Health care spending concept illustration In another boon to consumers, the plan requires that thesavings generated for providers be used to negotiate reducedpayments and savings for plans.

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A newly published policy proposal imagines aUnited States health care system where insurers, not individualproviders, take over the responsibility of collections andbilling.

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Among other benefits, the authors tout their proposal as ananswer to "surprise billing" — the problem of out-of-networkbilling that has vexed consumers, employers and legislators.

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Authors John Sackett, COO of Adventist HealthCare, and healthcare consultant Allen Dobson call their plan the consumerprotection realignment, or CPR. The policy proposal prescribesshifting the billing and collections effort from individualproviders to insurers, thus creating a centralized billing process.The proposal, the authors say, would address several flaws in thehealth care industry such as stingy cost-sharing, provideradministrative fees and the high cost of care.

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Related: Unraveling the complexity of our health carebilling system

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"We propose a realignment of the billing and collection ofdeductibles, coinsurance, and copayments from health care providersto health insurance plans," the authors wrote.

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Shifting these duties to insurers, the authors say, willincrease the risk that insurers will take on debt. This new riskwould incentivize health plans to reverse the trend of increasingout-of-pocket costs for patients, as insurers look to avoidincurring debt from consumers who cannot pay their medical bills.Additionally, insurers would be in a better position to negotiatereduced health care rates.

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The providers would see savings from the elimination of the riskfrom uncompensated care costs, as well as the substantialadministrative fees incurred from collections, follow-ups andconsumer assistance, the authors say. According to a 2018 study,the estimated costs of billing and insurance-related activitiesranged from $20 for a primary care visit to $215 for an inpatientsurgical procedure.

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Consumers would see lower costs of care and a streamlined, userfriendly process. The authors offer up a scenario where a shouldersurgery patient receives several bills from different providers —the anesthesiologist, surgeon, internist and hospital — including asurprise bill if even one of the providers is out-of-network. Underthe CPR, which forbids almost all instances of provider billing,patients would receive one bill payable to the health plan. Anotherprovision of the policy would require that patients sign a waiverand be handed out-of-pocket costs estimates if a provider isout-of-network.

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"Given that the out-of-network provider is now in dialogue withthe plan," the authors wrote, "a collateral benefit of CPR is thatthe provider would eventually consider joining an insurancenetwork, fully protecting their income and their patients fromsurprise billing costs."

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In another boon to consumers, the plan requires that the savingsgenerated for providers be used to negotiate reduced payments andsavings for plans.

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The authors note that these changes must be enactedlegislatively. They add that more research is needed in order tomost effectively implement the policy, including realisticestimates of provider savings and quantitative analyses on ratecuts for services.

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"We expect and welcome public debate by stakeholder groups onthe operational feasibility and legislative and regulatorypossibilities of CPR," the authors wrote. "Given the status quo ofour health care system; such debate is overdue."

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Dylan Jackson

Dylan Jackson writes about the business of law and race. He can be reached at [email protected] or 305-347-6677. On Twitter @DylanBJackson