Xu Tim, Park Angela, Bai Ge, Joo Sarah, Hutfless Susan M, Mehta Ambar, Anderson Gerard F, Makary Martin A
Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland.
Carey Business School, The Johns Hopkins University, Baltimore, Maryland.
JAMA Intern Med. 2017 Aug 1;177(8):1139-1145. doi: 10.1001/jamainternmed.2017.1598.
Uninsured and insured but out-of-network emergency department (ED) patients are often billed hospital chargemaster prices, which exceed amounts typically paid by insurers.
To examine the variation in excess charges for services provided by emergency medicine and internal medicine physicians.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis was conducted of professional fee payment claims made by the Centers for Medicare & Medicaid Services for all services provided to Medicare Part B fee-for-service beneficiaries in calendar year 2013. Data analysis was conducted from January 1 to July 31, 2016.
Markup ratios for ED and internal medicine professional services, defined as the charges submitted by the hospital divided by the Medicare allowable amount.
Our analysis included 12 337 emergency medicine physicians from 2707 hospitals and 57 607 internal medicine physicians from 3669 hospitals in all 50 states. Services provided by emergency medicine physicians had an overall markup ratio of 4.4 (340% excess charges), which was greater than the markup ratio of 2.1 (110% excess charges) for all services performed by internal medicine physicians. Markup ratios for all ED services ranged by hospital from 1.0 to 12.6 (median, 4.2; interquartile range [IQR], 3.3-5.8); markup ratios for all internal medicine services ranged by hospital from 1.0 to 14.1 (median, 2.0; IQR, 1.7-2.5). The median markup ratio by hospital for ED evaluation and management procedure codes varied between 4.0 and 5.0. Among the most common ED services, laceration repair had the highest median markup ratio (7.0); emergency medicine physician review of a head computed tomographic scan had the greatest interhospital variation (range, 1.6-27.7). Across hospitals, markups in the ED were often substantially higher than those in the internal medicine department for the same services. Higher ED markup ratios were associated with hospital for-profit ownership (median, 5.7; IQR, 4.0-7.1), a greater percentage of uninsured patients seen (median, 5.0; IQR, 3.5-6.7 for ≥20% uninsured), and location (median, 5.3; IQR, 3.8-6.8 for the southeastern United States).
Across hospitals, there is wide variation in excess charges on ED services, which are often priced higher than internal medicine services. Our results inform policy efforts to protect uninsured and out-of-network patients from highly variable pricing.
未参保以及参保但不在医保网络内的急诊科患者通常被按照医院收费标准计费，这一费用超过了保险公司通常支付的金额。
研究急诊医学和内科医生所提供服务的超额收费差异。
设计、设置和参与者：对医疗保险和医疗补助服务中心在2013年日历年向医疗保险B部分按服务收费受益人群提供的所有服务的专业费用支付索赔进行回顾性分析。数据分析于2016年1月1日至7月31日进行。
急诊和内科专业服务的加价率，定义为医院提交的费用除以医疗保险允许金额。
我们的分析包括来自50个州2707家医院的12337名急诊医学医生和来自3669家医院的57607名内科医生。急诊医学医生提供的服务总体加价率为4.4（超额收费340%），高于内科医生所有服务的加价率2.1（超额收费110%）。各医院所有急诊服务的加价率范围为1.0至12.6（中位数为4.2；四分位间距[IQR]为3.3 - 5.8）；各医院所有内科服务的加价率范围为1.0至14.1（中位数为2.0；IQR为1.7 - 2.5）。医院对急诊评估和管理程序代码的中位数加价率在4.0至5.0之间变化。在最常见的急诊服务中，伤口缝合修复的中位数加价率最高（7.0）；急诊医学医生对头CT扫描的会诊医院间差异最大（范围为1.6 - 27.7）。在不同医院中，相同服务的急诊加价通常大大高于内科。急诊较高的加价率与医院的营利性所有权相关（中位数为5.7；IQR为4.0 - 7.1），与所诊治的未参保患者比例较高相关（≥20%未参保患者的中位数为5.0；IQR为3.5 - 6.7），还与地理位置相关（美国东南部的中位数为5.3；IQR为3.8 - 6.8）。
在不同医院中，急诊服务的超额收费存在很大差异，其定价通常高于内科服务。我们的结果为保护未参保和不在医保网络内的患者免受高度可变定价影响的政策努力提供了信息。
