About 14% of patients received a "surprise" out-of-network medical bill in 2016 for care received at an in-network hospital, according to a new report from the Health Care Cost Institute (HCCI), Modern Healthcare reports.
For the report, HCCI analyzed almost 620,000 in-network inpatient admissions and claims filed in 2016 in 37 states and the District of Columbia.
Overall, the researchers found that one in seven of these patients received a "surprise" medical bill, which the report defined as an out-of-network bill received for care provided at an in-network hospital.
The share of in-network admissions with at least one out-of-network claim varied across the country, from a high of 26.3% in Florida to just 1.7% in Minnesota. In 10 states, at least 15% of in-network admissions had at least one out-of-network claim.
HCCI also looked at which specialties were responsible for the largest percentage of the total number of out-of-network claims examined. Anesthesiology was at the top of the list at 16.5%, followed by miscellaneous "other" specialties at 13.5% and primary care at 12.6%.
In addition, HCCI looked at how often an out-of-network claim was filed by each specialty. HCCI found lab claims topped the list with 22.1% of lab claims for an in-network admission having an out-of-network charge, followed by emergency medicine at 12%.
The finding that about 14% of in-network patients were hit with a surprise bill "certainly is a striking number," according to Kevin Kennedy, co-author of the report and a researcher at HCCI. "A patient can choose a hospital that's in-network and just get stuck with a surprise bill in the end."
Kennedy added that the state-by-state variation discovered in the report could provide a pathway to solving the problem. "By showing state-by-state variation, maybe we can see what Minnesota is doing with the relationships between hospital and insurers and the legislation involved and how it compares to states like Florida or Kansas," he said.
At a Modern Healthcare leadership symposium last week, Chip Kahn, CEO of the Federation of American Hospitals, said, "Something may give" in regards to surprise bills, "because it is an issue that touches so many people."
Anthony Barrueta, SVP of government relations at Kaiser Foundation Health Plan, said any solution will require all stakeholders to come together. "We should all own that," he said. "We should all sit down together and solve it. … [N]o one is innocent in this and it is a big problem" (Kacik, Modern Healthcare, 3/28; Baker, Axios, 3/29; Gooch, Becker's Hospital CFO Report, 3/28).
New: The patient financial experience toolkit
As hospital margins remain narrow, health systems face enormous pressure to protect their revenue. At the same time, the rise of patient consumerism has pushed hospitals to offer a best-in-class patient experience. These goals can actually support each other: by offering an ideal patient financial experience, providers can increase a patient’s satisfaction, as well as a patient’s likelihood to pay.
Access this toolkit to get 8 resources to help revenue cycle leaders implement the ideal patient financial experience.