Before Congress Tries to Eliminate IDR, There's Another Side to the Story
When a physician wins an IDR dispute, the final award often attracts attention. What receives considerably less attention is how the dispute reached arbitration in the first place.
That distinction matters as Congress considers the Lower Premiums, Faster Payments Act (H.R. 10788), legislation that would eliminate the federal Independent Dispute Resolution (IDR) process under the No Surprises Act and replace it with a payment framework based on insurer-calculated rates.
The proposal has generated concerns among physician organizations, particularly regarding the implications for independent practices, reimbursement negotiations, and access to specialty care.
But before fundamentally changing the system, it's worth examining what the available data actually tells us.
What the IDR Numbers Don't Always Reveal
Recent scrutiny of federal IDR has focused on high dispute volumes, physician success rates, and arbitration awards substantially exceeding qualifying payment amounts (QPAs).
These figures raise legitimate questions about the process.
However, a September 2026 analysis from the American Society of Anesthesiologists (ASA), American College of Emergency Physicians (ACEP), and American College of Radiology (ACR) offers additional context.
According to federal data cited in their analysis:
24.5% of decided IDR line items in 2025 resulted in insurer defaults, meaning insurers did not submit an offer.
8.2% of decided line items involved insurer offers of $1 or less.
These figures do not explain every arbitration outcome. However, they highlight why physician win rates and award amounts should not be evaluated without considering insurer participation and initial payment practices.
An arbitration award substantially exceeding the QPA may appear excessive at first glance.
Yet the QPA itself is a calculated benchmark, not necessarily an independently established measure of appropriate reimbursement.
For physicians, the central issue is whether the payment process provides a meaningful opportunity to challenge amounts they consider inadequate.
Why Physician Organizations Are Concerned
On October 8, ASA, ACEP, and ACR jointly opposed H.R. 10788, warning that eliminating independent arbitration could reduce providers' ability to challenge disputed insurer payments.
Their concerns extend beyond individual reimbursement amounts.
Smaller and independent practices may have fewer resources and less negotiating leverage when navigating complex payer relationships.
The organizations have also raised concerns about the potential implications for community-based and hospital-based specialty care, where physician availability is particularly important.
These are considerations worth examining alongside the legislation's stated goals of reducing administrative expenses, improving payment predictability, and addressing unusually large arbitration awards.
Is Eliminating IDR the Only Way Forward?
The timing of the legislation introduces another important consideration.
Federal agencies finalized significant IDR operational reforms in May 2026, with certain provisions still awaiting implementation.
Meanwhile, an August appellate court ruling addressed contested aspects of QPA calculations.
These developments suggest that the existing framework is already undergoing meaningful changes.
Physician organizations have advocated alternatives that include stronger enforcement of payment obligations, greater transparency, improved eligibility screening, and additional scrutiny of unusual arbitration outcomes.
Such measures could address documented operational concerns while preserving an independent mechanism for resolving qualifying disputes.
A Conversation Worth Having Before the Rules Change
The debate over H.R. 10788 should be about more than arbitration costs or individual awards.
It should also consider the accuracy of payment benchmarks, participation by both parties, and the practical consequences of removing independent review.
The No Surprises Act established important patient protections. The challenge is ensuring that the reimbursement process supporting those protections remains efficient, accountable, and fair.
Improving federal IDR and preserving independent oversight are not necessarily competing objectives.
As Congress considers the legislation, the physician community's perspective deserves meaningful consideration.
Learn More About H.R. 10788 and the Physician Response
The Medical Society of the State of New York (MSSNY) has launched a campaign opposing the proposed elimination of federal IDR.
The campaign outlines concerns about physician reimbursement and access to specialty care, and provides an opportunity for individuals to contact their congressional representatives.
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