By Ted Shaw, President/CEO, Texas Hospital Association
Patients should never be surprised by unexpected bills for out-of-pocket costs for emergency or unplanned health care services.
Unexpected bills distract patients from healing and recovery and a perpetuate a false notion that health care works against patients. This deters some from seeking the care they need, which ultimately exacerbates the severity of existing conditions and prolongs recovery—health outcomes and philosophies that Texas hospitals, physicians and other providers actively work against through process of health care delivery.
But, in Texas, many patients are experiencing that financial surprise after a hospital stay. These bills typically come from hospital-based physicians, such as anesthesiologists, emergency room physicians, and pathologists, who care for hospitalized patients but do not work for the hospital. These physicians negotiate their own contracts with health plans, and sometimes the physician and the hospital do not share the same insurance contract, which means a patient can receive in-network hospital care, but the physician component of that care is out-of-network.
To some, this is a bug in our health care system. But, it actually is a long-standing component of the health care system in Texas that has a strong legal prohibition against the corporate practice of medicine and employment of physicians by most hospitals.
Hospitals themselves are rarely out-of-network. Yet, they recognize that surprise billing is a practice that should be eliminated. Receiving an unexpected bill, and the shock, distress, and anxiety that it can cause undermine a patient’s road back to good health. And it contravenes the covenant that hospitals and their care providers forge with their patients to first and foremost, do no harm.
Several lawmakers in Austin from both sides of the aisle have working together tirelessly on legislation to ensure patients are not financially crippled by unexpected medical bills. They are to be applauded for this work, and hospitals unequivocally support protecting patients.
The legislative solution that is making its way through the Texas Legislature navigates a delicate balance to create processes that work for physicians and providers as well as hospitals and other facilities. The measure would create a process where physicians and providers enter into a “baseball-style” arbitration process with a patient’s health plan to settle on a payment amount for an out-of-network health care claim. Hospitals, however, would stay in the current mediation process where the Texas Department of Insurance works with the parties to settle on a payment amount. Under mediation, the government does not set parameters for payment amounts and allows hospitals and health plans negotiate towards a compromise.
This is the best possible outcome because it achieves the most important goal—eliminating surprise billing for Texas patients, while also affording providers and facilities the unique flexibility they need to negotiate adequate reimbursement.
As with everything in medicine and health care, a one-size-fits-all approach isn’t the best or most effective remedy. Precision, targeted solutions are the future of medicine. And they’re what is needed for policy as well. Texas hospitals support protecting patients from surprise bills and maintaining a fair and balanced process of mediation.