Good or Bad or Simply Unsustainable? No Surprises Act Arbitration Process — What Now?

Effective advocacy can lead to better care

In the CORRelations post “Good or Bad or Simply Unsustainable? No Surprises Act Arbitration Process,” Julie Barnes JD points out how the dispute resolution process outlined in the No Surprises Act (NSA) has tended to lean in favor of the physician. This is surprising, and she stated, “The law may not be delivering the savings to the healthcare system that were expected, according to a recent Brookings report and CMS data.” Payments that were arbitrated through the independent dispute resolution (IDR) process were about 3.7 times greater that the in-network Medicare prices!

It's critically important to remember how we got here. The AAOS strongly advocated for the NSA, and there were competing legislative vehicles that were far less “physician friendly.” Nonetheless, the bill we wanted was passed, and then it went off to the agencies for the rule-making process, where the wheels fell off. Without doubt, the Departments of the Treasury, Health and Human Services, and Labor changed the intent of the legislation by writing rules that strongly disadvantaged physicians in the IDR process.

Stated another way: Although we got the law that we wanted, the interpretation of the law radically changed its legislative intent. A number of groups then sued the federal government, and to make a long story short, the rule-making process subsequently fell in line with what Congress had originally intended.

The point of this story is that the NSA is yet another example of effective advocacy by our national organizations to enable us to better care for patients. When we unite as a common force for the good of our patients and our profession, great things can happen. The next time you get an email urging to contact your local or national lawmakers, remember this example.