Enjoy your NCMS Morning Rounds!

June 28, 2019

Federal Debate Continues Over Surprise Billing Legislation

Earlier this week the US Senate Health, Education, Labor and Pensions (HELP) Committee passed S. 1895, the Lower Health Care Costs Act, which included provisions related to protecting patients from surprise medical bills. Unfortunately, this proposal would use benchmarks to set prices when patients cannot see in-network physicians, while the NCMS and other physician groups favor arbitration to set these prices. Thankfully, other legislation (the Ruiz-Roe bill), which has been introduced in the US House, is based on New York’s arbitration model. The debate will continue next week on Capitol Hill.

NCMS CEO Robert W. Seligson, MBA, MA has been highly engaged in this issue both in his role with the NCMS and as President of the Physicians Advocacy Institute. His latest statement on the topic, below, was picked up by the national trade press.

Seligson’s statement on the legislative proposals addressing surprise billing:

“Surprise medical bills have become an American epidemic as health insurers continue shifting their financial responsibility for the cost of care directly onto consumers through increasingly high deductibles and restricted provider networks.

“Physicians applaud the Senate HELP Committee for holding patients financially harmless for out-of-network services when they cannot choose in-network providers. However, we remain deeply concerned that arbitrary, government-set payment benchmarks championed by the health insurance industry will further undermine provider networks and devastate patients’ access to critical medical services.

“As Congress continues discussing solutions, it would be shortsighted to endorse an approach that will curtail patients’ access to essential medical care, especially in an emergency. Artificial payment benchmarks give insurers even more power to refuse contracts with doctors, leaving more out-of-network and pushing down payments to levels even below the true cost of medical care across the board.

“Congress should support the ‘Protecting People From Surprise Medical Bills Act,’ sponsored by Congressmen Raul Ruiz (D-CA) and Phil Roe (R-TN), because it implements New York’s successful approach, which is deterring some disputes from reaching arbitration, using fair, transparent and independent data to inform resolution, and keeping premium growth below the national average.

“Patients deserve a solution that holds them harmless from surprise medical bills and ensures they can see the doctors they need in an emergency.”

Thank you for the more than 1,000 responses to our Action Alert this week. Your Congressional representatives know you’re paying attention to this issue. Watch your NCMS Morning Rounds for updates in the coming days and weeks.

Calling All NCMS PA Members!

Please help out your colleague Quinette Jones, PA-C, a 2019 Leadership College scholar. This Kanof Institute for Physician Leadership program requires participants do a research project, and as part of her project, Jones is surveying the PA community about their experiences with leadership. She is asking PAs to take this brief survey, which takes less than five minutes to complete, and will help inform development of leadership training and opportunities in PA education and professional practice. The survey is open until July 14. If you have questions, please email Jones at [email protected]

Take the survey.

The results of this and the other 2019 Leadership College Scholars’ research projects will be presented through MEDTalks at the NCMS LEAD Health Care Conference, Oct. 3-4 in Raleigh. Watch previous scholars’ MEDTalks.

Kudos to WakeMed Cardiologist Williams

Congratulations to WakeMed cardiologist and NCMS member Judson Williams, MD for implementing an enhanced recovery after surgery (ERAS) program at WakeMed. As reported recently in the Triangle Business Journal and a WRAL-TV broadcast, the program has dramatically improved heart surgery recovery times. In the first three months since implementation, aggregate time spent in the ICU for a heart surgery patients has been reduced from 43 hours to 28 hours and resulted in a more than 30 percent decrease in ICU readmission rates. Dr. Williams and his partner in the design of the system, Gina McConnell, BSN, RN, CCRN, believe their ERAS program will be replicated widely, according to the media reports.

You may have already read about this if you subscribe to the Journal of the American Medical Association Surgery, where an article about the research behind the process is the most viewed article in the history of the Journal.

Congratulations to Dr. Williams and Gina McConnell!

In the News

This Doctor Knew He Was Dying. He Couldn’t Get His Own Physician to Admit It, The Advisory Board Forum, 6-18-19

Learning Opportunity

Registration for the North Carolina Institute of Medicine’s (NCIOM) Annual Meeting on North Carolina’s transformation of Medicaid, is now open. The meeting will be held Thursday, Sept. 5, from 9 a.m. to 4 p.m. at the McKimmon Center in Raleigh, and will focus on the state’s transition to Medicaid managed care. Learn more and register.