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No Surprises Act Independent Dispute Resolution Outcomes for Air Ambulances
Erin L Duffy1, Christopher Garmon2
1Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles.
JAMA Network Open
|March 3, 2025
Summary
Air ambulance organizations won the majority of No Surprises Act (NSA) independent dispute resolution (IDR) cases in 2023, leading to higher payments from insurers. Further monitoring is needed to assess the full impact of the NSA on air ambulance costs.
Area of Science:
- Health Policy and Economics
- Healthcare Dispute Resolution
- Air Ambulance Services Regulation
Background:
- The No Surprises Act (NSA) introduced an independent dispute resolution (IDR) process to settle payment disputes between insurers and healthcare providers, including air ambulance organizations.
- Understanding the utilization and outcomes of the NSA's IDR system is crucial for refining its implementation, particularly for air ambulance services which are a significant component of these disputes.
Purpose of the Study:
- To analyze the parties involved and the outcomes of air ambulance cases processed through the NSA's IDR system in 2023.
- To provide insights into the effectiveness and financial implications of the IDR process for air ambulance transportation disputes.
Main Methods:
- A cross-sectional study analyzing 5,678 air ambulance payment disputes arbitrated via the NSA IDR system in 2023, using data from the Centers for Medicare & Medicaid Services.
- Evaluation of fixed-wing and rotary air transport disputes, examining disclosed parties, outcomes relative to Qualifying Payment Amounts (QPAs), and monetary measures compared to Medicare rates.
- Data analysis included ownership status (e.g., private equity) and prevailing party determinations, with financial metrics assessed for a subset of cases due to data limitations.
Main Results:
- Air ambulance organizations were the prevailing party in 86.4% of 5,678 IDR cases, with average payments significantly exceeding the insurers' offered Qualifying Payment Amounts (QPAs).
- A substantial portion (61.3%) of disputes involved organizations owned by private equity, and these cases showed higher offers relative to QPAs.
- Analysis of financial measures revealed that winning offers were substantially higher than QPAs and significantly exceeded Medicare's urban allowed amount, though data limitations affected comprehensive financial assessment.
Conclusions:
- The study indicates that air ambulance organizations predominantly win NSA IDR cases, resulting in higher reimbursement rates from insurers.
- The current NSA framework does not mandate adjustments to patient cost-sharing based on IDR outcomes, and data limitations hinder a full financial impact assessment.
- Continued surveillance of air ambulance IDR cases is essential to fully evaluate the long-term effects and effectiveness of the No Surprises Act in controlling healthcare costs.
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