Following a recent congressional field hearing on emergency care in rural and underserved communities, the Texas Medical Association emphasized in written comments how federal regulators’ flawed implementation of the No Surprises Act has exacerbated access challenges.
The No Surprises Act took effect in 2022, aiming to protect patients from surprise medical bills and to improve transparency around health care costs. But the associated rulemaking process introduced new obstacles, prompting four TMA lawsuits and congressional scrutiny.
For instance, the U.S. House Ways & Means Committee hosted the hearing at the site of an air ambulance provider in Denton on March 18. It was one of several recent congressional discussions that have touched on the law's flawed implementation.
Like TMA, “Congress is frustrated that [regulators] ignored the language of the law and their legislative intent,” TMA President Rick Snyder, MD, told Texas Medicine Today.
Dr. Snyder says the No Surprises Act rulemaking has skewed the surprise-billing dispute resolution process in payers’ favor and created obstacles to physicians accessing that same process. This creates practice viability challenges that can negatively affect patient access to care.
Dr. Snyder also noted the rules that unlawfully tilt the dispute resolution process in favor of payers are “likely to result in health plans exerting more pressure to lower in-network rates (effectively creating a race to the bottom) and health plan termination of long-standing physician contracts,” he wrote. “This will compromise patient access to in-network care and is likely to lead to forced consolidation of physician practices to survive the payment cuts.”
House Ways & Means Committee Chair Jason Smith (R-Missouri) echoed these concerns in his opening statement.
“Hospitals have had to cut emergency room staff to make ends meet as insurance companies are slashing reimbursements,” he said. “It’s a nasty consequence from the Biden administration’s flawed implementation of a law Congress passed to ban surprise medical bills.”
In addition to suing federal regulators to ensure the law’s fair implementation, TMA has taken several other steps to improve access to physician-led care across Texas, which Dr. Snyder enumerated in his comments. At the state level, those include successfully advocating for graduate medical education and physician loan repayment program funding; the interstate medical licensure compact, which simplifies the process for highly qualified physicians licensed in other states to be licensed in Texas; and medical liability reform.
At the federal level, TMA continues to urge Congress to overturn the ban on creating and expanding physician-owned hospitals.
“These entities can aid in boosting patient access to care and the quality of that care, as local physicians not only treat patients but also are heavily involved in making decisions about hospital operations, staff, equipment, training, and procedures that can best serve their patients and community,” Dr. Snyder wrote.
During the hearing, U.S. Rep. Michael Burgess, MD (R-Texas), a long-time proponent of physician-owned hospitals, spoke about his bill, the Patient Access to Higher Quality Health Care Act (House Resolution 977), which would repeal the ban. He also asked one of the invited witnesses – Robert Morris, CEO of Complete Care, a network of freestanding emergency departments in Texas and Colorado – about the appeal of physician-owned hospitals.
“A lot of [physicians] are looking for some flexibility and autonomy that perhaps they haven’t always been able to get in a hospital setting,” Mr. Morris responded. “So, when you talk about a rural environment, being able to give a physician the opportunity ... to manage ... operations, I think ... that would encourage more docs to move out into rural communities and to be part of the solution.”
For more information about the No Surprises Act and TMA’s litigation, check out TMA’s Surprise Medical Bills webpage.
Emma Freer
Associate Editor
(512) 370-1383