Prices For Common Medical Services Vary Substantially Among The Commercially Insured

Newman, David; Parente, Stephen T.; Barrette, Eric; Kennedy, Kevin

doi:10.1377/hlthaff.2015.1379

Cited by 29 publications

(19 citation statements)

References 2 publications

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“…16 The data include the amount paid by the insurer plus any copayments or other payments made by the patient. 17 We also compared to Medicaid physician reimbursement rates publicly reported by the Texas Medicaid program based on new office visit CPT codes 99203-99205 for orthopedic surgeons. 18 Analysis For all calls, we calculated the relative risk that patients with Medicaid or who were uninsured would receive an appointment compared with privately insured patients.…”

Section: Discussionmentioning

confidence: 99%

“…However, healthcare costs in Texas are generally near or slightly below national averages. 17 Dallas in particular has the highest costs of any metropolitan area in Texas for knee replacements, which may indicate that its costs for orthopedic care are higher than average. 17 Texas also has the highest uninsured rate in the nation, which may exacerbate access difficulties and health disparities in this state.…”

Section: Limitationsmentioning

confidence: 99%

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“I Broke My Ankle”: Access to Orthopedic Follow‐up Care by Insurance Status

Medford‐Davis

Lin

Greenstein

et al. 2017

Academic Emergency Medicine

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Objectives: While the Affordable Care Act seeks to reduce emergency department (ED) visits for outpatienttreatable conditions, it remains unclear whether Medicaid patients or the uninsured have adequate access to followup care. The goal of this study was to determine the availability of follow-up orthopedic care by insurance status.Methods: Using simulated patient methodology, all 102 eligible general orthopedic practices in Dallas-Fort Worth, Texas, were contacted twice by a caller requesting follow-up for an ankle fracture diagnosed in a local ED using a standardized script that differed by insurance status. Practices were randomly assigned to paired private and uninsured or Medicaid and uninsured scenarios.Results: We completed 204 calls: 59 private, 43 Medicaid, and 102 uninsured. Appointment success rate was 83.1% for privately insured (95% confidence interval [CI] = 73.2% to 92.9%), 81.4% for uninsured (95% CI = 73.7% to 89.1%), and 14.0% for Medicaid callers (95% CI = 3.2% to 24.7%). Controlling for paired calls to the same practice, an uninsured caller had 5.7 times higher odds (95% CI = 2.74 to 11.71) of receiving an appointment than a Medicaid caller (p < 0.001), but the same odds as a privately insured caller (odds ratio = 1.0, 95% CI = 0.19 to 5.37, p = 1.0). Uninsured patients had to bring a median of $350 (interquartile range = $250 to $400) to their appointment to be seen, and only two uninsured patients were able to obtain an appointment for $100 or less up front. In comparison, typical total payments collected for privately insured patients were $236 and for Medicaid patients $128. When asked where else they could go, 49 (48%) uninsured callers and one Medicaid caller (2%) were directed to local public hospital EDs as alternative sources of care. Of the practices that appeared on Medicaid's published list of orthopedic providers accepting new patients, 15 told callers that they did not accept Medicaid, 11 did not treat ankles, nine listed nonworking phone numbers, and only three actually scheduled an appointment for the Medicaid caller.Conclusions: Less than one in seven Medicaid patients could obtain orthopedic follow-up after an ED visit for a fracture, and prices quoted to the uninsured were 30% higher than typical negotiated rates paid by the privately insured. High up-front costs for uninsured patients and low appointment availability for Medicaid patients may leave these patients with no other option than the ED for necessary care.T he Emergency Medical Treatment and Labor Act (EMTALA) is a federal law that guarantees emergency care to anyone presenting to an emergency department (ED) in the United States that accepts federal funding.1 For a fracture, the standard for emergency care includes reduction and splinting of the fracture. After an ED visit for a fracture, orthopedic follow-up care is important to convert splints to casts, determine the need for surgery, and ensure optimal healing to prevent nonunion or other complications. 2,3However, access to nonemergent care in the out...

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Section: Discussionmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

“I Broke My Ankle”: Access to Orthopedic Follow‐up Care by Insurance Status

Medford‐Davis

Lin

Greenstein

et al. 2017

Academic Emergency Medicine

View full text Add to dashboard Cite

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“…Goz and colleagues recently found significant regional differences in the cost for spinal surgery across the United States. Newman and colleagues found that, despite the differences expected based on operation costs in different regions, the variability in price appears to be largely a result of market dynamics in a given area. As they indicated, additional research is now required to understand the market dynamics and determine why there is such great variation across the country for the same services and whether this variation is justifiable.…”

Section: Discussionmentioning

confidence: 99%

Inpatient cost analysis for treatment of myasthenia gravis

2017

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“…Our results contribute to the growing literature in health economics on price dispersion for medical supplies (Grennan & Swanson, 2018;Grennan, 2013), pharmaceuticals (Starc & Swanson, 2018), and medical services (Cooper, Craig, Gaynor, & Van Reenen, 2018;Newman, Parente, Barrette, & Kennedy, 2016;Xu, et al, 2015;Dunn, Liebman, & Shapiro, 2017). 3 The previous papers looking at medical services have relied on data sets that do not include explicit information on the payer with which each patient is associated.…”

Section: New Contributionmentioning

confidence: 68%

Prices for Medical Services Vary Within Hospitals, but Vary More Across Them

2019

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Using commercial claims for 2012-2013 from Colorado's All-Payer Claims Database, we examine how medical service prices vary for five hospital-based procedures and the complexityadjusted inpatient price. We find that prices vary substantially in multiple dimensions. Our analysis indicates that there is significant price variation across payers for the same service in the same hospital. If prices converged to the lowest rate each hospital receives, commercial expenditures would fall by 10-20%. The share of overall price variation accounted for by hospitals variation tends to be even more substantial. For four out of six prices, we find that differences associated just with hospitals' metropolitan areas account for over 45% of the total variation. We observe substantial residual variation (17-50%) after accounting for factors specific to a given payer or provider.

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Prices For Common Medical Services Vary Substantially Among The Commercially Insured

Cited by 29 publications

References 2 publications

“I Broke My Ankle”: Access to Orthopedic Follow‐up Care by Insurance Status

“I Broke My Ankle”: Access to Orthopedic Follow‐up Care by Insurance Status

Inpatient cost analysis for treatment of myasthenia gravis

Prices for Medical Services Vary Within Hospitals, but Vary More Across Them

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