Specialist
Current Associate Director, The Brookings Institution
Agenda
- Efforts to curb unplanned medical bills and the possible impact on hospitals and staffing companies
- Potential to increase consolidation in the space
- Scope of impact on companies and subsequent effect on rated issuers
- 2019 outlook and beyond
Questions
1.
Could you explain the concept of surprise billing and how it differs from balance billing as a whole, as well as other healthcare legislation that has been highlighted in the news recently?
2.
What are the root causes of unplanned medical bills? Are hospital and physician groups incentivised to remain out-of-network, or do they generally struggle negotiating appropriate rates with insurance companies?
3.
What payment rates are physicians receiving in-network and out-of-network? Do those rates somewhat differ between individual companies, from a healthcare provider and staffing group perspective?
4.
You touched on some of the specialities that are more immediately affected – ER docs, anaesthesiologists, radiologists. Which other specialities might be affected on a more ancillary level? In total, what percentage of out-of-network spend do these specialities account for?
5.
Why is the in-network guarantee proposal losing momentum in Congress?
6.
What are the mechanics of the median rate proposal? What are some of the higher-level pros and cons of that proposal?
7.
How would you anticipate the burden of this proposal for the median rate falling upon providers, staffing companies and hospitals? Speculatively, would you be able to quantify that?
8.
What is the impact of getting paid above or below the median from a staffing company’s perspective, or when hiring physicians? How significant could it be in terms of physician movement?
9.
Do you have anything further to add about the median proposals?
10.
For the third option, arbitration, what are the mechanics of that side of the deal? What are the pros and cons for that proposal?
11.
Which of the different arbitration policies do you think has more traction moving forward? Perhaps between the arbitration and the benchmark options, which do you expect to have more stick?
12.
How do you think a median rate or an arbitration proposal will impact negotiations? Perhaps for providers who are currently in-network and may have a strong, but not median-controlling, share of the market?
13.
How much of the value proposition of physician staffing companies was driven by an ability to balance bill? If bill balancing is removed, what is the probability of hospitals in-sourcing rather than increasing subsidies?
14.
Are you aware if staffing companies are doing anything in anticipation of a potential outcome? Any mitigation strategies, perhaps?
15.
Ambulatory care is a big component of the bill that may not be as defined, currently. What is the likelihood that the law’s protection would extend to out-of-network ambulatory care?
16.
How much of total out-of-network spend in healthcare is accounted for within ambulatory care?
17.
You mentioned that roughly a third of air ambulances are in-network. Do you have any figures for ground?
18.
Air ambulatory care operates at a loss when transporting Medicare and Medicaid patients and typically overcharge private insurance patients to make up that difference. How do you think those dynamics may change, from a transportation and insurer side?
19.
Beyond the median rate and a total re-evaluation of the Medicare rate, are there other methods that might be used to determine a fair market price?
20.
If RVUs [relative value units] for emergency care change, will the median prices referenced by the surprise billing legislation be impacted? You mentioned the other option of perhaps looking at previous billing, but how do you foresee that?
21.
Why is surprise billing, the median, used as a minimum and not a maximum? What is the negotiation leverage for a provider to do better than the median?
22.
What is your expected timeline for the Lower Health Care Costs Act passing? Is there any other legislation in Congress that may slow the momentum of this particular bill?
23.
Are there any components of the bill that may not be receiving as much press, but could affect some ancillary parties? Thinking on the McConnell tobacco age, as well as any sort of drug pricing components that may be included in the bill?
24.
What is your outlook on company financial impact over the next 12-18 months? In terms of all the parties involved, do you expect any consolidation among staffing companies, hospital groups, etc?
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