The Next Chapter of IDR: Trends, Metrics, and Strategies for Providers

Summary

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Podcast Summary: "The Next Chapter of IDR: Trends, Metrics, and Strategies for Providers"

Becker’s Healthcare Podcast
Host: Chris Sosa
Guest: Patrick Vellachi, Chief External Affairs Officer, Halo md
Date: December 4, 2025

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Overview

This episode of Becker’s Healthcare Podcast explores the evolving landscape of Independent Dispute Resolution (IDR) under the No Surprises Act (NSA). Chris Sosa interviews Patrick Vellachi, drawing on his wide-ranging experience across provider, payer, and policy sectors. They discuss emerging trends from early IDR cases, important metrics for budgeting, and how leaders can use recent data to inform their revenue and negotiation strategies.

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Key Discussion Points & Insights

1. Background & Patrick Vellachi’s Experience

• Patrick shares a multi-faceted healthcare policy background, having worked on Capitol Hill, for payers (Humana and Anthem/Elevance), the Federation of American Hospitals, Envision Healthcare, and now Halo md.
  • “I like to say I think the only sides of the table I haven't sat on are probably pharma and med device.” (01:08 - B)

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2. Emerging IDR Trends & What They Mean for Providers

• Publicly available CMS data shows providers consistently winning around 80% or more of IDR arbitrations.
• The strong provider win rate encourages providers to consider IDR for out-of-network disputes.
  • Quote: “They've shown consistently about an 80% or higher success rate on the provider side of the equation...when providers engage in the arbitration process, they usually win and are able to obtain fair and sustainable rates." (01:35 - B)
• Patrick emphasizes that the IDR process is a valid solution for concerns about out-of-network reimbursement.

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3. Key Metrics and Challenges for Budget Planning

• Expect increased uncompensated care due to laws like the OPBA and possible loss of exchange subsidies.
• Unfavorable payer mix and reductions in Medicare physician fee schedule could further erode reimbursement.
  • Quote: “You're likely to see increased rates of uncompensated care and unfavorable payer mix...facilities really need to understand those different risks and start to identify opportunities to fill those holes.” (03:15 - B)
• Many service lines are subsidized by hospitals; hospitals need to be prepared for physicians to request increased subsidies.

Strategic Takeaway:
Facilities that proactively assess and plan for these shifts—using tools like IDR to close revenue gaps—will fare better than those who wait.

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4. Negotiation Strategies with Payers – Using IDR Leverage

• NSA and IDR were designed to drive sustainable, in-network contracts.
  • The arbitration process creates an "economic equilibrium" by revealing fair rates both sides can reference.
• Despite positive trends, most organizations have been slow to shift toward permanently sustainable network arrangements.
  • Quote: “It's a little discouraging that we haven't seen that really take place yet. I think the adjustment period is taking a little longer than most of us anticipate.” (05:43 - B)
  • “The IDR process is not the last resort when negotiations fall apart. It's a tool in the toolbox toward finding that sustainable equilibrium...to drive toward a durable in network arrangement.” (06:40 - B)

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5. Current Climate & Utilization of IDR

• The strong provider win rate (~80%) demonstrates to payers that prevailing rates are fair and sustainable, incentivizing both sides to settle in-network.
  • Quote: “If we want to address some of those costs, the answer is get in network at the rates that have been prevailing in the IDR process.” (07:37 - B)
• The cumbersome nature of arbitration is deliberate: “The arbitration process was designed to be cumbersome and expensive so that folks didn't rely on it on either side...” (07:10 - B)
• Patrick expresses hope that these trends will push markets to a “tipping point,” driving more sustainable in-network deals.

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6. Underutilization and Opportunity—Especially for Facilities

• Misconception: Some facilities think IDR is only for ED visits or limited situations.

  • Patrick urges hospitals and systems to reevaluate their eligibility, as there is “a whole lot more opportunity than...realize.” (08:28 - B)

• Noteworthy moment: Major health systems are seeing growth thanks to improved IDR outcomes, as cited on a recent HCA earnings call.

