House panel puts hospitals and specialists on the spot for surprise bills

April 02, 2019 / SUSANNAH LUTHI 

Hospitals took a beating in the first House legislative hearing on surprise medical bills, and major trade groups followed up with a letter to the committee leaders to defend their position.

The House Education and Labor Committee’s health panel convened the bipartisan hearing and pointedly called witnesses from the policy and consumer advocacy worlds rather than industry.

“I think everyone is trying to figure out ways to come to the table, but right now, I think not a lot of people have much patience left for providers and the games that they play,” said Shawn Gremminger, senior director for federal relations at the liberal advocacy group Families USA, after the hearing.

As the hearing wrapped up, the American Hospital Association, the Federation of American Hospitals and the American Medical Association sent a letter to Committee Chair Bobby Scott (D-Va.) and Ranking Member Virginia Foxx (R-N.C.). They stated groups’ support for legislation to limit patients’ bills to their in-network co-pays but urged lawmakers to keep it simple.

AHA’s Executive Vice President Tom Nickels noted the panel’s criticisms of hospitals and said it was “unfortunate” there weren’t any providers on the panel “to be able to address those issues.”

“One reason we sent the letter today, though not the only reason, was to get our view of the issues out there,” he said.

In one exchange, freshman Rep. Lauren Underwood (D-Ill.), a registered nurse and former HHS official under the Obama administration, questioned Christen Linke Young of the Brookings Institution on the role of specialty physicians in surprise medical bills. She focused on neonatologists who take care of babies who need intensive care after birth.

Young, a fellow at the USC-Brookings Schaeffer Initiative on Health Policy at Brookings, described specialists who practice in hospitals as having a captive audience and little incentive to accept hospital terms that will limit their pay.

“Once a provider like an anesthesiologist or neonatologist is in the hospital practicing, they will receive a flow of patients whether or not they contract with insurance company networks and regardless of what price they set,” Young said. “That neonatologist, when they’re in the hospital, will be then taking care of those babies, and they have a very limited incentive to join an insurance network and accept a negotiated contract rate.”

She said the key is for lawmakers “to get rid of that set of incentives and encourage them to get back in network for their payment.”

In another exchange, GOP Rep. Dan Meuser of Pennsylvania asked another witness, Ilyse Schuman, to lay out the role hospitals play in the issue. Schuman is the senior vice president of health policy for the American Benefits Council.

Schuman told the panel that hospitals “play a critical role in this.”


Chris J. Stewart

Chris currently serves as President and CEO of Surgio Health. Chris has close to 20 years of healthcare management experience, with an infinity to improve healthcare delivery through the development and implementation of innovative solutions that result in improved efficiencies, reduction of unnecessary financial & clinical variation, and help achieve better patient outcomes. Previously, Chris was assistant vice president and business unit leader for HPG/HCA. He has presented at numerous healthcare forums on topics that include disruptive innovation, physician engagement, shifting reimbursement models, cost per clinical episode and the future of supply chain delivery.

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