Specialist
Former manager at UnitedHealth Group Inc
Agenda
- Historical context on US surprise billing legislative initiatives leading to policy initiatives from Trump and Biden administrations
- Trickle-down impact on staffer and PPM (physician practice management) business models from No Surprises Act and potential hit to revenues from future uncollected out-of-network procedure bills
- Dispute resolution process and benchmark reimbursement analysis for in- vs out-of-network negotiations
- Staffers' ability to weather regulatory headwinds and implications of in-network contracts on revenues
- 2022 physician staffing sector outlook, strategic assessments and scenario analysis post-2022 midterm elections
Questions
1.
What are the most important trends and developments in the physician staffing market that you’ve been following over the past year or so, both regulatory and otherwise?
2.
What are your thoughts on the broader impacts around the No Surprises Act, set to take effect on 1 January 2022? Could you reconcile the ramifications for provider staffing groups from losing out on out-of-network income with the potential effects on commercial payers from the policy?
3.
Could you outline the current cost sharing dynamics between providers and payers for in-network and out-of-network services respectively? I appreciate this will vary considerably across reimbursement demographics, geographies and service lines.
4.
How much leverage does arbitration give to provider groups to extract higher prices? Could you reconcile that with the cost of entering arbitration for providers? Is there a substantial cost disincentive?
5.
What might be the overall impact on out-of-network care volumes longer term? Might patients simply be pre-emptively more aware when they’re receiving out-of-network care? How might that affect out-of-network care volumes longer term?
6.
What made anaesthesia unique in being able to operate out of network for so long?
7.
How does the inapplicability of notice and consent exception to neonatology, anaesthesiology and so on affect the provider groups’ negotiating positions?
8.
How do you think the No Surprises Act will affect third-party repricers and analytics companies? Could the savings there decrease because the spread between the initial bill from providers will likely converge towards the QPA [qualifying payment amount] over time?
9.
Might payers start calculating the QPA on their own, especially larger, more sophisticated payers? What are the major considerations here?
10.
I understand QPA is based on at least three median in-network contracts in a specific MSA [metropolitan statistical area] and then extended to further MSAs if data points are insufficient. How common is it for an insurer to contract with at least three in-network providers for a specific service such as ER [emergency room] in a single MSA? If it’s common, were they mostly focused on contracting with larger providers?
11.
What levers, if any, could staffers pull to offset vulnerability and challenges created by the No Surprises Act? To what extent could favourable supply and demand dynamics around contract labour pricing provide any relief?
12.
You mentioned ER groups were billing at 500% of the Medicare rate. What rates were they collecting from commercial insurance?
13.
What would be the expected rate for players such as Envision or TeamHealth if they go in-network? Would 130% of Medicare make sense?
14.
Providers would appear to have very little leverage going forward due to this policy. Would you expect more haircuts from payers on some services going forward such as ER? What would stop them from reducing reimbursement levels further?
15.
How do you expect insurance premiums to trend over the next couple of years? Might there be a low-single-digit move in either direction?
16.
Are you monitoring any further regulatory developments at the state level, perhaps amending or introducing policies that could supplement the federal balance billing legislation?
17.
Would you expect increased funding through Medicare at the state level? How are strained state budgets affecting funding for Medicaid programmes? How are state budget concerns being managed?
18.
Could you discuss No Surprises Act’s implications for air ambulance players? How much of a headwind could a broad balance billing ban be for air ambulance players?
19.
Could you expand on the No Surprises Act’s impact on Mednax’s neonatal intensive care business?
20.
What’s your 12-18-month outlook for the physician staffing industry as regulation begins to take effect? Is there any risk of a regulatory rollback or amendment based on scenario outcomes of the mid-term elections in 2022?
