Association of Surprise-Billing Legislation with Prices Paid to In-Network and Out-of-Network Anesthesiologists in California, Florida, and New York An Economic Analysis
Association of Surprise-Billing Legislation with Prices Paid to In-Network and Out-of-Network Anesthesiologists in California, Florida, and New York An Economic Analysis
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DOI：
10.1001/jamainternmed.2021.4564
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发表时间：
2021-08-16
影响因子：
39
通讯作者：
Casalino, Lawrence P.
中科院分区：
文献类型：
--
作者：
La Forgia, Ambar;Bond, Amelia M.;Casalino, Lawrence P.
几个州已经通过了医疗账单立法，以保护患者免受意外的网络外医疗账单的影响，然而，关于州法律如何影响网络外价格以及是否存在对网络内价格的溢出效应知之甚少。目的确定在州通过网络计费立法之前和之后，在网络内设施处支付给网络外麻醉师和网络内麻醉师的价格的任何变化。背景和参与者这项回顾性经济分析使用差异中的差异方法来比较加州，佛罗里达和纽约立法通过前后的价格变化，这些立法在2014年1月1日至2017年12月31日期间通过了全面的免费计费立法，45个州没有。来自卫生保健成本研究所的商业索赔数据被用来确定支付给医院门诊部和门诊手术中心麻醉师的价格。最终分析样本包括3个治疗州和45个对照州的2713913例麻醉索赔。揭示了暴露于麻醉计费立法的时间和州一级的变化。主要结果和指标（每单位服务标准化的允许金额）支付给网络内设施的网络外麻醉师和网络内麻醉师，结果对2 713 913例麻醉索赔的回顾性经济分析发现，在3个州通过了免费计费法后，其中2个州支付给网络内设施的网络外麻醉师的单价显著下降：加州，-12.71美元（95% CI，-25.70至0.27美元; P = .05）和佛罗里达，-35.67美元（95% CI，-46.27至25.07美元; P < .001）。在纽约，整体网外价格的下降在统计上并不显着（-7.91美元; 95%CI，-17.48美元至-1.68美元; P = 0.10）;然而，到2017年第四季度，降幅为-41.28美元（95%CI，-70.24美元至-12.33美元; P = 0.01）。加州的网络内价格下降了-10.68美元（95% CI，-12.70至-8.66美元; P < .001）;在佛罗里达，-3.18美元（95% CI，-5.17至1.19美元; P = .002）;纽约，-8.05美元（95% CI，-11.46至-4.64美元;结论和相关性这项回顾性研究发现，支付给网络内和网络外的价格，医院门诊部和门诊手术中心的网络麻醉师在引入费用计费立法后减少，这为在联邦无意外法案和最近通过自己立法的州中价格可能如何变化提供了早期见解。
IMPORTANCE Several states have passed surprise-billing legislation to protect patients from unanticipated out-of-network medical bills, yet little is known about how state laws influence out-of-network prices and whether spillovers exist to in-network prices.OBJECTIVE To identify any changes in prices paid to out-of-network anesthesiologists at in-network facilities and to in-network anesthesiologists before and after states passed surprise-billing legislation.DESIGN, SETTING, AND PARTICIPANTS This retrospective economic analysis used difference-in-differences methods to compare price changes before and after the passage of legislation in California, Florida, and New York, which passed comprehensive surprise-billing legislation between January 1, 2014, and December 31, 2017, to 45 states that did not. Commercial claims data from the Health Care Cost Institute were used to identify prices paid to anesthesiologists in hospital outpatient departments and ambulatory surgery centers. The final analytic sample comprised 2 713 913 anesthesia claims across the 3 treated states and the 45 control states.EXPOSURES Temporal and state-level variation in exposure to surprise-billing legislation.MAIN OUTCOMES AND MEASURES The unit price (allowed amounts standardized per unit of service) paid to out-of-network anesthesiologists at in-network facilities and to in-network anesthesiologists.RESULTS This retrospective economic analysis of 2 713 913 anesthesia claims found that after surprise-billing laws were passed in 3 states, the unit price paid to out-of-network anesthesiologists at in-network facilities decreased significantly in 2 of them: California, -$12.71 (95% CI, -$25.70 to -$0.27; P = .05) and Florida, -$35.67 (95% CI, -$46.27 to -$25.07; P < .001). In New York, a decline in the overall out-of-network price was not statistically significant (-$7.91; 95% CI, -$17.48 to -$1.68; P = .10); however, by the fourth quarter of 2017, the decline was -$41.28 (95% CI, -$70.24 to -$12.33; P = .01). In-network prices decreased in California by -$10.68 (95% CI, -$12.70 to -$8.66; P < .001); in Florida, -$3.18 (95% CI, -$5.17 to -$1.19; P = .002); and in New York, -$8.05 (95% CI, -$11.46 to -$4.64; P < .001).CONCLUSIONS AND RELEVANCE This retrospective study found that prices paid to in-network and out-of-network anesthesiologists in hospital outpatient departments and ambulatory surgery centers decreased after the introduction of surprise-billing legislation, providing early insights into how prices may change under the federal No Surprises Act and in states that have recently passed their own legislation.