Another emergency physician asked me what I think will happen if the “surprise bill reform” with a benchmark fix happens. I told her privately, but I am sharing, so everyone can understand why I am working so furiously on a seemingly boring and crass issue of reimbursement. I do believe that patients should be taken out of the middle and shouldn’t be harmed by surprise bills. I do believe balance billing is a problem to be solved. But this fight between private equity and special interests is being used as a Trojan Horse to enable “an unprecedented transfer of market power to insurers by sanctioning government-mandated price-setting.” The implications and impact of “all-payer rate setting” are far greater than the balance bill problem and will eventually impact all physicians and our health care system.
This is what I believe about the benchmark fixes for surprise billing that Congress is considering:
I believe average compensation for independent group EM physicians will decrease by about 20 to 50 percent if the benchmark per the Senate HELP bill is implemented. The “compromise” passed by the House Energy & Commerce Committee isn’t much different because the $1,250 limit is far too high to put a meaningful guardrail on unfettered insurance leverage that will be granted by a government-mandated price.
I believe that nonprofit-employed physician compensation will follow suit. In our market, in the last three years we have had two physician groups who “went independent” because their hospital told them it was illegal to pay “above fair market value” and they would have to take pay cuts.
I believe rural hospitals won’t be able to staff with physicians and so they will either use NPs or close. Since I believe rigorous and lengthy emergency medicine physician training enables us to save lives when seconds matter, I believe patients will die because of these closures.
I believe it will force more physicians to be employed and increase market consolidation. Since I believe in the value of physician independence of corporations, who have a fiduciary duty to shareholders and not to patients, I feel this is a negative.
I believe specialists will stop taking call, and this will affect our networks of care, even in suburban hospitals. For example, one of our two neurosurgeons hated doing brain bleeds in the middle of the night, and he recently quit and joined an ortho practice where he does spine surgeries in their outpatient surgical center. I anticipate that university hospitals and safety-net hospitals may be the only places left to get emergency specialist care.
I believe that our poorest patients and those on Medicaid will have trouble then getting follow-up care.
I believe that it will be “wholly demoralizing” to all of us who work so hard to have our pay arbitrarily slashed because some seemingly unbiased economists (funded by insurance industry) and health care policy experts (with an agenda) believe we are no more valuable than commodities and have realized that they can use “surprise billing reform” as a Trojan Horse to save money on “emergency services” a.k.a. our pay.
I believe that the physician shortage will worsen as physicians will retire early, work less, or get out as soon as they are able.
I believe that this will be deadly for some physicians who are trapped by $300K in educational debt and don’t have another career option.
Health policy experts and economists with an agenda are playing dangerous games with the lives of physicians and patients. Physicians need to speak up and start taking action. We are not commodities to be cut. We are not waste. We are at the heart of medicine, and we must make our voices heard.
You may not agree with me, but every one of us should at least understand the issues before deciding to take action or stand idle.
Amy Cho is an emergency medicine physician and founder, The High Yield Script. She can be reached on Facebook and on Twitter @amychomd.
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