Peter Schorsch
The ledgers of Florida’s major hospitals are a widely various mixture of uncompensated care in emergency rooms — the first and last line of medical defense for the indigent and uninsured — combined with more profitable services that help balance the books and ensure that hospitals have money to keep their infrastructures up to date and allow patients access to a wide range of elective operations that could not be provided at a loss.
A well-meaning bill now emerging in the Senate might well throw off that delicate balance.
SB 516 would create, in statute, a fixed-payment schedule for services provided by out-of-network or non-participating providers to patients of a preferred provider organization (PPO) or an exclusive provider organization (EPO) and prohibit providers from charging anything above that scheduled rate.
Introduced in the wake of reports of high rates billed to trauma patients, this bill’s cure would be worse than the disease.
For years, emergency room service providers have negotiated rates in a market setting with insurance companies to come to a schedule of rates that both can live with. This arrangement has led to nationally recognized
SB 516 would stop those talks and force hospitals to limit care in some specialties in order to make up the capital they would lose from the presumably lower rates that result from the government-set payment schedules.
Besides disrupting current contract talks and the painstaking planning on the part of hospitals to coordinate services across our massive state, the bill would remove any further incentive for the insurers and hospitals to negotiate going forward, wedging state government bureaucrats — God bless them — in between the doctors who provide emergency care to folks at their most vulnerable and the insurers who pay for it.
