Grassroots Spotlight: WHA Meets with Reps. Grothman and Moore to Discuss Surprise Billing

Continue to ask for fix to federal legislation

September 03, 2019

WHA hospital and health system leaders met with Congressman Glenn Grothman and Congresswoman Gwen Moore in separate meetings on August 28 to discuss federal legislation aimed at tackling surprise medical billing.

The first meeting was hosted by Ascension Columbia St. Mary’s Ozaukee in Mequon. Grothman toured the facility and met with a group of WHA advocates from Ascension, Hospital Sisters Health System Eastern WI Division, Froedtert Health, Children’s Hospital and Health System, and Columbus Community Hospital.

David Lally, of HSHS Eastern WI & Caleb Jensema of St. Nicholas Hospital in Sheboygan, discussed voluntary efforts hospitals are already doing to meet customers’ desires for more transparency and price information. They discussed WHA’s PricePoint website, which allows consumers to compare charges for hospitals across Wisconsin, as well as a website HSHS has developed for its patients. This website allows patients to obtain online estimates for planned procedures and takes into consideration a patient’s health insurance plan so they have a better idea of what they might be paying out of pocket.

Grothman said he has been following the legislation in Washington that would end surprise medical billing and understands that it has been introduced to address consumer frustration with unexpected medical bills. He said he was unsure where the legislation would end up but hoped it would not become mired in partisan politics and would actually present a workable solution.

Katie Burns and Lindsay Punzenberger of Children’s Hospital walked through efforts Children’s makes to stop patients from receiving a surprise medical bill. Burns mentioned that Children’s, like many Wisconsin hospitals, does up-front work to keep its providers in-network. It will also negotiate single-case agreements with insurers Children’s does not have a contract with. Many Wisconsin hospitals take these steps to help make Wisconsin a state with a low rate of surprise medical bills compared to other states.

John Russell, CEO of Columbus Community Hospital, offered his perspective as a small, rural, critical access hospital. He noted that while hospitals support taking the patient out of the middle and avoiding surprise medical bills, the mechanism that would pay providers a government set median in-network rate would create other problems that heavily favor insurers at the expense of hospitals and patients’ choices of providers.

Grothman thanked the group for sharing their perspectives, which he said he would keep in mind should the Education & Labor Committee he serves on take up this legislation.

WHA then went to meet with Congresswoman Moore in her district office in Milwaukee and was joined by Ascension Wisconsin and Children’s Hospital of Wisconsin. Moore said she is currently a co-sponsor of legislation authored by Ways & Means Committee Chair Lloyd Doggett (D-TX) which would require hospitals to inform patients if a provider is out of network prior to services being provided, otherwise the patient could receive a bill for no more than an in-network charge.

Elizabeth Cliffe of Ascension noted that Wisconsin hospitals in the Milwaukee area all work to keep providers in-network as much as possible, which reduces the amount of surprise medical bills. She noted that current studies on the issue suggest Wisconsin has a low rate of surprise medical billing, but that current legislation requiring providers to accept government-set benchmark rates would create challenging issues for all Wisconsin hospitals and the patients they serve. Moore said she is aware of the concerns over this issue and will keep that in mind as legislation comes before the Ways & Means Committee she serves on or to the floor for a vote.

WHA will continue to meet with lawmakers in Wisconsin and Washington, D.C. to request the government rate-setting provisions be dropped from legislation before it comes to the floor for a vote. For additional information, contact WHA Director of Federal and State Relations Jon Hoelter.

This story originally appeared in the September 03, 2019 edition of WHA Newsletter