  • Quote: “Folks who have maybe written that off and thought, hey, this is really mostly for providers, facilities really ought to take a look and see whether there's an opportunity to stabilize revenue through some of those IDR opportunities.” (09:07 - B)

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Notable Quotes & Memorable Moments

• “They've shown consistently about an 80% or higher success rate on the provider side of the equation...the message is...the IDR process might be a solution worth considering.” (01:35 - B)
• “Facilities really need to understand those different risks and start to identify opportunities to fill those holes or solutions for efficiency and improve improvement of their operations. And the facilities that do that now are going to be a whole lot better shape than the ones that do it six months from now...” (03:47 - B)
• “The IDR process is not the last resort when negotiations fall apart. It's a tool in the toolbox toward finding that sustainable equilibrium...” (06:40 - B)
• “There are unnecessary costs in the system from arbitration fees and from the cost of the process. That's intentional...the answer is get in network at the rates that have been prevailing in the IDR process.” (07:10 / 07:37 - B)
• “For folks who have maybe written that off and thought, hey, this is really mostly for providers, facilities really ought to take a look and see whether there's an opportunity to stabilize revenue through some of those IDR opportunities.” (09:07 - B)

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Timestamps for Important Segments

• 00:25 – 01:21 Background and experience of Patrick Vellachi
• 01:35 – 02:16 Provider win rates in IDR outcomes and implications
• 02:28 – 04:55 Financial and operational challenges for facilities and key metrics to watch
• 05:06 – 06:48 Negotiation strategies and the intent behind NSA/IDR
• 06:56 – 08:20 Trends, tipping point, and market dynamics in IDR
• 08:25 – 09:20 Underutilized IDR opportunities for hospitals and facilities

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Conclusion

This episode provides actionable insights and a hopeful outlook on IDR as both a negotiation tool and a revenue stabilizer under the No Surprises Act. The strong record of provider success in arbitration suggests opportunities for both providers and facilities to improve financial performance and drive more sustainable, in-network relationships with payers. Facilities are encouraged to reassess their use of IDR, stay alert to emerging financial pressures, and use this moment to strategically recalibrate.

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Transcript

[A]

Hi everyone, this is Chris Sosa with Becker's Healthcare. Thank you so much for tuning in today's podcast of the Becker's Healthcare podcast series. Today we're going to talk about the next chapter of IDR trends, metrics and provider strategies. Joining me for today's discussion is Patrick Vellachi. He is the Chief External Affairs Officer at Halo md. Patrick, thank you for being here today.

[B]

Thanks for having me, Chris.

[A]

Awesome. Well, Patrick, to kick us off, can you share a little bit about yourself and how you work in healthcare?

[B]

Yeah, thanks. So I got my start in healthcare on Capitol Hill, worked for a member of the US Senate for a number of years and then moved over to the side handling policy issues for both of those members. I've worked on the payer side on advocacy issues, worked in house for Humana and then for Anthem, which is now elevance. Have also worked for the Federation of American Hospitals, so have sat on the hospital side of the table and most recently with Envision Healthcare, a large multi state, multi specialty medical group. Joined Halo about two and a half months ago and I'm really, really excited to be bringing some of these IDR solutions to clients on this side.

[A]

Excellent. So yeah, you've been all over the place having worn a number of different hats. So that experience I'm sure comes in handy with your position now.

[B]

Yeah, I like to say I think the only sides of the table I haven't sat on are probably pharma and med device. So yeah, I've either heard or sort of put out just about every angle on healthcare policy, so.

[A]

Well, fantastic. Excited for this discussion. All right, so first question I have to you for you is simply we're starting to see patterns emerge from early IDR cases under the no Surprises Act. What trends are you seeing in arbitration outcomes and what do they signal for providers moving forward?

[B]

Yeah, so the trends have been really positive for providers and facilities. There's publicly available data known as the CMS public use files that detail the actual outcomes from arbitration and they've shown consistently about an 80% or higher success rate on the provider side of the equation. Which means when providers engage in the arbitration process, they usually win and they are able to obtain fair and sustainable rates through utilizing that process. So really the message is on that. Look, if you are thinking about engaging the IDR process and concerned about out of network reimbursement, the IDR process might be a solution worth considering.

[A]

Definitely. Good to know. Second question I have for you simply, Patrick is as finance leaders plan budgets for the next year. What key metrics or benchmarks should they be watching for to better anticipate IDR related revenue shifts?

[B]

