WHA Back on Capitol Hill to Discuss Surprise Billing

WHA members also advocate for telehealth and Stark Law reform

October 31, 2019

WHA was back in Washington, D.C. on Oct. 29 to discuss federal legislation on surprise billing with Wisconsin’s Congressional delegation. The group met with all nine of Wisconsin’s Congressional offices and discussed upcoming telehealth reform legislation and a new proposed rule from CMS on Stark Law reform.

While surprise billing has been a hot topic since early summer, disagreement over the mechanism to end surprise billing disputes has slowed momentum for the legislation in recent months. Most of Wisconsin’s Congressional delegation noted that while they support ending surprise medical bills, they understand WHA’s concerns that using a benchmark rate as a mechanism to end surprise billing could have unintended consequences that could limit patient choices and create new challenges for hospitals with low revenue margins, particularly in rural areas. 

U.S. Rep. Ron Kind gave WHA an overview of the prescription drug reform package the House Ways and Means Committee he serves on has been working hard on in order to bring more transparency to prescription drug pricing and lower prices for consumers. He said now that the committee has completed its work on that package, he expects they will turn their attention to surprise billing. He also noted there is still a wide disagreement over how to solve surprise billing and that could create challenges for the committee and Congress as a whole. In addition to Rep. Kind, most of Wisconsin’s Congressional delegation mentioned they were uncertain whether there would be enough votes to pass surprise billing legislation before the end of the year. Many thought presidential impeachment talks in particular could slow down this and other legislation Congress has been considering.

WHA members also discussed how their hospitals are increasingly turning to telehealth to deliver better patient care at lower costs. Michelle Abey of Stoughton Hospital noted how her hospital uses telehealth to help hospitalists work more efficiently. Rather than having one hospitalist present at all times to admit patients, telehealth allows that hospitalist to serve three hospitals. This has the twofold impact of helping alleviate the health care workforce shortage while also saving dollars in the health care system. Unfortunately, due to Medicare’s outdated payment structure, Stoughton Hospital does not receive Medicare reimbursement for any telehealth services as it is not in a rural health professional shortage area (HPSA).

Tiffany Huston of Door County Medical Center noted that while their hospital is in a rural HPSA and eligible for telehealth reimbursement, Medicare still will not pay for telehealth services delivered to a patient’s home. This can be problematic for patients who are ready to be discharged but need follow-up care or assistance from a caregiver, as it often forces hospitals to keep patients at the hospital longer or forces patients to drive long distances back to the hospital for follow-up care. Medicare’s policy of not reimbursing for home care ends up driving up costs in the health care system and inconveniencing patients in the process. The group provided these as examples of why Wisconsin’s Congressional delegation should cosponsor upcoming WHA-supported telehealth reform legislation that will soon be introduced in the U.S. House and U.S. Senate.

WHA and its members thanked Wisconsin’s Congressional delegation for its support earlier this year in urging the Centers for Medicare & Medicaid Services (CMS) to update the outdated physician self-referral or Stark Law. Tony Curry of Advocate Aurora Health mentioned that while the changes appear to be a step in the right direction, ultimately Congress may need to update this law due to statutory barriers that persist.

WHA will continue to advocate on all these issues and will keep members updated as new developments happen. Contact Jon Hoelter for more information.

This story originally appeared in the October 31, 2019 edition of WHA Newsletter