What’s happened: On August 27, ASA, the American College of Emergency Physicians, and the American College of Radiology® issued a news release challenging a Health Affairs Forefront report claiming that the NSA’s Independent Dispute Resolution (IDR) process has generated $22.4 billion in “costs.”
Why it matters:
- The paper suggests that it is somehow unreasonable for physicians to be paid more than the insurer-calculated Qualifying Payment Amount (QPA).
- We pointed out that the report’s claim is built on a deeply flawed premise: that the insurer-calculated QPA is accurate and represents an appropriate in-network payment rate.
- The evidence is overwhelmingly clear that QPAs can be wrong, inaccurate, and unreasonably low.
- QPA calculations are opaque and independently unverifiable by physicians.
Bottom line: The Health Affairs paper posits that appropriate payments to front-line physicians for patient care translate into higher premiums. This framing overlooks the reality of big insurance: many of the nation’s largest commercial health insurers report annual profits in the billions of dollars. If insurers choose to pass the cost of reasonable physician payments on to consumers rather than absorb those costs within their substantial revenue and profits, that is an unfortunate, profit-driven, business decision, not an inevitable consequence of the IDR process.