Congress must avoid benchmarking

Pennsylvanians have had enough of getting slammed by surprise bills for medical care they thought would be covered by their insurance plans. It’s time for Congress to solve this issue once and for all — but they need to do it the right way to ensure access to care and affordability are not adversely impacted.

Unfortunately, that’s precisely what one proposed solution in Congress would do. Known as benchmarking, this approach would put the government in charge of setting rates to doctors who perform out-of-network services. These rates would be drastically lower than the true market value of these services, shifting enormous losses onto local hospitals and ERs.

Particularly for rural communities where health care facilities already struggle to stay open in the face of a growing doctor shortage and high consolidation rates. Benchmarking would make these issues that much worse, which in turn would have a devastating impact on patient care — reducing access while driving up prices.

Congress must avoid benchmarking at all costs and instead pass a solution that preserves access and affordability. Just such a solution can be found in legislation that includes Independent Dispute Resolution (IDR) as the means by which to protect patients from surprise bills.

IDR would facilitate fair and transparent negotiations between physicians and insurers, separating patients from the process while ensuring payments are based on the true market value of the services provided. Moreover, IDR would help keep rural hospitals and ERs financially secure by making sure providers receive interim payments until an impartial mediator has made a final decision on payment amounts.

Senator Pat Toomey should fight for Pennsylvania patients and rural communities by opposing benchmarking and supporting the IDR framework. IDR must be at the core of any solution Congress passes to fix surprise billing for good.

Doug McLinko