Panel: Surprise Medical Bills: Causes, Consequences, and Policy Solutions

Friday, November 8, 2019: 8:30 AM-10:00 AM
I.M Pei Tower: Majestic Level, Majestic Ballroom (Sheraton Denver Downtown)

*Names in bold indicate Presenter

Organizer:  Erin E. Trish, University of Southern California
Panel Chair:  Erin E. Trish, University of Southern California
Discussants:  Richard Lindrooth, University of Colorado, Denver and Caitlin Westerson, Colorado Consumer Health Initiative

Surprise out-of-network medical bills occur when patients are treated by providers outside their health plan’s contracted network under circumstances that cannot reasonably be avoided.  Surprise bills have recently received considerable media attention and momentum is growing for federal action to address the issue. However, while there is general consensus about the need to protect patients, there is continued disagreement about how to determine appropriate compensation for providers to address the issue while avoiding unintended negative consequences. As a result, evidence from states that have passed surprise billing protections can be useful to federal policymakers as they weigh the tradeoffs of various policy proposals. 


In this panel, we present evidence on several aspects of surprise medical bills and explore the potential effects of various policy approaches to address the issue. The first paper presents evidence on the prevalence and magnitude of surprise medical bills in ambulatory surgery centers, including novel analysis of the extent to which health plans pay a portion or the entirety of bills generated by out-of-network physicians. The second and third papers evaluate different aspects of New York’s law prohibiting surprise bills, which took effect for fully-insured enrollees in the state in 2015. The law, which uses binding arbitration to resolve payment disputes between insurers and providers, has gained considerable attention in Congress as a potential model for federal policies to mitigate surprise billing. Thus, evidence on the experience in New York is particularly relevant to the current federal discussion. One of these papers evaluates data from New York’s arbitration system to provide evidence on the outcomes of the arbitration process, while the other uses claims data to evaluate the impact of the law on broader market outcomes, including physician network participation and contracted rates. Finally, the fourth paper evaluates policy options to address surprise air ambulance bills which, while rare, are generally quite large in magnitude. This paper evaluates the nuances of policy and legal solutions to address surprise air ambulance bills which are related but somewhat distinct from surprise bills for other health care services (such as out-of-network physicians and other health care providers, including ground ambulances), such as the fact that state policies to address air ambulances are pre-empted under the Airline Deregulation Act.       


Taken together, these papers will provide important evidence on the issue of surprise medical bills and the potential effects of various policy approaches to address the problem. The findings from the four papers in this panel are highly relevant to the current policy debates on this topic and have the potential to inform federal policy on this issue. The panel also includes two discussants, one an academic health economist who will provide comments on the research methods and evidence, and the other the policy director at a non-profit, non-partisan consumer-focused organization who will provide additional insight on the policy and practical implications of the work.    

Surprise Medical Bills in Ambulatory Surgical Centers: Prevalence, Magnitude, and Attributes of Providers and Health Plans
Erin Duffy1, Loren Adler2 and Erin E. Trish2, (1)Pardee RAND Graduate School, (2)University of Southern California

Analyzing the Impact of New York's Surprise out-of-Network Billing Law
Loren Adler1, Erin Duffy2, Bich Ly1 and Erin E. Trish1, (1)University of Southern California, (2)Pardee RAND Graduate School

Policy Options for Surprise Air Ambulance Bills
Mark Hall, Wake Forest University and Erin C. Fuse Brown, Georgia State University

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