The focus on “surprise” or out-of network bills continues, with many potential solutions being considered and implemented in a number of states. Bloomberg reports on a solution based on a Major League Baseball style arbitration which is in effect in several states including New York. In this construct, disputed bills place the doctor and the insurer into arbitration. Each side submits a price for services delivered and the arbitrator must choose one of the offers. This model in theory requires both parties to moderate their price request since the arbitrator must pick one or the other. Outrageous pricing by either party will likely lead to a ruling for the other.
EHC NOTE: The spotlight on out-of-network billing will clearly have an impact on the leverage of anesthesia and other hospital based physician groups in payer contract negotiations. Some state rules are in place and more are under consideration, many of which place a limit on payments to “in-network” levels. The definition of in-network is often open to interpretation and as most anesthesia providers are aware, in-network rates vary significantly even in the same city or state. Ultimately, these changes shift negotiating power to payers and will likely lead to a flattening of the rates among groups toward the average. This will result in relative winners and losers, with those negatively impacted likely to approach hospital leadership for increasing levels of support to maintain provider compensation.