Ending surprise bills, a big concern for voters of all stripes, was viewed as one of the only health issues in Congress with bipartisan appeal and the backing of the Trump administration. | Joe Raedle/Getty Images Health Care Health groups backed dark money campaign to sink 'surprise' billing fix

A group calling itself Doctor Patient Unity has spent nearly $30 million on a campaign designed to kill the leading congressional legislation that would make it harder for hospitals and doctors to spring massive, unexpected bills on patients.

Its funding source has been secret thanks to the rules surrounding this “dark money” group, but multiple sources tell POLITICO that doctor staffing firms Envision Healthcare and TeamHealth are significant sponsors — showing just how powerful corporate medicine has become in trying to derail changes to a system that has put thousands of Americans in debt.


The group emerged shortly before Congress' August recess and began running $28.6 million in ads targeting prominent lawmakers, according to Advertising Analytics, an independent tracking firm. The goal was to stop legislation that would hold insured patients harmless for sometimes staggering bills for out-of-network care by setting federal rates to resolve billing disputes. Both the Senate health and House Energy and Commerce committees have passed versions of this policy.

The two health staffing companies have both previously been accused of shifting the cost of uncompensated care in billing disputes to patients. Both say that's no longer the case and that they support a federal solution to surprise billings. But they don't like the congressional panels' approach, which they call government "rate-setting." Their involvement was first reported by the New York Times.

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Ending surprise bills, a big concern for voters of all stripes, was viewed as one of the only health issues in Congress with bipartisan appeal and the backing of the Trump administration. Everyone agreed that a patient who followed the rules and went to an in-network hospital shouldn't get slammed with enormous bills because he or she ended up with an out-of-network provider, such as an emergency physician or anesthesiologist. But insurers, employers, doctors and hospitals from the beginning have vigorously fought over how to solve the problem and who should pay.

Two sources affiliated with Doctor Patient Unity confirmed that Envision Healthcare and TeamHealth are funding a portion of the $28.6 million campaign that runs from July 30 to Sept. 17 in states including Alabama, California, Colorado and New Hampshire, according to Advertising Analytics. The sources wouldn't say who else is involved but confirmed the two companies are funders.

Greg Blair, a spokesperson for Doctor Patient Unity, also confirmed the two companies are funders, and in a statement said the pair represent tens of thousands of doctors who support an alternate approach to ending surprise medical bills that's been enacted in New York and Texas. Those states both use independent mediators to settle payment disputes — an approach known as arbitration — not a government-set pay scale.

“We oppose insurance industry-backed proposals for government rate setting that will lead to doctor shortages, hospital closures and loss of access to medical care, particularly in rural and underserved communities,” Blair said in the statement.

Envision and TeamHealth both confirmed they back Doctor Patient Unity and echoed similar sentiments.

TeamHealth Executive Vice President Dan Collard said the group wants to submit billing disputes between health providers and insurers to arbitration instead of using government-set benchmark rates.

"We will continue to fight an insurance industry proposal to use government rate setting as a vehicle to increase their profits at the expense of potential hospital closures and doctor shortages in underserved communities," Collard said.

Envision spokesperson Aliese Polk said the company “support[s] an independent dispute resolution process that removes patients from the middle.”

The onslaught of negative ads helped stall the legislation from being brought up for a vote on the floor of either chamber of Congress. Two additional House committees are working on their own surprise billing legislation, muddling prospects for compromise by year's end.

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The messaging from the health staffing companies, doctors and hospitals has been countered by the Coalition Against Surprise Medical Billing, backed by employers and insurers, which recently launched a multimillion-dollar ad campaign claiming arbitration is a handout to health providers backed by private equity firms. They portray federal benchmark rates as the only effective way to clamp down on health costs.

The alliances reflect the changing nature of the health care system. In the past, doctors typically worked for a hospital. Now, staffing companies like Envision and TeamHealth employ many doctors in certain specialties and hire them out to hospitals. Kaiser Health News reported earlier this month that private equity and venture capital firms are buying up physician staffing companies— and could see their bottom lines cut by certain billing reforms.

The House Energy and Commerce Committee plans an investigation of private equity firms and surprise billing, according to committee aides.

Doctor Patient Unity sent mailers over August recess as part of its campaign. One obtained by POLITICO that was sent to constituents of Rep. Dan Kildee (D-Mich.), a Ways and Means Committee member, urges them to tell him to “say no to rate setting” as the panel prepares to draft its own billing legislation. Kildee’s office says he’s already signed onto a bill providers like. Another mailer thanks Sen. Marsha Blackburn (R-Tenn.) for “stopping the health care nightmare of rate setting.”

Doctor Patient Unity will continue to push its rate-setting message and shift to more 'thank you' messages to members, and also advocate for arbitration, according to one source.

