Congress now has several options on the table when it comes to ending surprise medical billing, an issue that has for too long hit vulnerable patients and their families with high, unexpected costs. However, not all of these solutions are made equally. In fact, some could make things substantially worse, especially for patients living in Pennsylvania’s many rural communities.

There is no doubt that patients will benefit from surprise billing reform, but proposals in both the House and Senate that seek to solve this problem through a government-mandated benchmark for out-of-network payments is the exact wrong approach for patients and providers alike. This benchmarking approach — as prescribed in Sen. Lamar Alexander’s Lower Health Care Costs Act (Senate Bill 1895) — would use insurers’ own highly biased data and in-network averages to set rates for physicians performing out-of-network care.

Because in-network rates have been highly discounted through the contract negotiation process, using them as a guide for out-of-network services would end up drastically reducing reimbursements to doctors and hospitals. As a result, physicians and health care facilities would face new financial losses that would undermine their ability to provide the highest quality care for the patients and communities they serve.

This could potentially undermine access and affordability for many patients, but the impact would be most pronounced in rural communities, where these issues can already prevent many patients from getting the care they so desperately need. Hitting rural health care facilities with massive financial losses could force many of them to scale back their offerings, consolidate with other providers or shut their doors for good. Any one of these options would mean rural patients would face fewer options, higher costs and potentially longer waiting times.

These outcomes should be unacceptable if improving the patient experience and lowering costs is the main objective. That is why Congress should focus on passing a solution that ends surprise billing while still protecting access to care for rural patients and communities. One such solution, known as Independent Dispute Resolution (IDR), can be found in the bipartisan Stopping The Outrageous Practice of Surprise Medical Bills Act (Senate Bill 1531), introduced by Sens. Bill Cassidy and Michael Bennet, and the Protecting People from Surprise Medical Bills Act (House Resolution 3502), introduced by Reps. Raul Ruiz and Phil Roe.

IDR would facilitate fair, open and transparent negotiations between providers and insurers by providing a simple, online platform through which each party could submit their best payment offer for disputed out-of-network services if they are not able to reach a mutual accommodation. Not only would this remove patients from the process completely, but it would help ensure payment amounts accurately reflect the true cost of care by leaving the decision up to an unbiased, third-party arbitrator.

Additionally, IDR would help keep at-risk health care facilities serving hard-to-reach rural patients and communities financially strong and stable by ensuring providers receive interim payments until a final decision has been reached by the arbitrator, if it reaches that stage at all. Ultimately, this is the most effective and most fair approach for patients, providers and insurers alike. New York has had such an approach in place for almost five years, with the results showing that out-of-network billing has been largely eliminated, more providers are in-network and health care costs have been controlled.

A third bill — this time in the House — known as the No Surprises Act (House Resolution 3630) muddies the waters a bit by trying to merge the fundamentally flawed benchmarking approach with the IDR process. While this bill claims to use IDR, it would only do so in cases where disputed amounts are greater than $1,250 — in all other cases, benchmarking would still be employed. Considering most physician claims fall below this high threshold, in the case of emergency physicians in the $200-$300 range for their professional services, this legislation is little more than another benchmarking bill in disguise.

Pennsylvania is lucky to have Sen. Bob Casey as one of the co-sponsors of the IDR-focused STOP Surprise Medical Bills Act in the Senate and Reps. Brian Fitzpatrick, Mary Gay Scanlon, John Joyce, Daniel Meuser, Lloyd Smucker and Glenn Thompson as co-sponsors of the IDR-focused Protecting People from Surprise Medical Bills Act in the House. Sen. Pat Toomey and our other Pennsylvania U.S. House members should also get behind this vastly superior approach and fight to incorporate IDR as the pillar of any legislation that rightly ends surprise medical billing as opposed to the potentially disastrous benchmarking approach.

Arvind Venkat, MD, FACEP, is president of the Pennsylvania College of Emergency Physicians (pacep.net).

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