The American College of Radiology sounded the alarm Wednesday following news of the first health insurer using surprise billing legislation to cut off payments to providers who won’t accept “drastic” pay cuts.
Blue Cross Blue Shield of North Carolina began circulating a letter to physician groups last month, noting the impending Jan. 1 start date for the No Surprises Act. Whereas the insurer previously contracted with providers charging what it deemed “an inflated rate,” the local Blue Cross is now seeking a “significant reduction” in what it pays certain “outlier” providers. Those who do not comply will face “terminations” of their contracts.
The college called the move “profit driven” and believes many physicians, already reeling from the pandemic, cannot withstand such reductions.
“Without regard for patient impact, insurers are trying to increase their already record profits by narrowing their provider networks,” Howard Fleishon, MD, chair of the American College of Radiology Board of Chancellors, said Dec. 1. “
The American Society of Anesthesiologists also expressed “grave concern” following BCBS of North Carolina’s “strong-arm tactics,” and said the payer has sought to cut reimbursement anywhere from 10% to 30%. The insurer has about 3.81 million members in the Tar Heel State, according to its website.
Lawmakers first enacted the legislation in late 2020, banning the practice of sending patients surprise medical bills and establishing a third-party process to settle payment disputes. Physician groups such as the ACR have said they support the thrust behind the effort but believe the Biden administration is failing to honor congressional intent in its rollout. Meanwhile, Health and Human Services Secretary Xavier Becerra defended the policy last month.
The Texas Medical Association filed suit in late October to stop the interim final rule from moving forward, and Fleishon said ACR is now “strongly considering” doing the same. Provider groups are particularly concerned about the weight placed on the “qualifying payment amount” in settling disputes with insurers. The college sees this as the primary factor in the process, and one that payers can wield to set “artificially low” benchmark payments.
Physicians are also concerned that savings will go straight into the pockets of already-flush insurance companies.
“Record insurer profits have not led to reduced premiums for beneficiaries,” the ACR said in its statement. “There is no indication—nor proof—that insurer profit increases gained via No Surprises Act-related network restrictions would result in lower costs to patients.”
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.