Author: Marie Benz MD FAAD

18 Aug Surprise Billing Legislation Linked to Decreased Payments to Anesthesiologists

MedicalResearch.com Interview with: [caption id="attachment_57937" align="alignleft" width="165"] Dr. La Forgia[/caption] Ambar La Forgia, PhD Assistant Professor of Health Policy & Management Columbia University Mailman School of Public Health MedicalResearch.com: What is the background for this study? Response: Over the past few years, there has been mounting pressure to protect consumers from surprise medical bills, which occur when a patient unknowingly receives care from an out-of-network practitioner at an in-network facility. In 2018, only six states had passed comprehensive surprise billing legislation, and by 2020, 17 states had passed legislation. In addition to protecting patients from financial liability for surprise medical bills, states adopted different methods for determining payments made by a patient’s insurer to the out-of-network practitioner. For example, some states, such as California and Florida, developed a payment standard that tied provider payments to median in-network rates, Medicare rates, or the usual and customary provider charges. Other states, such as New York, developed an independent dispute resolution process, which uses a third-party arbiter to resolve payment disputes between insurers and practitioners. However, little is known about how state laws influence the prices paid to out-of-network practitioners and whether spillovers existed to in-network prices. In this study, my co-authors and I study the association between the passage of surprise billing legislation in California, Florida, and New York, and prices paid to anesthesiologists in hospital outpatient departments and ambulatory surgery centers using commercial claims data from 2012-2017. We focused on anesthesiology because it is one of the specialties with the highest proportion of potential surprise bills since patients do not usually choose their anesthesiologist.