If Tennesseans learned one thing in the past year, it’s that life can change in a moment. We witnessed devastating tornadoes rip through our communities, tearing apart our families and infrastructure in a matter of minutes. We felt tremendous loss as COVID-19 swept through our state and took thousands of lives. And we watched the opioid epidemic in Tennessee reach tragic new heights, with a 51 percent increase in opioid-related deaths in the first eight months of 2020.
As an emergency physician and former president of the Tennessee chapter of the American Academy of Emergency Medicine, I’ve witnessed first-hand the critical importance of our emergency healthcare system – the nation's medical safety net. Our heroic front-line physicians, nurses, paramedics, and others treat patients in every corner of Tennessee when their lives suddenly take a dangerous turn, delivering life-saving care for those in need.
Emergency physicians take care of anyone at any time regardless of their insurance status or ability to pay. We take pride in that, but since the Emergency Medical Treatment and Active Labor Act became federal law in 1986, we have had a legal obligation to do that on top of our ethical commitment. The federal government made America's emergency departments the nation's medical safety net by law, but has never funded that mission. As a result, according to a 2003 report from the American Medical Association's Center for Health Policy Research (Kane, CK: The Impact of EMTALA on Physician Practices), on average every emergency physician in the United States donates about $140,000/year in uncompensated charity care. Despite that huge contribution to the well-being of the country, patients are often still faced with surprise medical bills so costly that families risk bankruptcy.
Last year, Congress passed the No Surprises Act, protecting patients from surprise medical bills that are no fault of their own. The legislation was built around an independent dispute resolution process that allows insurers and providers (physicians and hospitals) to settle billing disputes without putting patients in the middle. This legislation will ensure that patients aren’t penalized for seeking emergency medical care and that front-line clinicians are compensated fairly.
Insurance companies spent millions lobbying for alternative legislation that would enhance their profits by cutting the reimbursements that emergency departments and physicians depend on by as much as 20 percent. Their caps and “rate-setting” approach would protect the insurance industry at the expense of quality medical care and patient access here in Tennessee and across the United States. Over the course of the past year, large health insurers have posted record profits while breaking promises to provide coverage for life-saving medical care such as COVID-19 tests and vaccinations. Now, following passage of the No Surprises Act, these insurers have resumed their lobbying efforts in an attempt to influence the rule-making process that puts the new law into action.
The Department of Health and Human Services will soon begin that rule-making process. This step will be critically important for patients and front-line providers. Congress included the IDR process to level the playing field between insurers and those who take care of patients. But if HHS builds the rules in favor of insurers, it will further damage our medical system at a time when we cannot afford to put more financial pressure on our hospitals and emergency physician practices.
Nationally, 25 percent of rural hospitals are at risk of closure if their financial situations do not improve. But the situation is worse right here at home. Sixty-eight percent of rural Tennessee hospitals will be forced to close their doors if we don’t correct the imbalance of power between insurers and emergency care providers. These at-risk rural hospitals employ more than 2,200 healthcare workers, and on average each treats nearly 13,000 patients per year.
Tennesseans have experienced too many hardships over the past year to let our hospitals fall through the cracks. An accident or medical emergency can happen in a moment, and Tennesseans should be able to get the help they need without fear of financial ruin. As insurance companies spend millions on lobbying at the expense of our local communities, I urge Senators Marsha Blackburn and Bill Hagerty to prioritize the millions of Tennesseans at risk of losing access to medical care and the thousands of healthcare workers who deliver life-saving treatment. To protect Tennesseans, Senators Blackburn and Hagerty must work with HHS to ensure the No Surprises Act is implemented as Congress intended – not in a way that favors the profits of insurance companies, which are already among the richest and biggest corporations in America and don't need any additional help from the federal government.
Dr. Andy Walker
Tennessee-based emergency physician, former member of the board of directors of the American Academy of Emergency Medicine and former president of the Tennessee chapter of AAEM