discussion board reply
Post 1:
Healthcare facilities across the world have experienced challenges during this Covid-19 Pandemic conducting clinical trials. When the Pandemic first hit, most clinical trial coordinators were forced to stay at home because there was the need to reduce over-crowding at the facilities (2020). This has necessitated the establishment of technologies by pharmaceutical companies that would allow clinical trials to be conducted remotely. There is a need to reduce in-person interactions between patients and physicians in this Pandemic period. Protecting medical staff and patients is the goal of every healthcare facility, so a more decentralized system needs to be adopted. I believe that healthcare institutions have taken too long to develop ways that physicians can attend to patients remotely. We cannot prognosticate when the next Pandemic hits again, but if hospitals could shift to a more decentralized system, we can manage it better than the current one.
The No Surprise Act is an act that will bring to an end to surprise medical bills that affect most Americans every year. From January 1, 2022, patients will only take care of their deductibles and the usually cost-sharing amounts (Pallone, 2019). The Act will cover no surprise billing for scheduled maintenance, no surprise billing for emergency care, and no surprise air ambulance bills. Once it is implemented in 2022, the Act will provide a fair process for medical practitioners and insurance companies to settle medical bill disputes without straining patients financially (Pallone, 2019). The No Surprise Act wont harm healthcare institutions that act in good faith. But it will minimize reimbursement rates among those few institutions that balanced billing to over-charge patients. In my opinion, the No Surprise Act has laid out an arbitration process architecture that is broad; there are finer details that are left and need to be implemented by federal agencies. The legislation will lift the burden most Americans have been facing with surprise medical bills.
References
Pallone, F. (2019, July 11). Text – H.R.3630 – 116th Congress (2019-2020): No Surprises Act. Congress.gov. https://www.congress.gov/bill/116th-congress/house-bill/3630/text.
Here are the major issues facing healthcare in 2021, according to PwC. Healthcare IT News. (2020, December 17). https://www.healthcareitnews.com/news/here-are-major-issues-facing-healthcare-2021-according pwc#:~:text=The%20healthcare%20industry%20has%20six,and%20build
Post 2:
What is the No Surprises Act and what is the intention?
Answer: The No Surprises Act was signed into law as part of the Consolidated Appropriations Act of 2021 (H.R. 133; Division BB Private Health Insurance and Public Health Provisions) on Dec. 27, 2020, and most sections of the legislation go into effect on Jan. 1, 2022. This Act addresses surprise medical billing at the federal level.
The No Surprises Act is intended to provide new federal consumer protections against surprise medical bills (American Hospital Association, 2021):
Patients are protected from receiving surprise medical bills caused by gaps in coverage for emergency services. To be specific, the Act states that the bill requires insurers offering plans that cover emergency services to bill plan holders no more than the median in-network rate for a particular emergency service, even if the service provider is out of network. (Congress. Gov, 2019)
Patients are protected from receiving surprise medical bills caused by the gaps from certain services provided by out-of-network clinicians at in-network facilities, including air ambulances. To be specific, the Act prohibits insurers from billing plan holders more than the median in-network rate for nonemergency services provided by out-of-network providers at in-network facilities. (Congress. Gov, 2019)
Patients will be held liable only for their in-network cost-sharing amount, meanwhile, providers and insurers will have an opportunity to negotiate reimbursement.
Providers and insurers can access an independent dispute resolution process in the event disputes arise around reimbursement. If that fails, these stakeholders can turn to arbitration. No benchmark reimbursement amount has set by this act.
Providers and health plans are required to assist patients in accessing health care cost information.
Funding will be provided to states to set up all-payer claims databases. (Jack Hoadley, J., Keith, K., & Lucia, K., 2020)
Thus, the No Surprises Act prevents providers from using the leverage derived from the ability to issue surprise bills to extract high prices (Adler et al., 2021). More details can find on https://www.ama-assn.org/system/files/2020-12/no-surprises-act-summary.pdf
2. What will the impact be on healthcare systems once it is implemented in 2022? & What is your opinion of it?
Answer: The No Surprises Act significantly expands restrictions on charging health care plan holders for the out-of-network rates for certain services, extends comprehensive protection to consumers across the US, and saves substantial costs to Americans. For example, Sen. Lamar Alexander (R-TN) and Rep. Greg Walden (R-OR) estimated that the implementation of the No Surprises Act would save $ 18 billion for four years (Cassidy.senate.gov, 2020). After it goes into effect in January 2022, in my opinion, the No Surprises Act would lead to multiple changes (Pros & Cons) in the healthcare system:
Pros:
First, it will significantly save costs for patients because they do not need to pay unexpected medical bills with surprisingly high amounts. Effectively, out-of-network providers cannot send patients bills for extra charges under the No Surprises Act. This Act also helps increase billing transparency for all patients, thereby helping patients to better understand their cost-sharing liability ahead of time (Hut, 2021).
