Physician Groups Back AMA-AHA Lawsuit Over Surprise Billing IDR Process

A coalition of physician organizations filed an amicus curiae brief stating HHS’ surprise billing independent dispute resolution (IDR) process will result in an increase in healthcare consolidation, fewer patient choices, and higher costs for out-of-network services. 

The several physician groups are led by the Physicians Advocacy Institute (PAI), American Association of Neurological Surgeons (AANS), and Congress of Neurological Surgeons (CNS), and joined by seven national medical societies and 16 state medical associations. The public statement supports a lawsuit filed by the American Medical Association and American Hospital Association against the federal government last month accusing the IDR process of unfairly favoring insurers.

“Physicians have an obligation to reinforce for the court just how far federal regulators walked away from the No Surprises Act’s balanced approach to resolving payment disputes and explain how bypassing the law will unfairly empower insurers at the expense of patients and their physicians,” Dustin Corcoran, president of the Physicians Advocacy Institute (PAI) and chief executive officer of the California Medical Association. said in the public statement.

“If the court allows this damaging example of regulatory overreach to stand, patients and physicians will pay the price.” 

The coalition stated that the regulation undermines Congress's original intent of establishing a balanced process to resolve payment disputes between physicians and payers in cases of surprise out-of-network billing. 

However, the providers accused lawmakers of issuing a rule that gives payers an unfair advantage by relying on one factor--qualifying payment amount (QPA)--instead of multiple factors as stated under the law. Under a final rule for implementation of the No Surprises Act, the QPA is determined by the payer’s median contracted rate for the same or similar service in the area. 

In addition, the amicus curiae brief addresses concerns regarding how the IDR process as defined by the final rule will encourage payers to shrink physician networks and decrease payment rates to physicians. 

“This deeply flawed regulation represents an approach Congress dismissed because it recognized that failure to consider multiple factors before deciding a payment dispute would make it harder and more costly for patients to access physicians, particularly for specialty care,” stated John K. Ratliff, MD, FAANS, a practicing neurosurgeon at Stanford University and chair of the AANS/CNS Washington Committee. 

“The patients my colleagues and I take care of suffer from painful and life-threatening conditions such as brain tumors, head and spinal trauma, and stroke. Without timely access and adequate neurosurgeons in health plans’ networks, they may face permanent neurologic damage, and sometimes death.”