NJBIZ: Group Aims to give Doctors a Stronger Voice in Out-of-Network Debate

A surgeon, a lobbyist and a politician walk into a room.

That is hopefully going to be a more common occurrence if the 2-month-old New Jersey Doctor-Patient Alliance has anything to say about it.

“We have just completely lost control, as doctors, of our own economy,” said Dr. Peter DeNoble, president and founding member of the new nonprofit social action committee.

The group aims to amplify the voices of those that have been blamed in the debate surrounding surprise out-of-network billing: out-of-network doctors.

While not a lobbying entity, the group aims to directly insert the doctors’ voice into policymaking, rather than rely on third parties. And the doctors in this group have decided to become more involved in the process on their own time, between treatments and surgeries.

The first agenda item is the focus on out-of-network bills.

State Sen. Paul Sarlo (D-Wood-Ridge) recently introduced a bill focused on transparency, which the alliance said it supports, compared with previous versions of the bill that mandate resolving surprise bills by using Medicare as a benchmark.

Stakeholders with interest in remaining out of network to have cited Medicare as a poor payor and said they would go out of business if the bill became law.

DeNoble, an orthopedic surgeon in Wayne and assistant clinical professor at Seton Hall University’s Department of Orthopaedic Surgery, said the group surveyed 117 specialists to discover what the effects of the current iteration of the out-of-network bill might be.

The specialists, mostly from North Jersey and mostly out of network, portrayed a grim future.

At least 50 percent said they would consider practicing elsewhere, and 20 percent said they would quit the industry.

Of those surveyed, 93 percent are out-of-network providers, and a majority are surgeons.

DeNoble admits the data set is small and not representative of the entire population of specialists in New Jersey, but the effects of the bill affect all specialists — in or out of network.

“According to the poll, if the out-of-network legislation was to become law, 56 percent said they would take less on-call shifts at Emergency Departments, while 30 percent would drop all or some of their hospital privileges,” according to a statement from NJDPA. “This would greatly limit the number of doctors serving insured, uninsured and low-income patients, many of whom use the Emergency Department for primary care.”

DeNoble explained that being out of network keeps doctors on their toes since they have to work harder for their paychecks, compared with those who are employed by hospitals.

“As a hospital employee, you’re contributing to the hospital’s machine,” DeNoble said.

That means there is less stress on scheduling patients, and appointments get pushed as much as two weeks out with a more relaxed schedule for the surgeon, he said.

If the bill passes, out-of-network doctors will also be less motivated to work, since Medicare, a typically low payor, will mean more work for less pay.

The almost eight-year debate over the bill is the result of excessive billing by some outliers, but its passing will affect everyone, including hospital employees, DeNoble said. It could drive down salaries across the board.

On the flip side, if costs aren’t reigned in, the health care system could crash on itself.

Already, there are movements in the field away from Medicare, such as 30 percent of the state’s doctors who don’t accept it, DeNoble said.

“There are many negative consequences to this bill that the public is largely unaware of. As with so many well-intentioned initiatives by politicians, this one will actually end up harming the very individuals they seek to protect,” he said. “The cost of providing medical care in New Jersey has increased by 20 percent since 2001. Meanwhile, reimbursements have remained flat or decreased. It has become difficult for many hospitals and practices to remain solvent.”

But how should the problem be solved? Does a cash market emerge from this mandate instead?

DeNoble thinks there is a possibility.

“Doctors need to take back control of medicine from administration, businesspeople, hedge funds … people who are profiteering off our way of life, what we spent 10 years training to do,” he said. “There are those who think that in order to address (billing issues) that we have to crash the system. But instead of hitting it with a sledgehammer, let’s hit it with a scalpel.”

The alliance will be working alongside traditional trade organizations like the Medical Society of New Jersey to engage politicians in a better understanding of how the bills affect doctors.