American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

ACS Advocacy Efforts Focus on Unanticipated Medical Billing Issues

Congress is reviewing multiple proposals to address the issue of surprise medical billing. As these legislative packages are developed, the American College of Surgeons (ACS) has been working with lawmakers to advocate for solutions that would best serve surgical patients and maintain the patient-physician relationship.

Sen. Bill Cassidy, MD (R-LA), and other members of the Senate Bipartisan Working Group, recently introduced the Stop Surprise Medical Bills Act, S. 1531. The ACS opposes this bill because it would give one-sided negotiating power to health plans, allowing insurers to use a median contracted rate as the benchmark payment rate for out-of-network physicians and to apply arbitration costs in determining their medical-loss ratio. Read the ACS press release on the Stop Surprise Medical Bills Act.

House Committee on Energy and Commerce leaders used a similar strategy in developing its draft bill, the No Surprises Act. This bipartisan proposal also uses the median contracted rate as the benchmark payment for out-of-network physicians. Such a benchmark will have negative consequences for both out-of-network and in-network providers. For physicians who want to be part of the health plan’s network, payment negotiations would be unfairly biased towards the plan, whereas in-network physicians who are paid above the median in-network rate could be subject to lower rates in the future due to the increased power of the health plans. This provision would have consequences for years down the road as insurers seek to drive down the median in-network rate. Read the College's letter to the House Committee on Energy and Commerce.

The ACS supports federal legislation that is based on proven efforts to address surprise billing. Reps. Raul Ruiz, MD (D-CA), Phil Roe, MD (R-TN), and colleagues recently released such a framework, which is modeled on a New York law that provides comprehensive patient protections, maintains adequate networks of physicians and specialists, establishes reasonable payment benchmarks, and offers alternative dispute resolution in certain cases. Read the ACS press release.

In addition, the College submitted a statement to the House Committee on Ways and Means for its recent hearing, Protecting Patients from Surprise Medical Bills.

For further information on ACS efforts in this area, contact Kristin McDonald, Manager, Legislative and Political Affairs, at kmcdonald@facs.org, or visit the ACS website.