Committee Backs Measure To Regulate Billing in Emergency Room Settings

The Senate Committee on Health this week passed a bill designed to ease the out-of-pocket expense of high emergency department costs. Emergency physicians said the bill could severely impact emergency care.

SB 1276 by Sen. Ed Hernandez (D-West Covina) seemed innocuous at first presentation, but it created a bit of a stir Wednesday before the Senate health panel.

“This bill makes modest changes to provisions of a law that requires hospitals and emergency physicians to establish policies for charity care and discounted payment programs for eligible individuals,” Hernandez said.

“This bill defines a reasonable payment plan,” he said, “…and it expands eligibility to people with insurance, if the bills exceed 10% of the patient’s income.”

The impact of the bill is more complicated than that, said Tim Madden, legislative advocate for the California chapter of the American Academy of Emergency Physicians.

Madden said emergency physicians should be exempt from the bill.

“We are opposed to the approach taken in SB 1276 that singles out emergency physicians as the only physician group to subsidize an individual’s care,” Madden said.

In the emergency department system, many other physicians see patients — from cardiologists to anesthesiologists to radiologists — but those physicians wouldn’t be asked to subsidize care in that way, he said.

“Emergency physicians already provide more charity care than any other group,” Madden said. “We’re proud of the fact that we treat people other physicians don’t want to treat. But the folks we’re talking about have insurance. … And we rely on the insured patients to offset the care we provide to other patients where we do offer deep discounts.”

Sen. Bill Monning (D-Carmel) asked Hernandez to respond to the emergency physicians’ concerns.

“We did talk to the emergency room physicians,” Hernandez said. “My understanding is they’re telling us their expense is less than $500 [per patient]. If that’s the case, I don’t think they would be wrapped into some of these larger [bills]. But we have some anecdotal evidence that shows there have been patients getting charges as high as $8,000 or $9,000.”

The bill is addressing astronomically high bills and unreasonable out-of-pocket cost, Hernandez said, so smaller bills wouldn’t really be at issue.

“What we’re trying to do is capture individuals who come through that system and reduce as much as possible their out-of-pocket expenses,” Hernandez said.

“We’d be more than willing to keep talking to [emergency physicians], but at this time we’re not willing to take them out of the bill,” he said.

The bill passed on a 5-2 vote.

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