Second, it may reduce the administrative burden of the medical-bill claims of patients. It is not uncommon that nonparticipating providers bill directly to patients and let the patients claim their insurers. The No Surprises Act seems to put the burden on nonparticipating providers to deal directly with their patients health plans because nonparticipating providers will need to obtain claim permissions (assignment of benefits) from patients (Kaiser Family Foundation, 2021)
Cons:
First, it may lead to a surge of the health plan premium. Since the No Surprises Act requires that health plans must cover the bills at in-network rates. Hence, the risk of cost-increase will be significantly increased. This may lead to some current insurees dropping from health plans.
Second, it may cause out-of-network providers to reduce their incentive to accept patients who will not pay extra. Thus, there may have more legal disruption for these cases, especially in the emergency care context.
Third, it requires extensive data collection and monitoring. The Secretary is required to post online information quarterly on the number of surprise bills that go to the independent dispute resolution process (IDR) process, the cost of the process, and amounts paid to each IDR entity (Kaiser Family Foundation, 2021) . Thus, it means that a considerable human and financial investment is needed to build a comprehensive and well-functional all-payer claims database. This may further overburden the health system.
What is more:
Moreover, the No Surprises Act may lead to the change of the healthcare ecosystem. Under the No Surprises Act, insurees have more options to choose health providers because the billing amount difference may be significantly narrowed between the service from in-network and out-of-network. Thus, the competition among providers may intensified. This ecosystem change may encourage providers to improve quality of care, but also may induce providers to conduct unhealthy competition, such as the violation of the Antitrust law.
In the current COVID-19 pandemic context that may even extend to 2022, the No Surprises Act probably can significantly reduce the financial burden for some patients who would experience COVID-19 emergencies. However, as I mentioned before, the No Surprises Act may result in some negative effects also. It will take time to improve the act to maximize its benefits to the society.
References
Adler, L., Fiedler, M., Ginsburg, P., Hall, M., Ippolito, B., & Trish, E. (2021). Understanding the No Surprises Act. Retrieved on April 26, 2021, from https://www.brookings.edu/blog/usc-brookings-schaeffer-on-health-policy/2021/02/04/understanding-the-no-surprises-act/
American Hospital Association. (2021). Comprehensive Legislation to Address Surprise Medical Billing at the Federal Level. Retrieved on April 26, 2021, from https://www.aha.org/advisory/2021-01-14-detailed-summary-no-surprises-act
Cassidy.senate.gov (2020). Surprise Billing EOY Request 12_14 Letter. Retrieved on April 26, 2021, from https://www.cassidy.senate.gov/imo/media/doc/Suprise%20Billing%20EOY%20Request%2012_14%20Letter.pdf
Congress. Gov (2019). Summary: H.R.3630 116th Congress (2019-2020). Retrieved on April 26, 2021, from https://www.congress.gov/bill/116th-congress/house-bill/3630
Hoadley, J., Keith, K., & Lucia, K. (2020). Unpacking The No Surprises Act: An Opportunity To Protect Millions. Retrieved on April 26, 2021, from https://www.healthaffairs.org/do/10.1377/hblog20201217.247010/full/
Hut, N. (2021). New legislation seeks to take unwelcome surprises out of patient billing. Retrieved on April 26, 2021, from https://www.hfma.org/topics/news/2021/01/new-legislation-seeks-to-take-unwelcome-surprises-out-of-patient.html
Kaiser Family Foundation (2021). Surprise Medical Bills: New Protections for Consumers Take Effect in 2022. Retrieved on April 26, 2021, from https://www.kff.org/private-insurance/fact-sheet/surprise-medical-bills-new-protections-for-consumers-take-effect-in-2022/
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The concept as it appears is legal aspects of health care
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