| Originally published on October 29, 2021 Updated November 2, 2021 [Austin, TX] — The Texas Medical Association (TMA) filed a lawsuit in federal district court in Tyler, Texas, after the Biden administration failed to follow clear direction from Congress about how to implement the dispute resolution process set forth in the No Surprises Act, legislation that was passed in 2020 to protect patients from surprise medical bills. “TMA supports the patient protection intent of the No Surprises Act,” TMA President E. Linda Villarreal, MD, said. “However, TMA’s lawsuit challenges one component of the administration’s rule that ignores congressional intent and unfairly gives health plans the upper hand in establishing payment rates when a patient receives care from an out-of-network physician, oftentimes in an emergency.” Congress intended to create a fair and unbiased process to resolve billing disputes between health insurance companies and physicians by ensuring that all relevant factors must be considered, with each given the weight deemed appropriate by the arbitrator. In contrast, the administration’s short-sighted approach will make it harder for patients to access care by driving down reimbursement rates and encouraging insurance companies to continue narrowing their networks. It will be difficult for small physician groups to keep caring for patients. “The lawsuit filed yesterday ensures that the protections for patients against balance bills will go into effect on Jan. 1, 2022, while seeking to stop the imminent harm to physicians and hospitals created by an unfair arbitration process,” Dr. Villarreal said. The recently released rule rewrites the statute by requiring the arbitrator in the independent dispute resolution process to presume that the qualifying payment amount (QPA), set by health insurance companies for patient cost-sharing purposes, is “the appropriate out-of-network rate.” This creates a bias that prioritizes offers closest to the QPA, rather than allowing arbitrators to exercise their discretion to weigh all relevant factors and select the reimbursement rate that most accurately reflects fair market reimbursement and individual circumstances. The TMA lawsuit asks the court to strike this section of the rule and instead restore the fair, balanced dispute resolution process that Congress created. The lawsuit also alleges a violation of the Administrative Procedure Act, which requires a formal notice and comment period in advance of finalizing such a rule. The agencies failed to solicit and incorporate comments from stakeholders for this crucial aspect of the law. “We wholeheartedly agree with U.S. Reps. Richard Neal’s (D-Mass.) and Kevin Brady’s (R-Texas) concern that the rule tips the scale in favor of insurance companies and will leave patients vulnerable,” Dr. Villarreal said. Representative Neal is chair of the U.S. House Ways and Means Committee, and Representative Brady is the past chair of the committee and currently ranking Republican member. “We are disappointed the Biden administration ignored congressional intent and essentially set up the arbitration system to operate like a casino, with health insurers playing the role of the house,” Dr. Villarreal said. “Everyone knows the house always wins. With the current rule, patients, physicians, and our country lose.” TMA is the largest state medical society in the nation, representing more than 55,000 physician and medical student members. It is located in Austin and has 110 component county medical societies around the state. TMA’s key objective since 1853 is to improve the health of all Texans. |
Andrew Selesnick to Discuss Legal Billing Issues Affecting Independent Emergency Physician Groups
IEPC is proud to present the 2021 Speaker Series, to continue on Monday, November 22 at 9 AM Pacific! This free speaker series will welcome leaders in the field to cover timely and engaging topics that are important to independent emergency physicians. The sessions will precede each monthly conference call and are open to all IEPC members and those who may be interested in joining.
Session: California Hospital Association and Independent Emergency Physicians
Presented by: Andrew Selesnick – Shareholder, Chairman of the Healthcare Litigation Practice Group
Time & Date: Monday, October 25 from 9:00 AM – 9:30 AM
This series will be presented on the fourth Monday of the month May – November. Advance registration is required and can be completed here. After registering, you will receive a confirmation email containing information about joining the meeting.
We hope to see you Monday!
IEPC Newsletter – November 2021
Click here to view a PDF of the newsletter.
In this issue:
• Stop Calling It Boarding – It’s ED Psychiatric Care
• California ACEP 2021 Legislative Review
• California Hospital Association 2021 Update
• AAEM Highlights of Legal Advocacy For Independent Emergency Physicians
• Trigger Point Injections
• Viewpoint In Emergency Medicine News
• IEPC Speaker Series
From the ACEP Advocacy Action Center: There is Still Time: We Need Your Help on Surprise Billing
There is still time to fight back and contact Congress about the second regulation released by the Biden Administration on surprise billing. A strong showing of bipartisan concern is critical to bring the Administration’s attention to the overreach and gross misinterpretation of the IDR section of this law and to compel their action to amend it to align with congressional intent.
Your advocacy is working, but we must keep the pressure on.
The letter circulating in Congress by Reps. Tom Suozzi (D-NY), Brad Wenstrup (R-OH), Raul Ruiz (D-CA) and Larry Bucshon (R-IN) is up to 124 signatures, equally supported by Democrats and Republicans in Congress. As stated in our communication to you last week, the letter addressed to HHS Secretary Becerra, Labor Secretary Walsh, and Treasury Secretary Yellen, urge their respective departments to follow the letter of the law and amend the IFR section of the No Surprises Act to align the law’s implementation with the legislation that Congress passed.
If you have not yet emailed your U.S. Representative, there is still time!
