Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Discuss the reason that the US Congress passed the No Surprises Act 2. Describe the findings in the JAMA Internal Medicine article “Association of Surprise-Billing Legislation with Prices Paid to In-Network and Out-of-Network Anesthesiologists in California, Florida, and New York”
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from 8/30/2021 through 12/15/2022, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.25 contact hours.
In December 2020, the US Congress passed the ‘No Surprises Act’, which is in effect as of January 2022. The purpose of this legislation is to protect patients from surprise medical bills that may occur when an individual unknowingly receives care from an out-of-network practitioner at an in-network health care facility. The law also establishes a method of determining payments made by a patient’s insurer to the out-of-network practitioner. Insurers and practitioners must first negotiate out-of-network rates. If negotiations fail, they may proceed to a federal independent dispute resolution (IDR) process in which each party submits a price, and an arbitrator decides using the insurer’s median in-network rate as a benchmark.
Restrict excessive out-of-pocket costs
Emergency services must continue to be covered
Without prior authorization requirement
Regardless of whether or not a provider or facility is in-network
What is a ‘Suprise’ Bill
Typically, health plans do not cover the entire out-of-network cost
This could leave a patient with higher costs than if they’d been seen by an in-network provider
Often occurs in an emergency situation where a patient lacks the ability to choose the provider
If out-of-network provider bills the patient for the difference between the charges the provider bills and the amount paid by the consumer’s health plan (known as balance billing) an unexpected balance bill will be generated
The unexpected balance bill is also known as a surprise bill
Key Elements of the Act
Establishing an independent dispute resolution process to determine out-of-network payment amounts between providers (including air ambulance providers) or facilities and health plans
Requiring good-faith estimates of medical items or services for uninsured (or self-paying) individuals
Establishing a patient-provider dispute resolution process for uninsured (or self-paying) individuals to determine payment amounts due to a provider or facility under certain circumstances
Providing a way to appeal certain health plan decisions
Early Evidence Regarding Impact on Physician Payments
Before the No Surprises Act, 18 states had enacted their own surprise billing legislation.
Using anesthesia services, researchers (JAMA Internal Medicine) conducted a retrospective economic analysis of data from 2014 to 2017 from three states, California, Florida, and New York, comparing price changes before and after with 45 states that had not passed such ‘surprise bill’ legislation. Anesthesiology is one of the specialties with a great potential for surprise bills because patients typically do not choose an anesthesiologist for service.
Each of the three study states used a different payment standard or independent dispute resolution to determine the out-of-network rate paid to practitioners. The data set to examine the effect of the law had short before and after periods. Finally, not all commercial claims were examined, only claims from three of the largest US insurers.
The researchers learned that compared to prices in the control state, prices paid to in-network and out-of-network anesthesiologists in hospital outpatient departments and ambulatory surgery centers declined after surprise-billing legislation was enacted in the study states. California practitioners have argued that out-of-network prices were too low compared to in-network prices. Florida saw the largest out-of-network decline but that may have occurred because those prices were already substantially higher than those of in-network prices.
In summary, state surprise-billing legislation directly lowered anesthesia out-of-network prices and indirectly lowered in-network prices in outpatient departments and ambulatory surgery centers. These findings, however, cannot necessarily be extrapolated to other specialties. Data collection will need to continue to have more comprehensive information over a longer period of time.
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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