Nation's Emergency Physicians Criticize CMS Ruling as Another Victory for Big Insurance

Mar 03, 2016, 09:54 ET from American College of Emergency Physicians (ACEP)

WASHINGTON, March 3, 2016 /PRNewswire-USNewswire/ -- In response to a ruling issued Monday by the Centers for Medicare & Medicaid Services (CMS) that exempts health insurance plans from meeting minimum quantitative standards in their networks of hospitals and physicians in 2017, the president of the American College of Emergency Physicians Jay Kaplan, MD, FACEP released a statement:

"CMS has handed another victory to the insurance industry at the expense of patients and the physicians who treat them. We have been waiting for a resolution to the ongoing problem of 'narrow networks' in which health insurance companies offer such limited rosters of physicians and hospitals that many patients have no choice but to go out of network for care, incurring much higher out-of-pocket costs. We advocated for CMS to monitor and enforce network adequacy in order to ensure that patients have access to the physicians and hospitals they need.  Rather than holding insurance companies to a reasonable standard of adequacy, CMS has effectively given these health care profiteers even more freedom to do what they like rather what is in the best interest of our patients.

"Nothing has changed since last year when we warned about a rising tide of patients delaying medical care because their health plans were failing to provide adequate numbers of primary care physicians.  Delayed care has dangerous consequences but we can't blame patients for fearing high out-of-pocket expenses that are recognized once they become aware of the fine print buried in plans they chose because of low-cost monthly premiums.  As recently as this week, another report has come out saying 35 percent of people could not find a physician who accepted their health insurance. 

"CMS is making more excuses for the health insurance industry and giving them more leeway to do essentially whatever they want to increase their profits. Meanwhile health insurers continue to shift costs onto patients and providers and then profess 'surprise' at the system they themselves created. Physicians and patients must join together to fight back against the 'heads I win, tails you lose' strategy employed by health insurers and backed by their friends in the federal government."

ACEP is the national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. 

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SOURCE American College of Emergency Physicians (ACEP)