
These 3 Things Will Solve Surprise Bills Better Than Any New Legislation
If we had a consumer-centered, market-based model that required transparency in costs and quality, accountability across the continuum with payments tied to outcomes, and real competition based on data that is made available in consumer-friendly ways, we wouldn't have the problem with surprise bills we see today.
There’s been a whole lot of talk — and a little bit of action – concerning surprise bills recently. Vox and Kaiser Health News, the latter in partnership with NPR, initiated these conversations by shining a light on so-called “balance billing” with their respective
Shortly thereafter, both the House and the Senate released proposals; the
The problem with these bills is that they are too narrow. We need systemic change, not point solutions. That means: empowering patients, whenever possible, to make high-quality, low-cost decisions; and changing our business model to one that supports a healthcare system in which no bills come as a surprise.
But before we can come to understand these solutions, we must first understand the many ways in which patients—1 in 7, according to the
Fortunately, approximately 25 states, according to
Clearly, our issue with surprise bills isn’t the result of a lack of rules and laws. It’s the result of fundamental flaws within our industry’s business model. Not being able to easily access information on how many providers, services, and their subsequent costs go into certain medical procedures keeps patients in the dark and prevents them from making well-informed decisions. Hospitals continuing to utilize the opaque fee-for-service payment model puts patients in emergency situations in a helpless position where there’s no time to figure out what’s in network and what isn’t.
If we had a consumer-centered, market-based model that required transparency in costs and quality, accountability across the continuum with payments tied to outcomes, and real competition based on data that is made available in consumer-friendly ways, we wouldn't have the problem with surprise bills we see today.
Legislation adds bureaucracy, and bureaucracy tacks on time. Consumers want solutions now, and we have the ability to give them that. All we have to do is make better use of laws that already exist, give patients the tools to make educated healthcare decisions, and provide truly value-based care by shifting away from fee-for-service and toward risk-based arrangements that increase accountability.
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