Blue Dog Democrats Raise Concerns for Healthcare Reform
The Blue Dog Coalition, a group of fiscally conservative House democrats, has submitted a letter to Speaker Nancy Pelosi and Majority Leader Steny Hoyer outlining a number of concerns about the Tri-Committee draft health reform bill. American Society of Anesthesiologists (ASA) strongly supports the Blue Dog Coalition’s concerns about a public plan option based on Medicare payment rates.
ASA President Roger A. Moore, M.D., has released the following statement in response to the Blue Dog Coalition’s letter: “On behalf of ASA’s 43,000 physician members, I applaud the Blue Dog Coalition members and leadership for opposing a public plan option based on Medicare rates, and for recognizing that a Medicare-like public option would negatively impact doctors and patients. Further, I am pleased that the Coalition maintains that physicians and other health care providers should be able to voluntarily participate in the program, rather than being mandated by Congress.
“We are working together on one of the most comprehensive health care reform efforts this government has ever undertaken. We commend the “Tri-Committee” members and staff for their efforts toward meaningful and effective delivery reform. However, we believe that as part of responsible reform, we must ensure that a public plan option fairly compensate physicians for their services. As it stands, Medicare pays anesthesiologists 33 percent of what private insurers pay—a rate that simply does not cover the costs of providing anesthesiology medical care. An expansion of this inadequate payment system as proposed by the “Tri-Committee” would not be sustainable for private practice and academic anesthesiologists.
Balance Billing Legislation is Spreading from California
California’s high court ruled that emergency-room patients can no longer be billed by
doctors and hospitals for care that isn’t fully paid by their health plans. Texas and Louisiana have similar legilation pending but with more sweeping coverage for pathologists, anesthesiologist, radiologists and emengency medicine providers.
Balance billing tends to be defined in the debate as the practice of out-of-network physicians billing a patient for the difference, or “balance”, between what the health plan pays for out-of-network services and the physician’s fee. Legislative proposals to eliminate balance billing tend to cast the practice in the same light as insurance fraud, with attendant civil fines and licensing sanctions. Physician-friendly legislation that addresses the subject would require payors to fully reimburse providers for most out-of-network services, regardless of the charges.
Anesthesiologist, Radiologists, Pathologist and Emenecency Medicine physicans will be severely impacted by his new legislation. It will mean that the leverage that they once had to negotiate higher rates with insurance payers has been eliminated. This is just one more parameter forcing these physicians to require more financial subsidies from the hospital to maintain their present income levels.
Immediate Implications from this loss in income stemming from the ruling could exacerbate challenges at hospital EDs and discourage medical specialists from accepting emergency cases. This could also cause a movement of physicians into states that do not have restrictions on their ability to earn a market competitive wage.
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