Addressing surprise medical billing

This resource aims to address and offer balanced and viable solutions for protecting patients from the effects of surprise medical billing and resolving the matter in a way that is fair to patients and ensures that critical healthcare services are available when they are needed. The narrative shaped by recent media reports falls short in addressing the unintended consequences that can arise as federal legislators undertake this thorny issue. Instead, we have seen a far too easy argument that incorrectly blames providers and investors (such as private equity) for the problem of surprise billing.

We hope you will review the information and resources that follow and come away with a new-found understanding of the issue and solutions that are needed to provide patients and consumers with the protections they deserve when accessing healthcare services in the commercial insurance marketplace.

TeamHealth is proud to be the leading physician practice in the U.S. Driven by our commitment to quality and safety and supported by our world-class operating team, we provide care to roughly 29 million patients annually across the country. Through our more than 16,000 physicians and advanced practice clinicians (APCs), TeamHealth offers emergency medicine, hospital medicine, critical care, anesthesiology, orthopedic surgery, general surgery, obstetrics, ambulatory care, post-acute care and medical call center solutions to approximately 3,100 acute and post-acute facilities and physician groups nationwide.

In 2018, we provided emergency medicine services for 16 million emergency department visits. We deliver emergency care to all patients who seek us out, regardless of their source of insurance or lack of insurance or means or ability to pay for that care. More than 85% of our care is delivered in-network. We operate profitably but at razor-thin margins of less than 10% per year, which allows us to recruit and retain the top clinicians in the country and ensure we deliver on our commitment for high-quality, best-in-class emergency care at all times.

In order to preserve and maintain the emergency medical delivery system and provide market-based compensation to thousands of qualified professionals who make up our medical staff, TeamHealth must operate under a strict set of criteria and budgetary expectations.

Like other emergency medicine providers across the country, TeamHealth relies on commercial reimbursement to off-set or cross-fund the underfunded and uncompensated care that TeamHealth’s practitioners render to Medicare, Medicaid, uninsured and other non-commercially insured patients who make up a large percentage of our overall patient population. In fact, three of four patients who visit TeamHealth’s affiliated emergency departments reimburse us for our services below our cost of $150 per patient visit, meaning the commercial population remains the only viable source of positive revenue for us.

This arrangement between providers and insurance companies creates a social safety net that allows all patients to receive emergency care – including the uninsured and indigent, who otherwise would have nowhere else to turn for care. But recently, the commercial insurance industry and the employer groups they represent have balked at this social arrangement, taking great strides to reset with a goal to reduce emergency clinician reimbursement by as much as 30%. This effort by insurers will put emergency medical delivery at risk of financial peril and endanger patients who rely on our emergency departments for critical care.

Insurers have also shifted risk to patients in the form of increasing out-of-pocket costs and higher deductibles, co-insurance and copayments. This has led to patients receiving egregiously large bills from providers that historically were silently reimbursed by the commercial insurance industry.

The system is clearly fragile, and absent the commercial insurance industry’s willingness to sustain the cost for underfunded and uncompensated care the most vulnerable and most acutely sick are left without access to care. In rural America, which already faces serious access challenges, insurers’ actions could effectively shutter the only hospitals or medical practices available in those communities. Furthermore, as the emergency delivery system continues to run the risk of collapse, it will become increasingly difficult to recruit and retain qualified medical personnel, particularly board-certified emergency physicians, which are already in short supply.

This resource will explore the causes of surprise medical billing and attempt to de-construct and correct several misused messages that are at the core of the debate. TeamHealth and our partners unequivocally support efforts to prohibit and protect patients from the practice of surprise medical billing, but we do so in a manner which will not undermine the emergency medical delivery system and leave it in a state that makes it non-functional and unable to fulfill its mission.

We are proud of this mission and carry it out without hesitation. However, we are also grounded in the fiscal realities and economics that drive our healthcare delivery system. It does not, as many cynics assert, imply we are beholden to a financially driven investor community. We stand behind our mission, the hospitals and patients we serve and the clinicians we represent. We hope following your review of this site you will develop a balanced view on the issue of surprise medical billing and efforts needed on both sides of the equation to eradicate its use in the healthcare delivery system.

Sincerely,

Leif Murphy

President and Chief Executive Officer