Although the price transparency elements of the No Surprises Act do shake up the payer-provider dynamic, the true controversy surrounding the act involves out-of-network rate mediation, Larry Levitt, Kaiser Family Foundation executive vice president for health policy, wrote in a Jan. 20 JAMA Health Forum op-ed.
Under the No Surprises Act, if a provider and payer cannot reach an agreement as to what rate a patient should pay for out-of-network care, they must use a mediator, who assumes median in-network rates for local providers are appropriate payment amounts.
That assumption, Mr. Levitt wrote, is at the heart of the No Surprises Act controversy.
As written, Mr. Levitt said the act will shift market power toward payers through lower payments to providers. This will also result in an estimated 0.5 percent to 1 percent decrease in average premiums.
The biggest losers in this arrangement are private physician practices that forego insurance networks and capitalize on surprise out-of-network billing. Fields such as emergency medicine, pathology, radiology, anesthesiology and behavioral health participate in this practice the most, Mr. Levitt said.