Surprise medical bills in ER and inpatient settings are soaring, JAMA finds

The frequency of surprise medical bills in emergency department and inpatient care situations is surging, while the cost of these bills is nearly double in some scenarios, according to a study published Monday in JAMA.

ED visits that resulted in a surprise bill leapt from 32.3% to 42.8% in 2016, and for inpatient admissions the increase was even greater -- from 26.3% to 42% in that same year. In each category, the cost of the bill nearly doubled, with the top 10% of ED visits yielding a bill greater than $1,000, and the top 10% of inpatient visits producing a $3,000-plus bill.

IMPACT

Certain hospitals, and the patients at these hospitals, are affected more than others. About 3,300 facilities were put under the microscope, and in half of them the chance of getting a surprise bill was only about 10%.

By contrast, the chance of a surprise bill was more than 90% in 15% of the hospitals studied. For ED visits, 23% of more than 4,000 hospitals studied carried with them a 90% or greater chance of doling out a surprise bill.

Of the ED visits, 39 percent of patients received a bill that was out of network, and the average amount rose from $220 to almost $630 over a period of six years. Thirty-seven percent of inpatients got at least one out-of-network bill, and the average cost jumped from $804 to $2,040 during that time.

Taking an ambulance to a hospital also carried significant financial risk for patients, the study found, with 85% of all ambulance rides resulting in out-of-network bills for patients.

THE TREND

Solutions that have been proposed to resolve the problem of surprise medical bills are a growing social risk for the healthcare industry, Moody's Investors Service said in a June report.

Solutions under consideration include capping out-of-network charges for emergency medical services at in-network levels, setting up an arbitration process to resolve out-of-network charges and requiring patients' consent for out-of-network charges. Other approaches would be to require a single, "bundled bill" for all care received in an emergency room, or have hospitals guarantee that all their affiliated doctors and service providers are in-network.

Among those options, bundled billing/in-network guarantee would be the most negative for hospitals and staffing companies, given that many hospitals outsource all their emergency department operations and billing to staffing companies. Meanwhile, an in-network guarantee would present steep challenges, since many physicians and ancillary service providers aren't employed or controlled by the hospital.

The largest providers would be least affected by any changes, Moody's said. Their scale gives them significant negotiating leverage with insurers, making them more likely to be in-network.
 

Twitter: @JELagasse

Email the writer: jeff.lagasse@himssmedia.com