The Effect of Healthcare Reform on Stakeholders

This assignment intends to discuss how the No Surprise Act of 2022 influences different medical system stakeholders. This reform has targeted the surprise medical bills that patients often encounter, which, over time, cause them a lot of financial stress. This paper defines the No Surprise Act, discusses its consequences for three sets of stakeholders, discusses financial impacts, and evaluates the pros and cons of each group. By synthesizing these aspects, this paper will deliver an understanding of how this act is influencing healthcare delivery: The Effect of Healthcare Reform on Stakeholders.

Define the No Surprise Act of 2022

The No Surprise Act took effect on 1st January 2022, and the main aim of the policy was to shield patients from out-of-network billing without any prior information. This includes common emergency scenarios or treatment by an out-of-network specialist at an in-network facility. On these occasions, patients were often financially and seriously affected before the passage of the act.

Balance billing in these circumstances is prohibited by the law, and there is a rebuttal procedure in an effort to assist with the payment disagreement among the providers and insurers (Nguyen et al., 2022). The Act aims to avoid shock bills among clients through a forceful call for transparency in healing charges and fairness in measures that strip out costs and inequalities that serve to deny patients quality care.

Different Stakeholders Impacted by the Act

From the No Surprise Act 2022, the most relevant stakeholders include providers, insurance companies, and patients. The primary stakeholders are patients in the Act (Lieneck et al., 2023). Before the enactment of the act, clients had been vulnerable to shock and multiple times outrageous charges, particularly when they could not and chose not to choose their doctors. The act shields patients from balance billing, hence guaranteeing patients’ financial safety and no anxiety.

Other relevant players affected by the act include healthcare suppliers such as hospitals and physicians. It is no longer possible for providers to balance bill patients for the remaining portion of out-of-network charges and begin an arbitration process with the insurer over the payment. This introduces some new administrative challenges and potential delays in payment.

Insurers also play a pivotal part in the enactment of the No Surprise Act (Lieneck et al., 2023). For one, the law mandates that insurers provide out-of-network coverage services without passing on additional costs to patients beyond what in-network rates would be. Insurers must respect requirements for transparency in coverage, including providing proactive cost estimates to patients.

Financial Impact on Stakeholders

Financial consequences brought forth by the No Surprise Act vary among diverse groups of stakeholders. For patients, the act greatly reduces their likelihood of getting surprise high medical bills. Consequently, it offers the patient financial stability and more predictable health expenses. Reductions in surprise billing contribute to the overall cost savings for the patients.

For providers, it is more financially complicated. In this case, a ban on balance billing prohibits them from getting the full amount they charge to the patients, yet arbitration provides a way of negotiating for reasonable compensation (Duffy et al., 2022). In the process, providers may have increased administrative costs and delayed reimbursement due to arbitration. Small or independent practices can be highly challenging since they do not have the resources or means to handle an extra administrative load.

Insurers take on financial risk for services offered outside of the network yet within the network rates. This practice might raise their overall costs. However, they may be able to make up for this expense by bargaining for lower payment rates from providers during arbitration. Moreover, additional transparency may mean investment in new administrative systems to accommodate the law.

Benefits of the Act on Stakeholders

Among the key benefits for stakeholders from the Act is the defense of patients from surprising health expenses, thereby improving their financial security and reducing apprehension about receiving needed care. The law also demands more price transparency from payers, thereby giving patients insights into how to make better decisions about their health. More specific guidance on billing practices would tend to cement, not damage, the providers’ relationships with their patients and the insurers.

While the burden of an arbitration process may indeed be unwieldy, it tries to ensure fairness in the payment to providers so that uncompensated care may be avoided or minimized (Hoadley & Lucia, 2021). The act standardizes billing practices among insurance companies and adds to their credibility in front of patients. Insurers cover out-of-network services without extra charges, hence raising customer satisfaction and probably retention rates.

