IMPORTANCE Although surprise medical bills are receiving considerable attention from lawmakers and the news media, to date there has been little systematic study of the incidence and financial consequences of out-of-network billing.OBJECTIVE To examine out-of-network billing among privately insured patients with an inpatient admission or emergency department (ED) visit at in-network hospitals. DESIGN, SETTING, AND PARTICIPANTSA retrospective analysis using data from the Clinformatics Data Mart database (Optum), which includes health insurance claims for individuals from all 50 US states receiving private health insurance from a large commercial insurer was conducted of all inpatient admissions (n = 5 457 981) and ED visits (n = 13 579 006) at in-network hospitals between January 1, 2010, and December 31, 2016. Data were collected and analyzed in March 2019.EXPOSURES Receipt of a bill for care from at least 1 out-of-network physician or medical transport service associated with patient admission or ED visit. MAIN OUTCOMES AND MEASURESThe incidence of out-of-network billing and the potential amount of patients' financial liability associated with out-of-network bills from the admission or visit.

Key Points Question Is early physical therapy associated with long-term opioid use by patients with musculoskeletal pain? Findings In this cross-sectional analysis of 88 985 patients with shoulder, neck, knee, or low back pain, early physical therapy was associated with an approximately 10% statistically significant reduction in subsequent opioid use. Meaning By serving as an alternative or adjunct to short-term opioid use for patients with musculoskeletal pain, early physical therapy may play a role in reducing the risk of long-term opioid use.

Background. Musculoskeletal pain is a common condition, raising the concern these patients may transition to chronic opioid use. However, the incidence of and risk factors for chronic opioid use among patients with new musculoskeletal pain are not fully understood. Objective. To characterize the incidence and risk factors of chronic opioid use among opioid-naive patients with newly diagnosed musculoskeletal pain in the knee, neck, low back, and/or shoulder. Methods and Findings. The IBM® Marketscan® database provide health care utilization data for patients receiving private insurance through a participating employer or government organization. Compared to the general United States (US) population, the Marketscan® population is slightly more female and from the southern US, and less likely to come from the western US.(1) Using this data, we identified 518,195 privately insured, cancer-free, and opioid-naïve (no filled opioid prescriptions in the year prior to diagnosis) adults ages 18–64 diagnosed with non-trauma related musculoskeletal pain between January 1, 2008 and December 31, 2014 and who remained continuously enrolled for the year before and after the initial diagnosis. Since musculoskeletal pain can have varying levels of severity, we restricted our analysis to patients with pain severe enough to result in a second outpatient visit or emergency room visit for musculoskeletal pain within 30 days of the initial diagnosis date.(2) We excluded 6,036 patients with missing opioid data and 100,138 patients with conditions that could be confused for musculoskeletal low back pain (nepholithiasis, urinary tract infection, osteomyelitis, cholecystitis, osteoporosis, cauda equina syndrome, and osseous defect), resulting in a final sample of 412,021 patients.

Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background In the United States, anesthesia care can be provided by an anesthesia care team consisting of nonphysician providers (nurse anesthetists and anesthesiologist assistants) working under the supervision of a physician anesthesiologist. Nurse anesthetists may practice nationwide, whereas anesthesiologist assistants are restricted to 16 states. To inform policies concerning the expanded use of anesthesiologist assistants, the authors examined whether the specific anesthesia care team composition (physician anesthesiologist plus nurse anesthetist or anesthesiologist assistant) was associated with differences in perioperative outcomes. Methods A retrospective analysis was performed of national claims data for 443,098 publicly insured elderly (ages 65 to 89 yr) patients who underwent inpatient surgery between January 1, 2004, and December 31, 2011. The differences in inpatient mortality, spending, and length of stay between cases where an anesthesiologist supervised an anesthesiologist assistant compared to cases where an anesthesiologist supervised a nurse anesthetist were estimated. The approach used a quasirandomization technique known as instrumental variables to reduce confounding. Results The adjusted mortality for care teams with anesthesiologist assistants was 1.6% (95% CI, 1.4 to 1.8) versus 1.7% for care teams with nurse anesthetists (95% CI, 1.7 to 1.7; difference −0.08; 95% CI, −0.3 to 0.1; P = 0.47). Compared to care teams with nurse anesthetists, care teams with anesthesiologist assistants were associated with non–statistically significant decreases in length of stay (−0.009 days; 95% CI, −0.1 to 0.1; P = 0.89) and medical spending (−$56; 95% CI, −334 to 223; P = 0.70). Conclusions The specific composition of the anesthesia care team was not associated with any significant differences in mortality, length of stay, or inpatient spending.