Viewpoint: Bundled payments are a simple way to end surprise billing

Combining payments to physicians and payments for nurses, X-rays and other parts of healthcare can help end surprise out-of-network bills, according to a website post published by STAT.

In the post, Ateev Mehrotra, MD, an associate professor of healthcare policy and medicine at Boston-based Harvard Medical School, and Vivian Ho, PhD, chair in health economics at Rice University's Baker Institute for Public Policy in Houston, argued such bundled payments are a simple solution to surprise billing.

Surprise billing can occur when a patient receives care at an out-of-network hospital or from an out-of-network provider at an in-network facility. For example, a patient goes to an in-network hospital or emergency department, but during his visit, he receives care from an emergency room physician, anesthesiologist or other provider outside his insurance network. He's then hit with an unexpected bill for the difference between the health provider's charge and the insurer's allowable amount.

More than 20 states have laws to protect patients from these surprise out-of-network bills, according to Dr. Mehrotra and Dr. Ho. U.S. senators also recently unveiled a bill that aims to prevent out-of-network providers from charging patients more for emergency care than the cost covered under their health plan.

These efforts — which aim to limit the amount a patient must pay for out-of-network physicians and/or specify the amount the insurer has to pay such physicians — will help, according to the physicians. But these efforts don't address the main cause of the problem and add regulatory and administrative duties, they said.

They advocated for bundled payments as a solution.

"This approach is neither new nor radical. The Reagan and Bush administrations proposed combining, or bundling, select physician and facility payments several decades ago but ran into stiff opposition from physicians," the physicians said. "Things are different now: The epidemic of surprise bills has increased the impetus for change."

"Congress could help eliminate surprise bills by passing legislation mandating that Medicare combine physician payments with other payments," they said.

Read the full post here.


More articles on healthcare finance:

Patient leakage costs nearly half of healthcare organizations 10% of annual revenue, survey finds
Student resource website ranks top college programs for medical billing and coding
Frustrated by billing, patients are skipping routine healthcare


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