Drawbacks of the Act on Stakeholders

The challenges of the Act are also evident meant for the different shareholders. For patients, it reduces surprise billing but does not eliminate high out-of-pocket costs due to high-deductible health plans. With the No Surprise Act, there is also a possibility that, on some occasions, patients may receive delayed care in case disputes arise between providers and insurers. Some could experience huge financial pressures due to the administrative costs associated with arbitration, besides the cuts they could likely face on out-of-network revenue streams.

These challenges might be difficult for the small practices to contain, and they may put the survival of the practices to a test in the long run (Christensen et al., 2024). On the other hand, holders of insurance policies or insurance companies also incur some disadvantages, such as higher administrative costs exerting pressure, and, at times, they have to offer lower rates of reimbursements during arbitration. These may compel them to provide limited networks of providers or increase the amount of premiums they charge their consumers.

Conclusion

Conclusively, the No Surprise Act of 2022 is a monumental change in the legislation of health care in the US because it directly addresses the concern that has likely negatively affected the finances of millions of patients. By doing away with surprise balance bills, the act increases the efficiencies in the delivery of healthcare services. Yet, its implementation also poses some problems, such as changes in some cash-flow items and workloads related to the administration of the rules.

Accordingly, stakeholders are required to act in unison and ensure that the goals of the act are met when delivering healthcare services and that they are not negated by added complexities. The Act remains a part of America’s healthcare modification, with stakeholders making a significant effort to grow a system that is both fair and accountable for patients.

References

Christensen, E. W., Waid, M. D., Hirsch, J. A., Parikh, J. R., Raja, A. S., Rathmell, J. P., & Rula, E. Y. (2024). Financial viability of the No Surprises Act independent dispute resolution process: Radiology and other hospital-based specialties. American Journal of Roentgenology, 222(4). https://doi.org/10.2214/ajr.23.30687

Duffy, E. L., Biener, A., Garmon, C., & Trish, E. E. (2022). Comparison of estimated No Surprises Act qualifying payment amounts and payments to in-network and out-of-network emergency medicine professionals. JAMA Health Forum, 3(9), e223085. https://doi.org/10.1001/jamahealthforum.2022.3085

Hoadley, J., & Lucia, K. (2021). The No Surprises Act: A bipartisan achievement to protect consumers from unexpected medical bills. Journal of Health Politics, Policy and Law, 47(1). https://doi.org/10.1215/03616878-9417470

Lieneck, C., Gallegos, M., Ebner, M., Drake, H., Mole, E., & Lucio, K. (2023). Rapid review of “No Surprise” medical billing in the United States: Stakeholder perceptions and challenges. Healthcare, 11(5), 761. https://doi.org/10.3390/healthcare11050761

Nguyen, T. H., Heller, R. E., Keysor, K., Milburn, J. M., Rula, E. Y., Spangler, R., & Hirsch, J. A. (2022). The No Surprises Act: What neuroradiologists should know. American Journal of Neuroradiology, 44(1), 7–10. https://doi.org/10.3174/ajnr.a7739

ORDER A PLAGIARISM-FREE PAPER HERE

We’ll write everything from scratch

Synthesize the effect healthcare reform has on stakeholders

For this assignment, you will examine the stakeholders impacted by the implementation of the No Surprise Act. Your paper must include the following:

The Effect of Healthcare Reform on Stakeholders

• • Introduction: identify the purpose of the assignment
• • Define the No Surprise Act of 2022
• • Differentiate between at least three groups of stakeholders impacted by the No Surprise Act of 2022
• • Examine the financial impact of the No Surprise Act of 2022 on each group of stakeholders
• • Summarize benefits of the No Surprise Act of 2022 on each group of stakeholders
• • Summarize drawbacks of the No Surprise Act of 2022 on each group of stakeholders
• • Conclusion-Takeaway points

The word count for your paper, excluding the title and reference pages should be between 825-1000 words.