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Episode 154: Hybrid Horizons: Balancing Security and Employee Satisfaction in the Workplace. Denis O'Shea, Mobile Mentor

June 16, 2022

Written by Robert Tennant, Vice President Federal Affairs

As we now know, the No Surprises Act (included in H.R. 133) requires that uninsured, self-pay, and commercially insured patients be given a “good faith estimate” (GFE) of the cost for their medical service. When a service requires the involvement of multiple providers or facilities, such as surgery, a “convening provider or facility” is responsible for contacting all other potential providers or facilities that may be involved in the patient’s service (“co-providers”), requesting a GFE for their portion of the service, compiling the GFEs, and giving them to the patient if the patient is uninsured or self-pay.

With there being currently no standardized data exchange process for the convening provider/facility requirement WEDI conducted a survey to ascertain how difficult this convening provider/facility requirement will be to implement. We received 274 responses. Small providers/clinics made up 39.6% of respondents, 11.5% of respondents were from large provider clinics, 10.4% were from health systems, 8.5% from medium sized clinics, 2.2% from hospitals, the remainder are from other provider types or other entities.

Highlights from the WEDI survey include:

  • Almost 2/3rds (65.8%) of respondents said it would be difficult or very difficult to determine who should be the convening provider/facility.

 

  • The vast majority (89.1%) stated it would be difficult or very difficult for the convening provider/facility to identify all appropriate co-providers and/or facilities for the specific medical service.

 

  • More than 9 out of 10 (91.5%) said it would be difficult or very difficult for the convening provider/facility to collect GFEs from” co-providers and/or facilities for the specific medical service.

 

  • Almost 9 out of ten (89%) stated it would be difficult or very difficult to provide the patient the completed GFEs within the required 3 business days of being requested or the service being scheduled.

 

  • Most importantly, more than 8 out of ten respondents (83.1%) were somewhat or stronglysupportive for the government delaying the requirement for the convening provider/facility to obtain a GFE from any co-provider/facility until there is standardized data exchange process in place to communicate information between convening providers and co-providers/co-facilities.

The survey results suggest strongly that providers and facilities will face significant challenges just identifying who the convenor should be, who the appropriate co-providers/facilities should be, and how to collect GFEs from these co-providers/facilities. As well, respondents were adamant that meeting the legislation’s 3-day deadline to get the GFE to the patient would be difficult or very difficult. Not surprising, respondents expressed strong support for the government delaying the convenor requirement until a standardized process to exchange data between convening providers and co-providers/co-facilities is established.

Access the full survey results here and additional WEDI No Surprises Act comment letters and resources at the WEDI No Surprises Act Resource Center.

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