ACEP to Congress: Take patients out of the middle

Dr. Vidor Friedman, president of ACEP, testified this week in front of the House Energy and Commerce Health Subcommittee. Friedman said:

“In a medical emergency, getting treatment as soon as possible is the number one priority—not verifying which providers are in-network, figuring out how much your deductible is, or worrying how much treatment will cost.

“Unlike most physicians, emergency physicians are prohibited by law from discussing with a patient any potential costs of care or insurance details until they are screened and stabilized. This important patient protection enacted in 1986 under the Emergency Medical Treatment and Labor Act ensures physicians focus on immediate medical needs. However, it also means that patients often do not fully understand the potential costs that could be involved in their care, or the limitations of their insurance coverage, until they receive their bill.”

ACEP has put forward a framework of key principles that Congress should consider:

Protect Patients – Take patients out of the middle of billing disputes. Establish caps on patient responsibility for unanticipated emergency medical care so that patients only pay the in-network amount of costs.

Level the Playing Field – Consider an independent dispute resolution process once the patient is out of the middle. One example, “baseball-style” dispute resolution is a simple, efficient solution that incentivizes providers to charge reasonable rates and insurers to compensate at reasonable rates. In New York, this model has almost eliminated surprise medical bills. Meanwhile, insurance premiums and health care costs in the state have grown more slowly than the rest of the nation. This model would be the least disruptive to the current system and is the only one with empirical data detailing the positive affect it has had for patients and stakeholders alike.

Improve Transparency – To ensure patients better understand the limitations of their insurance coverage and all potential out-of-pocket costs each time they seek care, insurers should more clearly convey beneficiary plan details to their customers. This should include printing the deductible on each insurance card; clearly explaining their rights related to emergency care in easy-to-understand, clear language; and maintaining up-to-date lists of in- and out-of-network providers that are easily accessible.

ACEP is the national medical specialty society representing emergency medicine.