American College of Surgeons opposes the "Stop Surprise Medical Bills" legislation introduced by Senator Cassidy and the bipartisan Senate working group

The legislation gives one-sided power to the health plans and does not appropriately address the root causes of the problem

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American College of Surgeons

May 16, 2019, 16:51 ET

WASHINGTON, May 16, 2019 /PRNewswire/ -- Today, the American College of Surgeons (ACS) announced its opposition to the legislation introduced by Senator Bill Cassidy (R-LA) titled "Stop Surprise Medical Bills." Unfortunately, the legislation is written in a manner that provides unbalanced power to the health insurance industry.

In setting payment rates for out-of-network physicians, the legislation uses insurer-dictated median in-network rates as the amount the plan pays the physician. This approach will likely have two major consequences:

For those physicians who want to be part of the health plans network, the ability to negotiate a payment rate with the health plan will be unfairly biased towards the plan.
For those physicians who are currently in-network and paid above the median in-network rate, the health plan will have the unfettered power to lower the rate paid to those physicians with no realistic alternative for the physician.

While the American College of Surgeons supports an arbitration process, this legislation allows the health plans to include the costs of arbitration as part of "medical care costs" in their medical loss ratio. This legislation once again gives the health plans a generous gift as they work to manipulate health care costs to their advantage.

Further, the bill allows the arbitrator to use insurance-controlled data rather than an independent database for benchmarking purposes. The ACS believes that an independent database, such as FAIR Health, which is used successfully in New York, is essential to maintaining the integrity of the arbitration process.

The American College of Surgeons is committed to working with Congress to develop legislation that would address the important issue of surprise medical billing. Such a solution should strike a balance between hospitals, insurers and physicians, while keeping patients out of the middle. The ACS believes that this legislation needs to be developed in a holistic manner, whereby all the root causes of this problem are appropriately addressed. Unfortunately, the proposal released today does not accomplish this goal.

About the American College of Surgeons
The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 82,000 members and is the largest organization of surgeons in the world. For more information, visit www.facs.org.

SOURCE American College of Surgeons