Complying with a stability billing ban is simpler for bigger organizations with extra subtle programs, stated Erin Fuse Brown, an affiliate professor of regulation at Georgia State College. The pilot might produce insights about how properly sufferers had been shielded from shock payments and the way a lot insurers really paid suppliers, however observing state laws corresponding to a brand new shock billing regulation in Indiana may very well be extra instructive, Fuse Brown stated.
The White Home official stated the COVID-19 shock billing ban may very well be a “very ripe analysis alternative,” and that the dearth of substantive pushback from healthcare suppliers may very well be a optimistic signal for extra complete reform.
Nevertheless, there are limits to the conclusions that may be drawn from such a slim coverage.
For one, it’s unclear precisely what number of suppliers had been affected by the ban. In accordance with HHS information, 394,146 suppliers with distinctive tax identification numbers had agreed to the phrases and situations of the grants as of Dec. 11.
Loren Adler, affiliate director of the USC-Brookings Schaeffer Initiative for Well being Coverage, stated it’s unclear whether or not bigger staffing corporations which have relied on shock billing for income accepted Supplier Aid Fund grants.
One among suppliers’ most vehement arguments in opposition to outstanding shock billing reform proposals is that they might damage in-network doctor cost charges as market dynamics change. The coverage is momentary, which suggests the total market dynamics will not play out, Adler stated.
“There’s not a lot time to do the negotiations, and it is a fairly small a part of your care. It is laborious to see a lot impact from this coverage,” Adler stated.
Even those who agreed to adjust to the ban noticed small populations impacted, stated Rick Kes, a companion and senior analyst with RSM US. Meaning some suppliers had been capable of deal with them on an almost case-by-case foundation, which might not be replicable when the ban is expanded to all providers and illness areas. “I believe the state of affairs is kind of totally different, and there may be not quite a bit to be realized past procedural course of inside your billing system,” Kes stated.
There additionally was not a transparent mechanism to implement the ban or an energetic monitoring course of, Hoadley stated. Suppliers might face False Claims Act legal responsibility for violating grant phrases, however auditing and reporting required by HHS might not essentially measure compliance with the stability billing ban.
The White Home official stated the pilot is not a great simulation of broader shock billing reform, however might nonetheless be helpful within the policymaking course of. If the brand new ban is enacted, HHS will pursue rulemaking to spherical out lawmakers’ define for the negotiation and arbitration processes by 2022.
Grogan stated a part of the coverage’s worth was retaining the shock billing challenge entrance and middle within the nationwide coverage debate, particularly after Congress failed to incorporate a provision in its giant COVID aid bundle final March.
“Even when we had been attempting to do nothing greater than messaging, I nonetheless suppose it was a worthwhile endeavor,” Grogan stated.