Published 7/10/2019

AAOS urges against benchmarks, in support of arbitration to resolve Surprise Medical Bills

Washington, D.C. (July 10, 2019) — Ahead of tomorrow’s House Energy and Commerce Health Subcommittee markup of the “No Surprises Act,” the American Association of Orthopaedic Surgeons (AAOS) reiterated its strong opposition to using government-set payment benchmarks for handling surprise medical bill disputes. It warned against the economic viability of such an approach — even if they’re tied to the Consumer Price Index for All Urban Consumers (CPI-U) — and urged Congress to instead support a fair arbitration process.

“If physicians lose the ability to fairly negotiate or suddenly have their value tied to a market basket for consumer goods, they will be forced to leave geographic areas with a mandated rate insufficient for covering costs,” said AAOS President Kristy L. Weber, MD. “The CPI-U can't keep up with new technology or the dynamic medical costs of innovation. Like any benchmark, it would threaten not only the independent practice of medicine but also patient access during a time when choice and competition are increasingly limited.” 

In its letter to the subcommittee, AAOS emphasized that allowing for arbitration is the only way to protect patients from out-of-network surprise medical bills while preserving a fair playing field for resolving payment disputes. The approach is incorporated in the recently introduced “Protecting People from Surprise Medical Bills Act” and addresses the source of the problem—narrow, inadequate health insurance networks. 

AAOS expressed its encouragement of the proposal when it was first unveiled by Reps. Raul Ruiz, MD (D-CA), and Phil Roe, MD (R-TN), in May. It explained that market forces can only draw providers to underserved areas if an arbitration system relies on a truly independent database like the “New York Model.”  

The physician community has been constructively engaged with Congress on addressing the issue of surprise medical billing and with patients through the recently launched Out Of The Middle (OOTM) coalition. In its press release in support of the Ruiz-Roe effort, OOTM emphasized that the bill goes further than protecting patients by also encouraging transparency from insurance companies without adding cost, bureaucracy, or delay. 

“The AAOS remains committed to fighting for a policy solution that incorporates arbitration and implores Congress to follow suit, carefully considering the unintended consequences of government price-setting,” said Dr. Weber. “Our physicians, patients, and the entire health care system are relying on its leadership.” 

Read AAOS' full letter to the House Energy and Commerce Health Subcomittee here
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Contact AAOS Media Relations 

Kristen Coultas