Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD; Department of Plastic and Reconstructive Surgery, Johns Hopkins Hospital, Baltimore, MD.
Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD.
J Hand Surg Am. 2022 Dec;47(12):1230.e1-1230.e17. doi: 10.1016/j.jhsa.2021.09.015. Epub 2021 Nov 8.
Patients may receive surprise out-of-network bills even when they present to in-network facilities. Surprise bills are common following emergency care. We sought to characterize and determine risk factors for surprise billing in hand and upper extremity trauma patients in the emergency department (ED).
We used IBM MarketScan data to evaluate hand and upper extremity trauma patients who received care in the ED from 2010 to 2017. Our primary outcome was the surprise billing incidence, defined as encounters in in-network EDs with out-of-network claims. We used descriptive and bivariate analyses to characterize surprise billing and used multivariable logistic regression to evaluate independent factors associated with surprise billing.
Of 710,974 ED encounters, 97,667 (14%) involved surprise billing. The incidence decreased from 26% in 2010 to 11% in 2017. Mean coinsurance payments were higher for surprise billing encounters and had double the growth from 2010 to 2017 compared to those without surprise billing. Receiving care from different provider types-especially therapists, radiologists, and pathologists, as well as hand surgeons-was associated with significantly higher odds of surprise billing. Transfer to another facility was not significantly associated with surprise billing.
Although the incidence of surprise billing decreased, more than 10% of patients treated in an ED for hand trauma remain at risk. Coinsurance for surprise billing encounters increased by twice as much as encounters without surprise billing. Patients requiring services from therapists, radiologists, pathologists, and hand surgeons were at greater risk for surprise bills. The federal No Surprises Act, passed in 2020, targets surprise billing and may help address some of these issues.
Many hand and upper extremity patients requiring ED care receive surprise bills from various sources that result in higher out-of-pocket costs.
即使患者前往联网医疗机构就诊，他们也可能收到意外的非联网账单。意外账单在急诊护理后很常见。我们旨在描述和确定急诊手部和上肢创伤患者遭遇意外计费的特征和风险因素。
我们使用 IBM MarketScan 数据评估了 2010 年至 2017 年间在急诊接受治疗的手部和上肢创伤患者。我们的主要结局是意外计费发生率，定义为在联网急诊室就诊但出现非联网索赔的就诊。我们使用描述性和双变量分析来描述意外计费，并使用多变量逻辑回归来评估与意外计费相关的独立因素。
在 710974 次急诊就诊中，有 97667 次（14%）涉及意外计费。该发生率从 2010 年的 26%下降到 2017 年的 11%。意外计费就诊的自付额更高，并且自 2010 年至 2017 年的增长率是无意外计费就诊的两倍。从不同类型的提供者那里接受治疗 - 特别是治疗师、放射科医生和病理学家，以及手部外科医生 - 与更高的意外计费几率显著相关。转至另一家医疗机构与意外计费无显著相关性。
尽管意外计费的发生率有所下降，但仍有超过 10%的手部创伤患者在急诊接受治疗时存在风险。意外计费就诊的自付额增长了两倍，而无意外计费就诊的自付额增长了两倍。需要接受治疗师、放射科医生、病理学家和手部外科医生服务的患者遭遇意外账单的风险更高。2020 年通过的联邦《无意外法案》针对意外计费问题，并可能有助于解决其中的一些问题。
许多需要急诊护理的手部和上肢患者会收到来自不同来源的意外账单，导致更高的自付费用。
