Members of the House Republican and Democratic “Doc Caucuses” sent a bipartisan letter to the Secretaries of Health and Human Services (HHS), Labor, and Treasury, expressing their concern with a recently announced policy change from Anthem Blue Cross Blue Shield stating that the payer will begin lowering payments to hospitals when out-of-network clinicians furnish care.
Effective Jan. 1, this new policy assesses a 10% administrative penalty on the hospital’s facility claims if out-of-network clinicians are involved in a patient’s care. Emergency services are excluded. It will only apply to Anthem commercial plans in the following states: Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, Ohio and Wisconsin.
Hospitals regularly contract with independent physician practices. While these independent practices usually accept most of the same networks as the hospital, this is not always the case. Penalizing hospitals that use out-of-network clinicians is unfair to both the hospital and the independent practice. Furthermore, it could force hospitals to pressure independent practices to join Anthem networks, potentially with unfavorable terms for the practice.
The letter argues “Anthem’s new policy attempts to bypass reasonable contract negotiations and independent dispute resolution (IDR) and effectively coerce hospitals – many of which are operating on razor-thin margins – to pressure physician groups into accepting unsustainable in-network rates. This tactic places hospitals in an untenable position: either compel physician groups to accept reimbursement that cannot sustain high-quality operations or restrict their patients’ access to high-quality clinicians in order to avoid being penalized by Anthem.”
The Doc Caucus letter also says this policy circumvents the No Surprises Act’s IDR process, which determines out-of-network reimbursements in these scenarios.
The Doc Caucuses ask the agencies to investigate the legality of this policy, which they believe is anti-competitive.
Independent allergy practices that contract to provide services for hospitals and large health systems should be aware of this new Anthem policy. The ACAAI Advocacy Council strongly supports the bipartisan Doc Caucuses’ efforts to oppose this policy.
The Advocacy Council – ADVOCATING FOR ALLERGISTS AND THEIR PATIENTS.