Yeah, there are a lot of challenges coming down the pike for facilities especially, but on the provider side as well. And it's never been easy to run a hospital. But really looking at next year, there's some challenges that facilities are going to have to get ahead of. You look at some of the impacts of the OPBA legislation that will almost certainly result in some level of increased uncompensated care. You look at the potential sunset of the exchange subsidies also likely leading to changes in coverage for millions of Americans. Facilities are likely to see increased rates of uncompensated care and increased rates of unfavorable payer mix. So being aware of that on the front end will hopefully, if they are aware and start to look into the potential impact for their specific facilities, allow them to identify the need to close gaps. And IDR is one way that they may be able to close those gaps. It'll also be important for facilities to understand their sort of relationship with contracted provider groups. Most facilities contract out for at least some of the services that they offer within their four walls. And a lot of those different service lines are often subsidized. Right. Where the, the physicians providing those services would be operating at a loss just on, on revenue. Right. So the facility has to make up that that delta through a subsidy arrangement. Providers are also going to be facing some challenges that could erode some of their reimbursement. The Medicare physician fee schedule final rule just and it finalizes some pretty significant reductions in practice expense RVUs for facility based physicians. So you may see some of these specialties that are already seeking subsidy in order to provide services come back in a couple of weeks to months to say hey, we need to talk again about more subsidy. So facilities really, like I said, need to understand those different risks and start to identify opportunities to fill those holes or solutions for efficiency and improve improvement of their operations. And the facilities that do that now are going to be a whole lot better shape than the ones that do it six months from now when some of those changes are already taking place. So I think the real message here is there are real challenges that require understanding and urgency to ensure facilities aren't negatively impacted.

[A]

Certainly a lot to think about there. Thank you so much for laying all that out, Patrick. So based on your experience, how can CFOs and revenue cycle leaders strengthen their negotiation strategies with payers in light of these IDR decisions?

[B]

Yeah, one of the great Things about IDR and the NSA generally is that when it was originally drafted, one of the key purposes behind it was to encourage in network arrangements that are sustainable and durable. The idea is that you might go through an arbitration process for several rounds, maybe a couple of months between a payer and a provider or facility. And that process ought to help both parties understand where the economic equilibrium is. Right. And if you are on either side of the equation, you keep losing over and over again at say an 80% of the time rate. You start to understand, hey, it would be a whole lot less expensive for me if I were to just contract at something approaching that rate, save the fees on both sides and reduce overall costs. So really behind the NSA is a mechanism to help reach those sustainable long term arrangements. It's a little discouraging that we haven't seen that really take place yet. I think the adjustment period is taking a little longer than most of us anticipate. But facilities especially, but provider groups as well, should really be looking at the IDR process as an avenue toward in network arrangements. Folks shouldn't want to be out of network. We should want to be streamlined and on a process that lets both sides be sustainable. I'm hopeful that the IDR process will still get us there, but that's really the way that most folks ought to be thinking about their engagement in the process. It is not the last resort when negotiations fall apart. It's a tool in the tool toolbox toward finding that sustainable equilibrium and rate and demonstrating its validity to drive toward a durable in network arrangement.

[A]

Do you think the current climate is pushing more organizations toward this process? Have you seen a tipping point in this process?

[B]

I think we're approaching it. I think the process has so consistently led to a result. Right. Like I said, since the public use files have started coming out, the rate of success on the physician and facility side has been 80% plus. Yeah, that's a pretty clear demonstration that the more reasonable offers here are coming from the provider and facility side. I obviously takes two to tango here, right? It takes both parties coming together negotiating on a rate. But I'm hopeful, like I said, that the consistency in the outcomes will start to drive that consensus toward, hey, let's network. There are unnecessary costs in the system from arbitration fees and from the cost of the process. That's intentional. The arbitration process was designed to be cumbersome and expensive so that folks didn't rely on it on either side of the equation. If we want to address some of those costs, the answer is get in network at the rates that have been prevailing in the IDR process. So there's a lot of opportunity there. I think we are again, with such a trend and consistency in the direction of these fair, reasonable, sustainable rates and winning on the provider side, I'm hopeful we start to see some of that transition in the networking and that sort of leveling out of utilization.

[A]

Understood. Patrick, is there anything that you'd like to touch on that we haven't covered in this conversation so far?

[B]

Yeah, I think more than anything else, I think facilities likely at this point underutilize the RDR process. I think there's a misconception as the services available to the arbitration process on the facility side and those being limited to really just ED visits, there's a whole lot more opportunity than I think a lot of facilities realize in engaging in IDR and understanding how the NSA applies to their facilities. And even worth noting, I think just last week, maybe the week before Aidan on the HCA earnings call, they identified improved outcomes in the IDR process as one of the drivers of growth. So there really are opportunities in the space on the hospital side. And for folks who have maybe written that off and thought, hey, this is really mostly for providers, facilities really ought to take a look and see whether there's an opportunity to stabilize revenue through some of those IDR opportunities.

[A]

Excellent. Thank you so much, Patrick, for all your time, your insights. We also, of course want to thank our podcast sponsor, which is Halo md. You can tune into more podcasts from Becker's Healthcare by visiting our podcast [e-mail].

[B]

Thank you very much. Appreciate it.