthesiology. ASA is committed to ensuring
physician anesthesiologists evaluate and supervise the medical care
of patients before, during and after surgery to provide the highest
quality and safest care every patient deserves. For more information
on the field of anesthesiology, visit the American Society of
Anesthesiologists online at asahq.org. To learn more about the role
physician anesthesiologists play in ensuring patient safety, visit
asahq.org/made
forthismoment. Like ASA on Facebook and follow ASALifeline on
Twitter.
The American College of Radiology (ACR), founded in 1924, is a
professional medical society dedicated to serving patients and
society by empowering radiology professionals to advance the
practice, science and professions of radiological care.
The American College of Emergency Physicians (ACEP) is the national
medical society representing emergency medicine. Through continuing
education, research, public education, and advocacy, ACEP advances
emergency care on behalf of its 40,000 emergency physician members,
and the more than 150 million Americans they treat on an annual
basis. For more information, visit
www.acep.org and
www.emergencyphysicians.org.
[By
Steve Arnoff]
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