End the surprise insurance gap

PFC Releases New Research That Shows Federal Benchmark Rate Would Risk Patient Access to Care

Date created

Mon, 07/15/2019 - 09:32

WASHINGTON – Physicians for Fair Coverage (PFC) released a new report that highlights the dangers of a federal benchmark policy approach to end surprise medical billing and its unintended consequences for patients. According to the data, benchmarking would threaten patient access to quality care by tying reimbursement for physicians to a median rate. This would particularly hurt rural patients, which have seen 64 hospitals close between 2013 and 2017 alone.1


“Applying Medicare, in-network, or other benchmark rates to out-of-network commercial services would further weaken hospitals’ financial position and negatively impact access to critical physician services,” the report states.


Dr. Sherif Zaafran, Chair of Physicians for Fair Coverage praised the new report noting, “This paper affirms what we in the physician community already know about benchmarking – a one-size-fits all approach misses the mark since it would exacerbate rural hospital closures and threaten millions of Americans’ ability to see the doctors they trust. We’ve seen this happen in states like California, hurting patients in America’s most populous state.”


Across the country … the need for specialists has grown, and appropriate levels of reimbursement will be critical in attracting providers to these critical specialties,” according to the report.


In 2017, California enacted a benchmark model, which led to narrower networks for patients, giving insurers more power to dictate the terms of care. The California Medical Association released a statement noting, “Some insurers are terminating contracts unless physicians accept a 40% payment reduction. Others are closing their networks to new physicians. This is happening because the California system does not incent physicians and insurers to contract with each other.”


The growing body of evidence makes it clear: a benchmarking approach at the federal level will hurt patients nationwide. To read the full report, click here.



American Hospital Association. AHA Chartbook. 2018. https://www.aha.org/system/files/2018-07/2018-aha-chartbook.pdf 

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