VOLUME 27, ISSUE 1
others. All of these costs contribute to the rising premiums. Of particular significance are the increases in the deductible, now frequently as much as $5,000 or $6,000 before the insurance coverage kicks in. Many of the less affluent patients just do not have that kind of reserves, effectively leaving them without coverage for a significant portion of the cost of their healthcare. This has had a major impact on cash flow for most hospitals and a number of physicians. This is clearly an unintended, but real effect of the ACA.
On to more issues that go bump in the dark: The 2015 Texas Legislative Session
As I write this we are over a month off from the start of the 2015 Texas Legislative Session, but the work of the session has already started with early bill filling and other preparations. Two topics of particular interests to Anesthesiologists have appeared: Out-of-Network Balance Billing and Price Transparency.
The problem of out-of-network balance billing has been an issue for several legislative sessions. During the last session there was some resolution of the problem with implementation of a mediation system. Unfortunately, the issue still remains a hot topic. The insurer of State Employees (United Healthcare) seems to generate a disproportionate number of complaints, perhaps because they advertise the complaint system. In this case advertising is defiantly good for their bottom line.
Briefly, the issue centers around out-of-network physicians, and in particular hospital-based physicians, who bill patients full rates while the insurance companies pay only a fraction of the bill. This leaves the patient with large and unexpected bills. Physicians who do not join networks get to bill their full non-discounted rate while insurance companies with limited networks have less financial responsibility if the patient goes out-of-network. The net effect for insurance companies is that having a reasonable sized (adequate) network of physicians is bad for the bottom line. Anesthesiology practices are a limited subset of the problem. Most of the out-of-network billing occurs with other specialties.
Several solutions have been enacted in other states and all of these solutions have been proposed in Texas at some point. Probably the most concerning proposed solution is an outright ban on balance billing. A ban would result in a race to the bottom for payments to physicians as there would be no incentive to the insurance companies to pay more than basement rates. This is particularly a problem for the hospital based physicians, as we often have little opportunity to choose our patients or even discuss their financial responsibilities prior to providing services. The TSA, in cooperation with the TMA and other specialties, is working hard with our legislators to reach a solution that is both fair to the patients and allows physicians to remain economically viable.
Another hot topic already in play in Austin is Price Transparency or in other words, price posting. The past several sessions of the legislature has seen proposed legislation dealing with price posting. Bills have ranged from reasonable to outrageous demands for posting all proprietary contractual rates in a public forum. In my opinion, knowing what you are going to pay for a product or service prior to purchase is a cornerstone of our economic system. The problem is in the details. What rates get posted and what are the penalties? It is particularly difficult for Anesthesiologists as we have a time component to our charges as opposed to a set fee. Again the TSA is hard at work with others in medicine and our elected representatives to find a solution that is reasonable for physicians as well as the citizens of Texas.
Finally, due to the reduction in Federal funds, a limited improvement in the insured numbers, and
