Emergency physicians have been feeling the squeeze of shrinking reimbursement. Now, they’re also dealing with the threat of insurance payers manipulating the value of their services.

According to the GAO report has, emergency departments are the most common place of service for Federal IDR disputes. And the reality is that all of these issues are starting to reach a breaking point as we continue to erode our nation’s health care safety net.

The Physician Community Has Continued to Advocate For Change and Lawmakers Are Starting to Listen and Voice Their Own Concerns

Groups such as ACEP and EDPMA have done a great job of collecting data on payer behavior and mobilizing the physician community to speak out—and lawmakers are now paying attention.

In a subcommittee hearing earlier this year, House Republicans blamed HHS Secretary Xavier Becerra for the lackluster rollout of the NSA.

• “This process is a failure and a failure because of poor planning on HHS,” said Rep. Michael Burgess, R-Texas. “… [then] to turn around and blame providers for your department not being prepared for the volume of claims just doesn’t square with me.”
  

  Rep. Larry Bucshon, MD (center, yellow tie), listened to ACEP members’ concerns about the NSA at a dinner at the 2023 ACEP Leadership & Advocacy Conference. (Click to enlarge.)

• Rep. Larry Bucshon, MD, R-Indiana, added, “We recently heard in [IDR] situations that even though providers are winning those cases, we still don’t have insurance companies paying after they have lost.”
• Rep. Mariannette Miller-Meeks, R-Iowa, also called on Mr. Becerra to address the recent legal setbacks surrounding the IDR process and use of the QPA. “We feel the comments we have gotten back from HHS have been less than satisfactory,” she said.

House Democrats have also expressed concern, including ranking member Richard E. Neal, D-MA, who made comments during a recent hearing on the implementation of the NSA. Rep. Neal lamented that the “implementation of this law has strayed from Congress’s approach, especially as it relates to the dispute resolution process.”

The NSA Was the Product of Years of Bipartisan Legislative Work, but Its Implementation Has Fallen Short of What the Law Envisioned

We’ve been able to shine a spotlight on this flawed administrative process, but change takes time and persistent effort. Physicians should continue working with groups such as ACEP and EDPMA to push for reasonable initial payments, an effective, independent, dispute resolution, and better enforcement of the law.