ANESTHESIOLOGY® 2026: No Surprises Act, IDR, and Out-of-Network Spending

Recorded at ASA Anesthesiology 2026 in San Diego, hosts Andy Cumpstey and Harriet Hopf speak with Patrick Velliky, Chief External Affairs Officer and Senior Vice President for Government Affairs at HaloMD, about misconceptions around the No Surprises Act (NSA) independent dispute resolution (IDR) process and its cost impact.

Velliky argues many studies cite total arbitration awards without a pre-NSA baseline, and his emergency medicine analysis comparing like-for-like out-of-network (OON) claims found OON spending is 13%–50% lower post-NSA, with modeled savings depending on assumptions about payments for the ~90% of eligible claims not going to IDR.

He discusses the qualifying payment amount (QPA), recent litigation finding unlawful QPA manipulation, and concerns about third-party administrators (TPAs), including lack of transparency, shared-savings fees, and a reported ~35% nonpayment rate of binding IDR awards.

The conversation links these issues to anesthesia, subsidies, consolidation, employer oversight, and pending bipartisan legislation to penalize nonpayment and improve accountability.