Knowledge Center

More than 80 percent favor delay due to lack of data exchange standards

WASHINGTON, DC, June 8, 2022 — The No Surprises Act (included in H.R. 133) requires that uninsured, self-pay, and commercially insured patients be given a “good faith estimate” (GFE) of the cost for their medical service. When a service requires the involvement of multiple providers or facilities, such as surgery, a “convening provider or facility” is responsible for contacting all other potential providers or facilities that may beinvolved in the patient’s service (“co-providers”), requesting a GFE for their portion of the service, compiling the GFEs, and giving them to the patient if the patient is uninsured or self-pay. There is currently no standardized data exchange process for the convening provider/facility requirement. WEDI conducted a survey to ascertain how difficult this convening provider/facility requirement will be to implement.

“While the No Surprises Act includes much needed consumer protections against catastrophic “surprise” bills, it also includes challenging data exchange provisions such as the convening provider/facility requirement,” stated Charles Stellar, WEDI President and CEO. “Even though the government plans to end enforcement discretion for self- pay patients at the end of this year, currently there is no standard format or established workflow to transmit data to or from the convenor.”

The following are the highlights from the WEDI survey:

• WEDI asked “How difficult will it be for providers and facilities to determine who should be the “convening provider/facility”? Results: 65.8% responded very difficult or difficult, 10.6% responded that they were neutral, 11.7% indicated that it would be easy or very easy, with 1.8% stating the question was not applicable.
• WEDI asked “How difficult will it be for the convening provider/facility to identify all appropriate co-providers and/or facilities for the specific medical service?” Results: 89.3% responded very difficult or difficult, 4.8% responded that they were neutral, 4.8% indicated that it would be easy or very easy, with 1.1% stating the question was not applicable.
• WEDI asked “How difficult will it be for the convening provider/facility to collect GFEs from” co-providers and/or facilities for the specific medical service”? Results: 91.5% responded very difficult or difficult, 5.5% responded that they were neutral, 1.1% indicated that it would be easy or very easy, with 1.8% stating the question was not applicable.

• • WEDI asked “The NSA requires that completed GFEs must be provided to the patient within 3 business days of being requested or the service being scheduled. How difficult will it be for the convening provider/facility to complete the GFE process for a specific medical service and provide this information to the patient or health plan within this required timeframe”? Results: 89% responded very difficult or difficult, 6.6% responded that they were neutral, 2.6% indicated that it would be easy or very easy, with 1.8% stating the question was not applicable.
  • WEDI asked “Rate your level of support for the government delaying the requirement for the convening provider/facility to obtain a GFE from any co-provider/facility until there is standardized data exchange process in place to communicate information between convening providers and co- providers/co-facilities”? Results: 83.1% indicated that they were somewhat or strongly in support, 4.4% responded that they were neutral, 7% were somewhat or strongly opposed, with 2.6% stating the question was not applicable.

“The survey results suggest providers and facilities will face significant challenges just identifying who the convenor should be, who the appropriate co-providers/facilities should be, and how to collect GFEs from these co-providers/facilities,” stated Stellar. “Survey respondents were adamant that meeting the legislation’s 3-day deadline to get the GFE to the patient would be difficult or very difficult. Not surprising, respondents expressed strong support for the government delaying the convenor requirement until a standardized process to exchange data between convening providers and co- providers/co-facilities is established.”

Survey methodology — WEDI conducted this survey from May 9, 2022 through May 31, 2022. It was electronically distributed as well as being posted on the WEDI website and WEDI received a total of 274 responses. Small providers/clinics made up 39.6% of respondents, 11.5% of respondents were from large provider clinics, 10.4% were from health systems, 8.5% from medium sized clinics, 2.2% from hospitals, the remainder are from other provider types or other entities. Access the full survey results here and additional WEDI No Surprises Act comment letters and resources at the WEDI No Surprises Act Resource Center.

About WEDI
WEDI was formed in 1991 by then HHS Secretary Dr. Louis Sullivan to identify opportunities to improve the efficiency of health data exchange. WEDI was named in the HIPAA legislation as an advisor to the Secretary of HHS. Recognized and trusted as a formal advisor to the Secretary, WEDI is the leading authority on the use of health information technology (IT) to efficiently improve health information exchange, enhance care quality, and reduce costs. With a focus on advancing standards for electronic administrative transactions, and promoting data privacy and security, WEDI has been instrumental in aligning the industry to harmonize administrative and clinical data. For more information, please visit wedi.org.

Contact
Samantha Holvey
Director, Community & Education
WEDI 304.689.0900
sholvey@wedi.org