Action Needed to Improve IDR Process in No Surprises Act 

As the No Surprises Act (NSA) is implemented, the tension is mounting for the Independent Dispute Resolution (IDR) process to be improved to ensure all participants are treated fairly. In late 2022, the Departments responsible for administering the NSA – Health and Human Services, Labor, and Treasury -- released an initial report on the NSA’s IDR process and its initial results.

The report showed that 90,000 out-of-network payment disputes were submitted between April 15 and Sept. 30, 2022 – far more than the 17,000 expected in a full calendar year. Only 23,000 of those cases have been closed and only 4% of the 90,000 submissions resulted in payment determinations.

There is growing concern regarding the number of ongoing disputes and delays with the IDR process and its negative impacts on physicians.

The AMA Steps In

On Jan. 23, the American Medical Association (AMA) sent a letter to the Departments outlining concerns with implementation of the No Surprises Act, and provided recommendations to improve the process and reduce the backlog of current claims.

The letter calls for review and modification in the following areas:

• Addressing common causes of ineligible claims determinations
• Potential use of federal portal for open negotiations process
• Need for increased enforcement and audits
• Access issues as a result of increased administrative fees

Federal Judge Asked to Delay Ruling on Abortion in Idaho



On January 5, the Idaho Supreme Court Justices found that our state constitution does not include a right to abortion. The decision means the state's three abortion bans — including one that outlaws the procedure from conception — can remain in effect. The ruling also contains a provision that states Idaho abortion laws do not apply to ectopic pregnancies or non-viable fetuses.

Now, representatives from new Idaho Attorney General Raúl Labrador's office intend to file a new brief in district court on the U.S. Department of Justice’s lawsuit against the state over its abortion bans conflicting with the federal EMTALA law.

Deputy Attorney General Steven L. Olsen asked the court not to issue a decision on the request to reconsider the ruling until the state can file its new brief. Olsen noted that the Idaho Supreme Court's view of the Planned Parenthood lawsuit contained determinations of law that are of "significant import" to the case.

The Idaho "trigger law" banning nearly all abortions went into effect August 25, 2022, with a federal judge blocking a key provision of the law that would have imperiled emergency care for pregnant women.

IMA is continuing conversations with policymakers about the need to revise Idaho's abortion laws to ensure that physicians can provide the best care for pregnancy complications consistent with community standards of care. 

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Washington Medical Commission Issues Charges Against Dr. Ryan Cole

On January 9, the Washington Medical Commission (WMC) issued charges against Ryan Cole, MD, who lives and practices medicine in Idaho. Even though Dr. Cole lives in Idaho, he has a license to practice medicine in Washington. And, although active, Dr. Cole's current Washington license is noted with enforcement action "pending."

"The statement of charges alleges that Dr. Cole made numerous false and misleading statements related to COVID-19 and treated patients with COVID-19 or seeking to prevent getting COVID-19 in a manner that was beneath the standard of care," the WMC said in a written news release. The WMC also reported that Dr. Cole provided negligent care to at least four patients to prevent or treat COVID-19.

The WMC stated that these actions "were harmful and dangerous to individual patients, generated mistrust in the medical profession and public health, and had a widespread negative impact on the health and well-being of our communities." Based on the alleged facts, WMC charged Dr. Cole with having committed unprofessional conduct. He was given a deadline of January 31 to respond to the charges.

It is unclear if the Idaho Board of Medicine (BOM) has taken any action on complaints they received against Dr. Cole. If the WMC does ultimately make sanctions against Dr. Cole’s Washington medical license, that could trigger action by the Idaho BOM.