Health care providers, insurers and legislators agree: Health care costs in Indiana are expensive and reimbursement is confusing.
Lawmakers on the Senate Committee for Health and Provider Services considered a bill Wednesday that hopes to introduce a series of reforms to improve health care access for Hoosiers, but the bill stalled instead of passing it. chose to continue.
Rather than a major overhaul of the state’s health care system, Senate Bill 400 aims to make several small changes with the knowledge that the legislation may evolve as it moves forward.
Bill author Sen. Liz Brown, R-Fort Wayne, said, “The reason for this is that we are always trying to tackle the problem of health care access in the legislature … while simultaneously keeping costs down.” “Speaking of components, there are a lot of small, incremental changes that will make vast improvements in the lives of some Hoosiers, but probably not all.”
trouble with prior authorizations
Nearly all testimony voiced support for the underlying bill, which aims to simplify the credentialing of physicians, pay for free dental care, and redirect licensing fees as an ongoing appropriation to public health.
But health care providers and insurers disagreed when it came to the bill’s provisions on prior authorizations, a process in which an insurer approves and pays for a health care services.
Practicing physicians testified that the current process was cumbersome and took them away from patients. according to a 2021 Physician Survey from the American Medical AssociationPhysicians and their staff spend an average of 13 hours each week, approximately two business days, on completing prior authorizations.
“Prior authorization is a constant barrier to providing timely patient care,” said Dr. Pradeep Kumar, president of the Indiana State Medical Association. “[It]eats up a lot of time that could be used on patients … Pre-authorization is a major cause of physician burnout.”
Because of the workload, hospital administrators testified that they hired staff specifically to work with insurers.
Specifically, proponents highlight scenarios in which, mid-process, a therapist finds another problem and decides to address it. After submitting that information to the insurer, that entity retroactively denied that claim, or changed the pre-authorization code that sparked a years-long battle between hospitals and insurers.
But insurance lobbyists urged reintroducing prior authorization language, saying it removes guardrails that prevent doctors from performing unnecessary procedures or prescribing unnecessary drugs — both of which would increase overall health care costs. .
“As a health care insurer we also want to improve this process,” said Maddie Augustus, director of government relations for the Insurance Institute of Indiana. “But we want to make sure it’s done in a way that maintains some of those guardrails … and make sure there aren’t unintended consequences.”
Brown argued that instead of reducing costs, these procedures increased them because they delayed patient care.
Sen. Ed Charbonneau, R-Valparaiso, wrote an amendment to Brown’s bill adding language from another bill, SB 191which allows graduating medical students who do not match residency to practice as “associate physicians”.
Charbonneau noted that Indiana had fewer residency slots than graduates annually, meaning that approximately 150 students left the state to further their education. He said he hoped the new licensing class would keep more students in Indiana, though Brown stressed it would be a temporary measure.
The ISMA, through Kumar, opposed the amendment saying that the students would instead like to see an increase in the number of residences.
Committee chairman Charbonneau said the bill would remain in committee for further consideration.
Another proposal to reduce health care costs
The committee heard another controversial bill, a split physicians and the hospitals they work for: non-compete agreements.
Sen. Justin Busch, R-Fort Wayne, said 78 of 92 counties had physician shortages, some of which were made worse by non-compete agreements in which a hospital (or other provider) would pay a departed physician a similar amount. Prevents working in position. Fixed time limits and geographic limits.
“Amidst Shortages, Can We Keep Physicians on the Sidelines?” Bush said.
Rural providers said the non-compete agreements protected the financial investment they made in health care workers.
Dr. Eric Fish, CEO of Schneck Medical Center in Seymour, said the non-compete agreements keep physicians in their community and ensure continuity of care. The nearest hospital in his area was 30-35 miles away.
But Brown rebukes Fish, saying that even non-competitions prevent doctors from leaving other health systems and joining Schneck.
Busch vowed to do more work on the bill to iron out the differences but said, “Ten states already have it and the sky didn’t fall there.”
The bill passed by an 8-3 vote, with one Democrat and two ‘no’ votes from Republicans, who were concerned about their rural hospital providers.