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Opinion >  Guest Opinion

James M. Burkman: We need a fair system to stop surprise medical bills


As a physician, my first priority it to protect my patients – both in and out of the operating room. To that end, I keep their best interests in mind and when they need care – particularly unexpected care – they can trust that I’m concerned with their health, not payment. For too many, however, their care is only the beginning of a life stressor: economic insult is added to medical injury weeks later when they receive surprise medical bills.

That’s why in Washington state, the physician community worked hard to keep patients out of the middle of “surprise” medical bill disputes and to make payment negotiations fair for both physicians and insurance companies. Surprise medical bills arise when a patient receives treatment that unknowingly is not covered by their health insurance. But in our state, a new bill passed this year, HB 1065, provides for an Independent Dispute Resolution (IDR), which allows a neutral, third-party analysis to determine fair market rates. The topic of surprise medical bills is a challenging one, but as Congress seeks a solution, I encourage Sen. Patty Murray to advance a similar approach at the national level.

Congress, and even the White House, recognize that surprise medical bills are a problem that must be tackled. Several proposals have been put forward, and, thankfully, all protect patients from receiving a surprise bill. But the full problem will not be solved without unwanted consequences unless Congress creates a system by which insurers and medical providers are able to resolve their differences on a level playing field.

On this point, it is critical that Congress tread carefully. Insurers would like lawmakers to set “benchmark” rates based on their own pricing. But that approach would undermine competition, shifting the lion’s share of costs to doctors and hospitals. Larger hospitals may be able to absorb those new costs, but smaller hospitals and practice groups – especially in rural areas – could see their fiscal solvency threatened. Too many rural hospitals have already closed across America – and benchmarking would put more at risk. I cannot pretend that the way we pay for health care in our country is the best way to do so, but the unintended consequences of patchwork fixes can be devastating to the fragile systems existing today.

As the ranking member of the Senate Committee on Health, Education, Labor and Pensions (HELP), Sen. Murray has an opportunity to rally Senate Democrats around a proven solution that not only serves patients, but also serves doctors, providers and insurers. Creating an IDR system represents a better path forward than the biased “benchmarking” solution currently favored by the HELP Committee.

The IDR system uses independently verified data – not insurers’ preferences – to establish fair pricing. IDR reflects local marketplaces, and its flexibility supports competition. Since 2015, New York has successfully used IDR to stop surprise medical bills without disrupting competition or threatening the financial viability of doctors and hospitals. New York’s IDR system even encouraged insurers to expand their networks, thereby improving patients’ ability to access in-network care.

Sen. Murray has a strong record of supporting meaningful improvements to our nation’s complex health care system. She understands the need for our nation’s health care policies to strike a balance between insurers and providers. Here is another opportunity for her to champion a balanced approach by supporting an IDR-based solution to stop surprise medical bills.

James M. Burkman, MD, is a member of the board of directors of the Washington State Society of Anesthesiologists and was its president in 2010 and 2011. He is also a delegate to the American Society of Anesthesiologists and the Washington State Medical Association.

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