Professor Mark Hall participates in event as Brookings Institution fellow to address surprise medical billing

Photo of Professor Mark Hall in the Professional Library at the Worrell Professional Center

When is a surprise not a good one? When you get a medical bill you weren’t expecting. Professor Mark Hall, director of the law school’s Health Law and Policy Program, participated in a Brookings Institution and University of Southern California Schaeffer Center for Health Policy and Economics event on Oct. 13, 2016, about how to get rid of surprise medical bills. Grant Ferowich writes for Fierce Healthcare, “Efficient, fair payer-provider negotiations first step in solving surprise bills,” and published the following article.

Surprise medical bills are tough on patients’ pocketbooks, but fostering just, efficient negotiations between payers and providers offers a way forward.

Payment negotiations have proved to be a “30-year tug-of-war between providers and health plans,” said Tom Priselac, president and CEO at Cedars-Sinai Medical Center, at a Brookings Institution and University of Southern California Schaeffer Center for Health Policy and Economics event Thursday to address the problem of surprise medical billing.

But payers and providers have a “shared desire” to solve consumers’ surprise medical bills, says Colin Drozdowski, vice president of national provider solutions at Anthem.

Incorporating independent arbiters, using a presumptive pricing model and benchmarking payment rates are crucial to facilitating payer-provider negotiations, says Mark Hall, law professor at Wake Forest University and nonresident senior fellow at Brookings.

Patients with HMOs and EPOs have little to no coverage for out-of-network services. As a result, the patients who are least able to afford surprise medical bills are often the ones who receive them most frequently, Hall says.

By banning balance billing, payment for specialty services as emergency care, anesthesiology or pathology could be sorted entirely by providers and payers, according to Hall and his team at Brookings. Such a strategy could go a long way toward reducing sticker-shock for patients with little choice but to get care services from an out-of-network provider.

Hall suggests a “baseball” style of negotiation featuring an independent arbiter to review health plans and providers proposed payment rate. The model places a price ceiling on the rate a provider can charge and a lower-bounded minimum price floor that payers must pay. Each side is allowed to submit one final price proposal, which encourages them to offer a fair rate, Hall added.

Read the entire article here.