Unfortunately, insurance companies may be incorporating contracted rates for services like those included in the PCP contracts that will never be provided by those physicians and for which insurers will never pay. Additionally, the inclusion of rates not actively negotiated by such providers will likely artificially lower the QPA, effectively reducing payments for the anesthesiologists, emergency physicians and radiologists, who actually do provide those services.

“On behalf of our all our members, the American College of Emergency Physicians (ACEP), the American College of Radiology® (ACR®) and ASA call on policymakers to eliminate the QPA as the sole/primary factor in arbitration and ensure the integrity of the QPA, by insisting they be calculated based on “same or similar specialty” in network rates, thus mitigating the unintended consequences of relying on health insurers’ median in-network rates based partially on data from providers who don’t actively negotiate those rates,” said Gillian Schmitz, M.D., FACEP, president of ACEP. “Physicians rely on fair reimbursement to keep their doors open and continue providing lifesaving medical care to their patients.”


“This study demonstrates yet another reason why policymakers cannot make the QPA the primary factor in such arbitration nor base important regulations solely on insurer-produced and defined data,” said Jacqueline Bello, M.D., FACR, Chair of the American College of Radiology Board of Chancellors. “Decisionmakers should work with healthcare providers and insurers to consider relevant and verifiable data, ensure that patients have adequate provider networks, and protect access to care by ensuring sensible, sustainable reimbursement.”

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