The second regulation, which sets forth how the critical independent dispute resolution (IDR) process will be implemented, is completely out of step with the final legislation, the No Surprises Act, that Congress voted on and passed last December. As intentionally designed by Congress, the IDR process was to offer a fair interaction between insurance companies and physicians once patients are out of the middle of billing disputes.
But instead, the new rule undermines the entire IDR process by requiring arbiters to greatly prioritize the artificially low Qualified Payment Amount (QPA), or median in-network rate, set by insurance companies, rather than giving equal weight to a mix of other factors which were prominently emphasized in the legislation (such as complexity of the case, level of training of the physician, etc.).
This approach is sure to drive payment rates lower and encourage insurance companies to narrow their networks even further, which would make it harder for patients to get emergency care. We now fear the viability of physician practices is at stake, and it will be harder for emergency physicians to care for patients, particularly in small or rural communities.
Click here to send a message to your U.S. House member. Ask them to sign on to the Suozzi/Wenstrup letter regarding the implementation of the IDR process in the No Surprises Act.
We must keep the pressure on the Biden Administration to enact the changes necessary to make sure this important legislation is implemented as Congress intended. Let them know that now is not the time to take away resources from emergency physicians who are needed on the front lines in communities across the country.
The letter closes on November 5, so please contact your legislator as soon as possible.
BJ Bartelson to Discuss California Hospital Association and Independent Emergency Physicians
IEPC is proud to present the 2021 Speaker Series, to continue on Monday, October 25 at 9 AM Pacific! This free speaker series will welcome leaders in the field to cover timely and engaging topics that are important to independent emergency physicians. The sessions will precede each monthly conference call and are open to all IEPC members and those who may be interested in joining.
Session: California Hospital Association and Independent Emergency Physicians
Presented by: BJ Bartelson, RN MS, NEA-BC – CHA VP, Nursing & Clinical Services
Time & Date: Monday, October 25 from 9:00 AM – 9:30 AM
This series will be presented on the fourth Monday of the month May – November. Advance registration is required and can be completed here. After registering, you will receive a confirmation email containing information about joining the meeting.
We hope to see you Monday!
Call for IEPC Member Announcements Due October 29
The next issue of the IEPC membership newsletter will be published in November. The purpose of this newsletter is to connect the IEPC membership with information, opportunities, resources, and each other.
We are very pleased to dedicate one section of this newsletter to recognize the professional accomplishments of our members but we need your help! Have you received awards or promotions, landed a great new job, or published an article or research in the last few months? We would like to know about it and celebrate your accomplishments in our newsletter!
Deadline: October 29, 2021
Members, please check your email for details regarding submission.
Mark Reiter to Discuss AAEM Priorities for the Independent Emergency Physician
IEPC is proud to present the 2021 Speaker Series, to continue on Monday, September 27 at 9 AM Pacific! This free speaker series will welcome leaders in the field to cover timely and engaging topics that are important to independent emergency physicians. The sessions will precede each monthly conference call and are open to all IEPC members and those who may be interested in joining.
Session: AAEM Priorities for the Independent Emergency Physician
Presented by: Mark Reiter MD, MBA, MAAEM – CEO, AAEM
Time & Date: Monday, September 27 from 9:00 AM – 9:30 AM
This series will be presented on the fourth Monday of the month May – November. Advance registration is required and can be completed here. After registering, you will receive a confirmation email containing information about joining the meeting.
We hope to see you Monday!
IEPC Newsletter – September 2021
Click here to view a PDF of the newsletter.
In this issue:
- The Deadly Cost of Psychiatric Boarding
- Emergency Personnel Are Scared Not of COVID, But of Violence
- Emergency Physician Staffing in the Wake of COVID
- Conflict of Interest of United Healthcare and Yale’s Study on Surprise Billing
- $3.8 Million Awarded to Physician Serves as Important Reminder About Fair Hearing Rights
- NEW IEPC Member Insurance Benefits Now Available!
Schneider to Discuss the Emergency Physician Workforce
IEPC is proud to present the 2021 Speaker Series, to continue on Monday, August 23 at 9 AM Pacific! This free speaker series will welcome leaders in the field to cover timely and engaging topics that are important to independent emergency physicians. The sessions will precede each monthly conference call and are open to all IEPC members and those who may be interested in joining.
Session: National The Emergency Physician Workforce
Presented by: Sandy Schnieder, MD, ACEP Director of EM Practice
Time & Date: Monday, August 23 from 9:00 AM – 9:30 AM
This series will be presented on the fourth Monday of the month May – November. Advance registration is required and can be completed here. After registering, you will receive a confirmation email containing information about joining the meeting.
We hope to see you Monday!
IEPC July Webinar with Andrew Selesnick Canceled
Due to a scheduling conflict, Andrew Selesnick from the Healthcare Litigation Practice Group will be unable to join us on Monday, July 26 as part of the 2021 IEPC Speaker Series. We hope that you will plan to attend the next session on Monday, August 23 at 9AM when we welcome Sandy Schnieder, MD, ACEP Director of EM Practice.
Further sessions in the series will be presented on the fourth Monday of the month through October. Advance registration is required for each session. After registering, you will receive a confirmation email containing information about joining the meeting.
We hope to see you in August!