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CEO Message: Protecting Patients by Fighting Back on Rate Setting

Earlier this week, we asked California’s hospital leaders to raise their voices to urge congressional leaders not to set a benchmark rate as a way of addressing surprise billing.

The need to push back arose late last week after committees in both the Senate and the House of Representatives announced they had reached an agreement on legislation to tackle the high-profile issue of consumers receiving surprise medical bills. The package — which could be voted on as soon as next week — includes both a benchmark rate and an independent dispute resolution process for claims over a certain amount.

Fortunately, on Wednesday, the House Ways and Means Committee offered another bipartisan alternative. As Congress grapples with this important issue, it’s more important that they thoughtfully consider all of the complexities than rush to a hastily crafted legislative solution.

Thank you to all who have already reached out to your representatives, helping to continue the drumbeat we began last year to make clear to lawmakers that hospitals support eliminating surprise billing, but that fixed “benchmark” rates are not the right solution and threaten critical resources for patients.

Protecting patients is what hospitals do, so for you as leaders, it’s simple: People seeking necessary medical care should be protected from unexpected bills, and no patient should ever pay more for emergency care just because their insurance company chooses not to contract with a hospital. Giving patients the peace of mind to heal includes removing them from payment negotiations between insurers and providers, and creating safeguards from the gaps in insurance that result in surprise bills.

We need to keep reminding policymakers that, while benchmark rates offer financial protections for insurers, they offer none at all for consumers.

As leaders, you also know that caring for patients includes protecting their access to care. It is incumbent on all of us to make sure Congress understands that creating a benchmark payment rate threatens access – both by reducing available resources and by giving health plans less incentive to enlist facilities and physicians in their networks.

What lawmakers need to do – and they need our help – is to prevent patients who have received needed health care services from getting surprise bills for that care. Once that assurance is in place, payments made from the insurer to the provider become irrelevant to patients.

As we learn more about details of the different federal proposals, we will share them with you. This issue, of vital importance to patients and hospitals alike, requires our vigilance now and in the near future.

We cannot afford to miss a beat.

— Carmela