There is a very heated debate going on right now on Capitol Hill regarding federal legislation to end surprise medical bills. The goals are fairly universally-aligned across partisan lines but the means to achieve those goals couldn’t be more disparate. From hospital-bundling of all practitioner rates to arbitration paradigms, the lobbyists are out in full force. In my experience, legislation that results from intense lobbying breeds unintended consequences. Provider burnout, over-crowded hospitals, diminishing networks, increasing patient cost-sharing (both in- and out-of-network), a monopolistic health plan model, pharmaceutical costs, etc. are all different cause and effect sides of the ever-complex and dysfunctional healthcare industry. So much so that even a limited focus on addressing surprise medical bills has launched a debate so vigorous that it makes the promise of a macro solution to our broken healthcare system even more bleak.
Putting cynicism aside… as one of the most experienced and early users of the New York IDR construct, I was pleased to see Sen. Bill Cassidy (R-La.) cited as leaning towards our State’s arbitration approach – “If the states are laboratories of democracy, we can see a laboratory experiment which seems to [have] worked.” While certainly not perfect, New York’s law has, in my opinion, addressed the problem in a thoughtful and effective way upon which we can build and tighten.
Although oNet consistently advocates for ways to better achieve the goals of our IDR system in a way that protects both the patients and their providers who answer the call, it is indisputable that New York’s law has proven to be one that should be emulated and embraced, especially for its application of a market-based and transparent FAIR Health reimbursement benchmark. Having been tested now for over four years without evidence of benchmark inflation, New York’s law has shown itself to be an effective model for application on the federal level to ERISA plans. Sen. Cassidy was smart and right to take notice of an existing solution that works.
For more information on oNet Systems LLC and how we can arbitrate for your practice, please contact us any time at 516-388-5110.
This blog does not provide legal advice and does not create an attorney-client relationship. If you need legal advice, please contact an attorney directly.