'This is not a sustainable reimbursement system': 1 leader on the No Surprises Act and pay discrepancies

Some healthcare leaders say the No Surprises Act, aimed to protect patients against balance billing and create cost transparency, has accelerated reimbursement issues. 

Laura Lowenstein, healthcare attorney and president of oNet Systems, joined Becker's to discuss how the No Surprises Act, paired with other administrative hurdles, has shifted reimbursement.

Editor's note: This response was edited lightly for brevity and clarity. 

Question: What are your biggest concerns regarding reimbursements right now?

Laura Lowenstein: Besides the obvious administrative hurdles — pre-authorizations and a myriad of claim follow-up obstacles — my central concern is that Medicare, which was never meant to be reflective of a true market rate, has become the de facto benchmark of both in-network contracting and out-of-network reimbursement. The result being an incredibly distorted reimbursement picture where everything is consolidating around a fixed government price that does not in any way reflect what would result from arms-length negotiated rates. This results in less patient access and more patient cost shifting to get their desired care. We need to move everything to a middle ground where rates are not dictated top down and instead vary based on a whole array of regional, provider and employer-specific considerations. If we do not return to a disparate free-market system of healthcare spending, we will continue to get concentrated power in insurer epicenters that do not serve the public interest. The NSA has only accelerated this concentration and siloing of healthcare systems due to the (potentially unintended) destructive forces that it created in the out-of-network market. When the independent out-of-network providers are not there as a counterweight, you get total insurer capture of in-network bargaining leverage. It is arguable that the NSA has caused as much, if not more, harm to in-network providers than out-of-network ones. This is not a sustainable reimbursement system.  

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