The American College of Radiology is suing the federal government to stop one key aspect of legislation meant to protect patients from surprise medical bills for out-of-network healthcare services.
ACR filed the complaint on Dec. 22 in a Chicago federal district court, joined by the American College of Emergency Physicians and American Society of Anesthesiologists. They’re hoping to halt a controversial provision in the “No Surprises Act” used to resolve payment disputes between commercial insurers and providers.
Under Congress’ original intent, independent third parties were supposed to consider a host of factors before reaching a final reimbursement amount. But physicians believe the Biden administration’s interpretation of the final rule misunderstands lawmakers’ original guidance and tips the scales in favor of insurers.
“The conscious decision by the White House to ignore the specific legislative language and intent of the ‘No Surprises Act’ as the new law is implemented has empowered insurers to drastically cut reimbursement, narrow medical networks and restrict patient access to their chosen providers — including radiologists,” ACR said in a Dec. 22 news update. “To draw attention away from this devastating impact, the government is attempting to financially pit providers against patients, which can only further harm the healthcare system and the doctor-patient relationship.”
ACR et al. joins several other provider groups already suing the feds over the rule, including American medical and hospital associations, Renown Health System in Nevada, UMass Memorial Health in Massachusetts and the Texas Medical Association. The college and others believe the rule is now emboldening payers to pad their profits using “strong arm” tactics. As an example, ACR and others have cited letters sent by the Blue Cross Blue Shield of North Carolina in November, threatening to cut off payments to docs who do not accept sizable reimbursement cuts.
Radiologists and other docs emphasized the suit would not impact provisions to protect patients, nor increase their out-of-pocket costs. However, they want independent arbitrators to consider a host of factors when settling disputes, such as quality of outcomes, market share, patient acuity and prior contract history between the two parties. As implemented, the law would make the “qualifying payment amount,” a number arbitrarily set by insurers, as the primary factor in such determinations.
“We are left with a law that will tilt market forces in favor of insurers and they are already exploiting their newfound incentive to push emergency physicians out of network. Legal remedy is necessary so that the [interim final rule] does not undermine the entire dispute resolution process," Gillian Schmitz, MD, president of the American College of Emergency Physicians, said in a statement.
On the other side, HHS Secretary Xavier Becerra has defended the administration’s implementation of the law, urging physicians to “tighten their belt.” Groups representing patient and insurer interests have also voiced their support.
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.