The Record: Vitale plan for surprise medical bills hurts patients

This op-ed originally ran on June 26 on

If you’ve been following the debate over out-of-network benefits, you’ve no doubt heard about the patient charged $49,000 for an overnight in the emergency room after a broken bone or another patient charged $59,000 for a two-day stay after kidney stones.

Examples like these have prompted the Legislature to consider a rash solution that will do far more harm than good to patients in New Jersey.

A bill, S-1285, sponsored by state Sen. Joseph Vitale, will inflict irrevocable harm on the healthcare safety net in New Jersey.  While previously termed the “out-of-network” bill, we now need to call it what it is – the medical price-fixing bill of New Jersey. 

TheRecord1200x800.pngIf passed into law, this legislation will artificially suppress out-of-network physician reimbursements to around Medicare prices, which run far below market rates for equivalent services. 

With better reimbursement laws in states like New York and Connecticut, the very New Jersey doctors who treat your medical emergencies 24/7 will rapidly leave the state, creating grave shortages of specialists in our 72 emergency rooms.

Unfortunately for an unassuming public, the byproduct of such shortages may lead to scenarios where New Jersey residents may die or suffer permanent injury caused by delays in care while transferring to larger medical centers.

If you think I’m being hyperbolic, consider the example of Alexis Morgan, an otherwise healthy 23-year-old new mom who began acting strangely during a summer evening in August 2016.

Her mother found her confused and losing consciousness. Alarmed, she called 911 and an ambulance immediately rushed Alexis to the nearest emergency room, which was at Chilton Hospital, a small outlying community hospital in Pompton Plains.

By the time she arrived, she was sleepy and unresponsive to stimulation.  An emergency CT scan showed that Alexis had a ventricular tumor inside her brain that was causing pressure to build-up. Transferring her to another facility was out of the question, as she was quickly slipping into a coma.   

Fortunately, a neurosurgeon was on-call at Chilton that night. Within 20 minutes of his arrival, Alexis was in the operating room for an emergency procedure in which a drain was placed in the center of her brain to relieve the excess pressure, preventing certain irreversible damage. 

The following morning the brain tumor was successfully removed, and 3 days later Alexis walked out of the hospital, returning to her normal life and raising her infant daughter. 

Had S-1285 been the law, there’s a good chance Alexis would not be alive today and her newborn daughter would be without a mother.

S-1285 does nothing more than allow insurance companies to retain much more of the money they collect from their customers, while decreasing payment to doctors and exerting downward financial pressure on all doctors in our state. 

Make no mistake; S-1285 will trigger a massive exodus of highly qualified doctors, as was confirmed by a recent survey conducted by our organization, the New Jersey Doctor-Patient Alliance.  Of the over 100 specialists polled, 50 percent would look for jobs outside of New Jersey, and 56 percent would restrict coverage of emergencies.

In turn, stories like Alexis’s will have more tragic endings because doctors like the neurosurgeon who treated Alexis will no longer be here to cover each and every emergency room across the state.

And despite this heartwarming story, you might be wondering if there was a surprise bill at the end of Alexis’ medical journey.  Well, she had NJ Health Horizon Medicaid insurance, which would have paid her neurosurgeon a modest fee.  Horizon, however, denied any payment after mistakenly claiming she was covered by another insurance policy.  To this date, her neurosurgeon still hasn’t received payment, but Alexis was not been sent a bill. 

Unfortunately for specialists who take calls in emergency rooms, Alexis’ scenario is not an exception to the rule.  As doctors, we routinely perform services that are underpaid from commercial insurance, Medicaid, Medicare and the uninsured. 

Despite this, we still deliver the necessary care because we understand the role we play in society. That said, if we are legally bound to underpayments on every patient we treat, many of us won’t be willing to staff the ERs or practice medicine in New Jersey.

Vitale’s price-fixing bill is a misguided effort that will result in tragic consequences for New Jersey residents.  While reform is needed, pulling the healthcare safety net out from underneath New Jersey citizens is not the way to do it.

Peter DeNoble, M.D., is the president of the New Jersey Doctor-Patient Alliance and an orthopaedic surgeon practicing in North Jersey.

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