Wheel of Misfortune: The Fix

Healthcare Transparency initiatives like the Alexander-Murray bill are getting a tremendous amount of press lately; deservedly so. But are these measures a fix or a baidaid?

Keep in mind, out-of-network “surprise” bills would not exist if not for the market surrogate (poor surrogate that it is) that we call PPO networks, which serve to suppress competition by obscuring prices & quality.

So, it is not a stretch to say that surprise bills occur by design. The way we’ve chosen to finance medical care allows prices to hide among the placeholders in the billing cycle because doctors have become defacto billing agents for the carrier networks and their anti-competitive, contractually-mandated CPT billing protocols. And the rights to those codes are owned by the AMA and the RVU dollar conversion factor is determined by CMS which guarantees upward trajectory of billed charges which make the process impervious to price competition.

This whole problem evaporates when providers remove themselves from the contract and replace these unholy inflationary-prone agreements with real prices and/or transparent service agreements.

Fix the problem: Keep the contract between the subscriber and the insurer.