We can protect rural health care and stop surprise billing
Rising health care costs can take their toll on anyone, but for patients living in rural communities that already contend with access issues, they are particularly burdensome. Add to that the unfair practice of surprise medical billing, and you have an untenable situation that compounds the financial pressure hardworking New Mexico families face.
As the administrator of Guadalupe County Hospital, a small hospital serving rural Eastern New Mexico, the families we treat are not only our patients but our neighbors, friends and family. We make every effort to protect patients from being caught in the middle of a surprise billing dispute; however, there is only so much we can do.
To comprehensively address this issue, Congress must pass legislation to stop balance billing when an individual accesses emergency services or ends up being seen by an out-of-network provider. One way Congress could protect patients is by separating them from outof-network billing disputes that lead to surprise billing. On that, we almost all agree.
What is still up for debate is how to do that without undermining health care, especially for those living in rural communities who face unique challenges all their own. To resolve this matter, Congress should pass strong, fair legislation that enables providers and insurers to settle out-of-network payments among themselves, leaving patients only responsible for their standard, in-network cost-sharing amounts. There may be a place for an independent dispute resolution process for the rare prolonged dispute, especially for physician claims.
Another approach outlined in competing legislation — known as “benchmarking” or setting an out-of-network payment rate in statute — would have the opposite effect. It would apply to all providers regardless of special circumstances, allowing insurers to simply default to that rate rather than work with providers on appropriate reimbursement. Benchmarking would be based on insurance companies’ own biased data and would result in tremendous financial losses to already struggling hospitals and emergency rooms serving rural New Mexico communities.
The government itself has acknowledged that such an approach would take nearly $20 billion out of the health care system over 10 years and that
80 percent of that would be from insurers depressing payment rates for care that has nothing to do with surprise bills. Benchmarking would establish an unfair reimbursement process, which would have a devastating impact on rural hospitals and, in turn, on access and affordability for rural communities. This is a recipe for disaster in our rural communities. As they end surprise billing, Congress must avoid solutions like benchmarking that could have unintended consequences.
While New Mexico passed its own law to protect patients from surprise billing last year, roughly 35 percent of New Mexicans could still receive these unexpected “surprises” in the mail weeks or even months after being treated. Federal legislation will provide an important backstop to our state law, ensuring that New Mexicans never have to worry about this issue again. Sens. Tom Udall and Martin Heinrich have long championed the effort to lower health care costs for New Mexico families while protecting access to rural health care. I hope they will protect patients and the providers who care for them by banning surprise billing and opposing a benchmarking rate. This approach is better for all New Mexico patients, families and communities — particularly those living in rural communities.
Christina Campos is the administrator of Guadalupe County Hospital, a board member with the American Hospital Association and former chairwoman of the New Mexico Hospital Association from 2010-11. She also served on the National Advisory Committee for Rural Health and Human Services in 2013 under then-Health and Human Services Secretary Kathleen Sebelius.