- Services most frequently cited in surprise medical bills had substantially increasing markups in recent years that far exceeded inflation, according to a research letter published Monday in JAMA Internal Medicine.
- Markups for emergency medicine increased 28% from 2012 to 2016 while anesthesiology services grew 32% in that time period, according to the analysis of Medicare Part B claims from more than 2,000 hospitals. That compares to a 7% growth for the internal medicine markup ratio.
- The annual increases were greatest at for-profit hospitals, those that served more uninsured patients (for emergency medicine services) and facilities in the Southeast, the research showed.
Time is running out for this Congress to pass a ban on surprise billing. While a number of drafts have been put forward and some have made it out markup, progress has stalled as payer and provider lobbies push back on various approaches and presidential impeachment proceedings take more of lawmakers' time.
Emergency services are a main culprit for surprise billing. Studies have shown that as many as one in five emergency visits typically involved an out-of-network provider. A Health Care Cost Institute report from earlier this year found that anesthesiologists were most likely to be out-of-network but treating an in-network hospitalization, with 16% of claims having that result.
The author of the JAMA study, Tim Xu of the Johns Hopkins University School of Medicine, wrote that the findings add to a "growing urgency for prompt national legislation" regarding surprise billing.
He noted the results showing hospitals serving more uninsured mark up emergency medicine prices in particular are cause for concern, as it's a potential sign of cost shifting under financial stress. "Policy makers should consider how legislation limiting the degree of markup could give insurers unfair negotiating leverage over these hospitals," he wrote.
As the national conversation around surprise billing has continued, many research reports and analyses have surfaced. In September, the USC-Brookings Schaeffer Initiative for Health Policy showed after a surprise billing ban was implemented in California, the share of certain specialty services delivered out of network declined by 17%. That did not hold true for emergency services, which weren't included in California's law.