无惊喜法案 紧急服务的独立争议解决结果
Erin L Duffy1, Christopher Garmon2, Loren Adler3
1Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA 90089, USA.
Health affairs scholar
|November 1, 2024
概括
没有惊喜法案.
科学领域:
- 卫生经济学 卫生经济学
- 医疗保健政策 医疗保健政策
- 医疗纠纷解决方案 医疗纠纷解决方案
背景情况:
- "无惊喜法"的目的是结束意外的医疗收费.
- 它建立了一个独立的争议解决程序 (IDR),用于医疗计划和提供者之间的支付分歧.
- 合格支付金额 (QPA) 是IDR仲裁中的一个关键因素.
研究的目的:
- 分析紧急医疗评估和管理服务IDR流程的结果.
- 调查QPA对仲裁决定的影响.
- 根据提供者所有权 (例如私募股权) 检查结果的差异.
主要方法:
- 从2023年开始对公共IDR数据的分析.
- 专注于对中度至重度紧急医疗访问的评估和管理服务.
- 与医疗保险支付相关的仲裁结果,裁决金额和QPA的比较.
主要成果:
- 在紧急医疗服务的IDR案件中,提供者占优势的比例为86%.
- 仲裁裁决的平均数量是QPA的2.7倍.
- 由私募股权支持的提供商实现了更高的胜利率和更大的奖励.
- 平均QPA是医疗保险支付的2.4倍.
结论:
- 使用QPA的IDR过程导致的决策明显高于紧急医疗的QPA.
- 私募股权参与可能会影响IDR结果.
- 一个集中的付款人和提供者的群体主导了争端,可能限制了市场的反映力.
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