Dec 17, 2019

Surprise medical bills inflate everyone's health insurance premiums

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Data: Health Affairs; Chart: Axios Visuals

Four specialties that are often out-of-network — anesthesiologists, pathologists, radiologists and assistant surgeons — raise employer insurance spending by 3.4%, according to a new study in Health Affairs.

Why it matters: Surprise medical bills are not only unaffordable for the patients who receive them, but also inflate everyone else's premiums.

Between the lines: Providers are more likely to be out-of-network at for-profit hospitals and those located in concentrated markets, the study found.

  • These four specialties are providers that patients don't choose. They ultimately get paid several times more than they'd make from treating a Medicare patient.
  • In contrast, orthopedists performing knee surgeries — which patients do have the ability to choose — were paid 164% of Medicare rates, on average.
  • The study's authors argue that these four specialties can use the threat of billing patients directly to gain leverage in negotiations with insurers.

By the numbers: If the payment rates for these four specialties were reduced to 164% of Medicare, total physician spending among privately insured patients would be reduced by 13.4%, or $40 billion a year for people with employer coverage, the study found.

  • That's exactly why providers are fighting so hard against Congress' efforts to include a benchmark payment rate for out-of-network care as part of a surprise billing solution.
  • Whatever they spend in lobbying is, comparatively, chump change.

Go deeper:

Go deeper

ER doctors' pay raises outpace other specialists

Data: Urban Institute; Chart: Naema Ahmed/Axios

Emergency doctors — which are at the center of the surprise billing debate — saw their compensation go up more than any other physician specialty between 2013 and 2017.

Why it matters: This translates into higher health care costs, which we all pay for through our taxes, premiums and out-of-pocket spending.

Go deeperArrowJan 15, 2020

Hospital charges surge over last 2 decades, especially in the ER

Reproduced from Thomas M. Selden, 2019, "Differences Between Public and Private Hospital Payment Rates Narrowed"; Chart: Axios Visuals

The rates charged by hospitals — especially for emergency department care — have skyrocketed over the last two decades, according to a new study in Health Affairs.

Why it matters: While most patients with insurance don't pay these prices for their care — insurers typically negotiate lower rates — those who are uninsured or out-of-network often do.

Go deeperArrowJan 7, 2020

The health care industry's happy holidays

Illustration: Eniola Odetunde/Axios

The year-end spending bill in Congress epitomizes the power of health care interests.

The big picture: There are lots of goodies for the industry, while patients will get the worst kind of holiday surprise — more medical bills.

Go deeperArrowDec 20, 2019