Health Affairs November 26, 2019
Over the past year, the congressional debate over surprise billing has converged on two policy options to resolve out-of-network payments—1) a simple benchmark, in which a health plan pays out-of-network providers the median rate agreed with local in-network providers in the same specialty, or 2) a similar benchmark combined with optional arbitration if the provider or payer objects to that default amount. These reforms would dent staffing company and hospital revenues by only 0.75 percent to 1.00 percent over the next 10 years—while aggregate hospital and physician revenues rise by more than 60 percent, or $1.6 trillion—yet, the legislation has sparked a furious lobbying campaign to perpetuate the status quo. Meanwhile, the Sturm und Drang over arbitration has eclipsed discussion...
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