November 05, 2019
Area(s) of Interest: Advocacy Payor Issues and Reimbursement Out of Network Billing
SACRAMENTO, Calif. — A new survey of California physicians illustrates serious unintended consequences from California’s surprise billing law (AB 72) that will have long term impacts on patient access to care if not corrected. While the California law has protected patients from surprise bills, physicians are reporting serious problems that will substantially increase health care costs by accelerating consolidation in the health care market, jeopardize the emergency care safety net and restrict patient access to in-network physicians.
“We all agree that patients must be protected from surprise medical bills,” said CMA President Peter Bretan, M.D. “This survey underscores some of the potentially harmful long-term impacts of California’s approach to ending surprise medical bills, and the dangers of tipping the scales too far in favor of insurance companies.”
Congress is currently modeling federal legislation on California’s surprise billing law. While California has succeeded in protecting patients from surprise medical bills, these survey results clearly demonstrate that rest of the law is not working. California’s experience should be a warning to state and federal policymakers, and CMA is urging Congress to consider other models, like the successful approach taken in New York, to protect patients.
The vast majority of physician respondents reported difficulties contracting with insurers since the passage of California’s law and 88% said that AB 72 decreased patient access to in-network physicians in their community. Over 90% of physicians agreed that federal legislation modeled after AB 72 would accelerate consolidation of the health care market. As independent physician practices can no longer remain viable without contracts or reasonable reimbursement rates, they will be forced to consolidate with larger hospital systems or private equity groups, which studies have shown can drive up health care costs by as much as 30%. These unintended consequences must be avoided to protect patient access to physicians and curb rising health care costs.
The survey includes responses from CMA physicians in all practice sizes and multiple specialties -- from primary care to surgery -- from 52 counties across California. Among the survey’s key findings:
- 88% of physicians said the California law allowed insurers to shrink physician networks, decreasing patient access to in-network physicians in their community.
- 92% said the law has reduced physician leverage to negotiate fair and reasonable contracts.
- 94% of physicians have experienced contracting difficulties since the passage of California’s law.
- 91% of physicians agree that the Congressional proposals modeled after the California law will accelerate consolidation of independent physician practices into larger hospital systems or private equity groups.
You can read the survey results here.