The New York Times reported that hospitals are turning more to companies like EmCare, which is one of the country’s largest physician-staffing companies for emergency rooms (ERs), to find ER doctors. Having outside doctors is causing patients to receive more expensive hospital bills because the ER doctors are considered out-of-network.
The Center for Public Priorities released a study earlier this year that found surprise billing is a problem that goes well beyond one company, but is an issue across the healthcare system.
Also, a new National Bureau of Economic Research study on out-of-network billing for emergency care found that patients who visited in-network hospitals for emergency care received out-of-network physician care 22% of the time. The study authors said: “Because patients cannot avoid out-of-network physicians during an emergency, physicians have an incentive to remain out-of-network and receive higher payment rates.”
Part of the issue with surprise billing, also known as balance billing, is that most states don’t have laws that protect consumers. Only six states have a “comprehensive” laws that protect against surprise billing, and there are no federal protections against the practice, according to The Commonwealth Fund.
The issue of surprise billing is another example of how the U.S. healthcare system confuses people. Patients who visit in-network hospitals often aren't able to make sure each doctor working on them is in-network. So, they're stuck with larger than expected hospital bills later.
Patients don't like it for obvious reasons, and payors aren't happy with the higher bills either. The hospital CEO the Times interviewed, Tom Wilbur of Newport Hospital in Spokane, Wash., said switching to EmCare turned out to be a fiasco as confused and angry patients started calling in. "Hindsight being 20/20, we never would have done that," he told the paper.
A recent Commonwealth Fund study found that 14% of ER visits and 9% of hospital stays were likely to produce a surprise bill. Patients who were admitted to the hospital via the ER were more likely (20%) to receive a surprise bill.
As health systems look to outside agencies more to fill gaps in coverage, surprise billing is not going away and could even intensify. What’s the solution? The Commonwealth Fund suggested it likely won’t come from Washington given the current toxic political climate — especially when it comes to healthcare. Instead, states will need to take up the issue in an attempt to protect consumers from getting large, unexpected hospital bills that are out of their control.