WASHINGTON, D.C.—The American College of Emergency Physicians (ACEP) stands firmly with the over 150 bipartisan members of Congress who call urgently on the Biden Administration to change the interim final rule (IFR) that details how to implement the No Surprises Act.
ACEP and other leaders throughout the medical community are deeply concerned that the IFR as written is a drastic departure from the legislation passed by Congress last December to resolve billing disputes fairly and without bias through an independent dispute resolution process.
Congress is also raising the alarm. On November 5, 2021 Reps. Tom Suozzi (D-NY), Brad Wenstrup, DPM (R-OH), Raul Ruiz, MD (D-CA), and Larry Bucshon, MD (R-IN) sent a letter to Health and Human Services Secretary Xavier Becerra, Labor Secretary Martin Walsh, and Treasury Secretary Janet Yellen expressing concern with how the administration plans to implement the No Surprises Act. The letter has broad support with 152 bipartisan members of Congress signing on—nearly a third of the chamber. It states:
“Unfortunately, the parameters of the [independent dispute resolution] process in the IFR released on September 30 do not reflect the way the law was written, do not reflect a policy that could have passed Congress, and do not create a balanced process to settle payment disputes.”
The No Surprises Act includes a dispute resolution process forged through bipartisan compromise to ensure a fair interaction between insurance companies and physicians. In the final legislation, Congress intentionally rejected options that would give single pieces of information outsized influence in billing disputes. But, the IFR would have arbiters give unequal weight to the qualified payment amount (the insurer’s artificially low median in-network rate for reimbursement), rather than a balanced mix of other factors in the process.
Emergency physicians are deeply concerned that this giveaway to insurance companies will undermine the entire effort to solve surprise billing. This approach would drive reimbursement rates lower and encouraging insurance companies to narrow their networks even further, which would make it harder for patients to get emergency care.
“This rule turns a blind eye to a carefully crafted bipartisan compromise that took years to reach,” said Gillian Schmitz, MD, FACEP, president of ACEP. “Unless it is changed, the IFR hands insurance companies an enormous amount of leverage in billing disputes and will make it much harder for emergency physicians to care for patients, especially in small or rural communities."
ACEP will continue to raise concerns about this flawed rule with legislators and regulators to ensure that this legislation can accomplish what it was thoughtfully designed to do—protect patients from surprise bills without threatening access to emergency care.