Why We Believe in Being the In-Network Emergency Department Management Group

Emergency medicine physician staffing firms are increasingly associated with egregious out-of-network billing practices. Not CareCulture Health Partners.

The in-network/out-of-network billing debacle is driven, at least in part, by a dysfunctional system. The current state of emergency medicine billing does not align healthcare facilities, providers, and consumers around patient care. Headlines regarding surprise out-of-network bills from other emergency medicine groups in our industry are ugly. Patients who receive surprise, exorbitant bills want answers. Hospitals, blamed for the exorbitant bills, are left trying to repair community perception and negative patient experience. And clinicians – the front line of the hospital’s community perception – are caught in the controversy, adding to the list of bureaucratic headaches driving physician burn out (all while we face an unprecedented physician shortage).

The tension between payers, providers, and consumers is certainly thick, but it is not impenetrable. The fact is, balance billing is not new. Since the unfunded EMTALA mandate in 1986, emergency departments have been particularly impacted by billing issues. This issue has come to the forefront as patients have become responsible for a larger portion of their healthcare costs.

As our health system changes, we are heeding the call to change along with it. Our mission at CareCulture is to inspire a movement to change the culture in which healthcare is delivered, for the better. We believe that includes empowering clinicians and ensuring they are paid fairly for the services they provide while also fostering a stable, positive patient experience that includes the post-discharge billing process.

That is why we prioritize negotiating in-network rates at all of our sites. It is an integral part of achieving our mission to be a responsible partner dedicated to changing the culture in which healthcare is delivered. Achieving the best outcomes for facilities, providers, payers, and patients, requires that we pursue positive healthcare change to not only empower clinicians and prioritize patient care quality, but also bear more of the financial burden associated with going in network. Doing so engenders more engaged clinician teams, better patient experiences, improved community perception, and reduced variability in patient care—all of which is appealing to both the managed care organizations we negotiate with and the facilities we serve.

Photo by NeONBRAND on Unsplash