Decision Strikes Down IDR Provisions Tilted Toward Insurers
WASHINGTON, D.C. and CHICAGO — The American College of Emergency Physicians (ACEP), American College of Radiology (ACR), and American Society of Anesthesiologists (ASA) are pleased that a Texas federal court ruled Feb. 6 in favor of the Texas Medical Association’s (TMA) second legal challenge to the improper implementation of the No Surprises Act (NSA). This ruling does not impact the patient protection provisions of the NSA, which all three societies continue to support.
The TMA lawsuit raised significant concerns about the flawed implementation of the NSA, namely that arbiters were required to give preferential treatment to the insurer-calculated Qualifying Payment Amount (QPA), a step that inappropriately slanted the independent dispute resolution (IDR) process toward insurance companies. The court’s ruling effectively strikes down these provisions, restoring balance and fairness to the dispute resolution process itself. But further reform is necessary to make sure that the IDR process is accessible to physicians, as Congress intended. The administration’s recent 600% increase in its administrative (non-refundable) IDR fee, from $50 to $350, has placed this process fundamental to the NSA almost entirely out of reach for many physician groups, once again tipping the balance toward insurance companies.
The three organizations said:
“We are pleased that the Texas court recognizes the need to make sure the No Surprises Act is implemented as Congress intended, rather than finalizing a flawed process that would give insurance companies an unreasonable advantage in arbitration.”
“The Texas court is right to strike down provisions that would have required arbiters to prioritize their determinations on the Qualifying Payment Amount — a figure that insurers miscalculate and artificially drive lower to the detriment of physicians and patients. Instead, this ruling restores fairness to the process, allowing the No Surprises Act to protect patients without compromising access to care.”
“This ruling means that arbiters will now consider all of the factors mentioned in the legislation instead of giving undue preference to the Qualifying Payment Amount in arbitration. ACEP, ASA and ACR filed an amicus brief in support of TMA which was referenced in the ruling.”
“This ruling is an important step in the right direction. Still, significant reform is necessary to make sure that the independent dispute resolution process functions and remains accessible as the law intends. A fair and balanced process is still out of reach for many physician groups, especially smaller independent practices.”
About the American College of Radiology
The American College of Radiology (ACR), founded in 1924, is a professional medical society dedicated to serving patients and society by empowering radiology professionals to advance the practice, science and professions of radiological care.
About the American Society of Anesthesiologists
Founded in 1905, the American Society of Anesthesiologists (ASA) is an educational, research and scientific society with more than 56,000 members organized to raise and maintain the standards of the medical practice of anesthesiology. ASA is committed to ensuring physician anesthesiologists evaluate and supervise the medical care of patients before, during and after surgery to provide the highest quality and safest care every patient deserves. For more information on the field of anesthesiology, visit the American Society of Anesthesiologists online at asahq.org. To learn more about the role physician anesthesiologists play in ensuring patient safety, visit asahq.org/madeforthismoment. Like ASA on Facebook and follow ASALifeline on Twitter.
About the American College of Emergency Physicians
The American College of Emergency Physicians (ACEP) is the national medical society representing emergency medicine. Through continuing education, research, public education, and advocacy, ACEP advances emergency care on behalf of its 40,000 emergency physician members, and the more than 150 million people they treat on an annual basis. For more information, visit www.acep.org and www.emergencyphysicians.org.
Curated by: Public Relations
Date of last update: February 8, 2023