School of Medicine, Tufts University, Boston, Massachusetts, USA.
Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA.
Otolaryngol Head Neck Surg. 2021 Nov;165(5):662-666. doi: 10.1177/0194599821994826. Epub 2021 Feb 23.
The degree of markup between provider charges and Medicare prices reflects the potential balance bill for out-of-network commercially insured patients. Using publicly available Medicare data, we performed a retrospective cross-sectional analysis of markup ratios (MRs; ie, the ratio of submitted charges to Medicare-allowed prices) for services commonly performed by otolaryngologists in 2017. Median MRs were as follows: 2.9 (interquartile range, 2.0-4.3) in facility settings (eg, hospital) and 2.1 (interquartile range, 1.7-2.9) in nonfacility settings (eg, physician office). Among the 10 highest-markup procedures performed by otolaryngologists in facility and nonfacility settings, there was no consistent increase in median MRs between 2012 and 2017 (compound annual growth rates, -4.6% for labyrinthotomy to 24.6% for ultrasound-guided biopsy). Median MRs for these procedures were not consistently lower in states with surprise billing protection laws. These findings may reflect the comparatively low potential to "balance bill" patients for elective otolaryngologic services and the limitations of state-level protections against surprise billing.
提供者收费与医疗保险价格之间的加价幅度反映了非网络商业保险患者的潜在结算账单。我们使用公开的医疗保险数据，对耳鼻喉科医生在 2017 年进行的常见服务的加价率（MR；即提交费用与医疗保险允许价格的比率）进行了回顾性的横断面分析。设施环境中的中位数 MR 如下：2.9（四分位间距，2.0-4.3）和非设施环境中 2.1（四分位间距，1.7-2.9）。在耳鼻喉科医生在设施和非设施环境中进行的 10 项加价最高的手术中，2012 年至 2017 年间中位数 MR 没有一致增加（复合年增长率，迷路切开术为-4.6%，超声引导活检为 24.6%）。在有意外计费保护法的州，这些手术的中位数 MR 并不总是较低。这些发现可能反映了对选择性耳鼻喉科服务“平衡计费”患者的潜力相对较低，以及州级对意外计费保护的局限性。
