Congressional Hearing Puts Spotlight on Flawed Federal IDR Implementation

Congressional Hearing Puts Spotlight on Flawed Federal IDR Implementation

This week, the US House of Representatives’ Ways and Means Committee held a widely attended hearing on the Implementation of the No Surprises Act.  Both Republican and Democratic Members emphasized the law must be implemented as Congress intended, and expressed dismay over challenges associated with implementation, and unintended consequences on patient costs and access to care.  In general, Republicans offered sharper criticism of Administration regulations, often emphasizing the regulations skew the Independent Dispute Resolution (IDR) process to favor insurers.  Multiple Democrats echoed those concerns, while also warning about the role of health industry stakeholders, including private equity firms, in surprise medical bills.

The Committee heard testimony from stakeholders offering recommendations to improve implementation, through administrative and legislative changes. Physician representatives generally called for enhanced enforcement and changes to address insurer practices, including low reimbursements, reduced provider networks, and failure to pay claims in a timely manner, and warned that patient access to emergency and other services is at risk.

For example, a witness testifying on behalf of the American College of Emergency Physicians (ACEP) stressed the IDR process is “virtually inaccessible” for smaller practices and warned that insurers are dropping physician practices from networks, which will ultimately threaten patient access to care. Similarly, the head of a nonprofit community hospital system cited unintended consequences of No Surprises Act, implementation, including that health plans have narrowed networks, often leaving enrollees without in-network emergency care, and insurers are reimbursing hospitals below sustainable levels. In contrast, the witness from America’s Health Insurance Plans (AHIP) testified that a small number of private equity-backed provider staffing companies dominate payment disputes.

Significant concerns were raised by Members and witnesses regarding the IDR process, including the impact of the closure of the IDR portal in response to court cases. There was reference by several members to lawsuits initiated by the Texas Medical Association and supported by MSSNY and medical societies throughout the country challenging implementation decisions that do not follow the law, and benefit the insurance industry.