Congress passed a Surprise Billing Act last December, which won't take effect until 2022 but will impact out-of-network providers, payors, and the patients they serve. (See Stauffer and Waldo at McDermott/Will/Emery here).
This week, two different articles in JAMA and in JAMA Internal Medicine report data on out-of-network billing and trends for clinical laboratory tests.
Ten-Year Trends (Song)
In a Research Letter in JAMA (325:1674, here), Song et al. (Harvard, IBM MarketWatch, and Yale) reported ten-year trends in percent of lab tests in and out of network, utilization of tests in and out of network, and price inflation per test, in and out of network. Trends are to more out-of-network tests and trends to higher prices.
2018 Deep Dive (Sen)In an Article in JAMA Internal Medicine (epub, April 26, here), Sen et al. (Hopkins) report one-year analysis for CY2018 of out-of network lab tests in privately insured patients. In a data set of 4M patients, 6% had an out-of-network lab service "with an average $81 balance bill." Out of network labs were 5X more common than out-of-network ER bills or 34X more common than out-of-network anesthesis. Of course, most patients get one or more labs in a year while few people get ER services or surgeries.
Both articles have extensive tables or supplements. Sen includes some discussion of the logistics of whether a test is directed during the care pathway to the patient's in-network or out-of-network lab, but note that "it is unlikely that the patient chose the laboratory."
On a related note, in Health Affairs this month, Whaley et al. note that Medicare spending on imaging and lab tests rose when providers became more vertically integrated (and it's implied, could capture profits on the ancillary tests). See Health Affairs 40:702, here.
In the same issue, Young et al. also speak to vertical integration and report that "hospital employment of physicians is associated with inappropriate diagnostic imaging." See Health Affairs 40:710, here.