没有惊喜法案 独立解决争议的结果 对于空中救护车
Erin L Duffy1, Christopher Garmon2
1Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles.
JAMA network open
|March 3, 2025
概括
空中救护车组织在2023年赢得了大多数"无惊喜法" (NSA) 独立争端解决 (IDR) 案件,导致保险公司支付更高的费用. 需要进一步监测,以评估国家安全局对空中救护车成本的全部影响.
科学领域:
- 卫生政策与经济 卫生政策与经济
- 医疗保健纠纷解决方案 解决医疗保健纠纷
- 关于空中救护车服务的规定
背景情况:
- 无惊喜法 (NSA) 引入了一个独立争议解决程序 (IDR) 来解决保险公司和医疗服务提供商之间的支付纠纷,包括空中救护车组织.
- 了解国家安全局IDR系统的使用和结果对于完善其实施至关重要,特别是对于空中救护车服务,这是这些争端的重要组成部分.
研究的目的:
- 分析2023年通过国家安全局的IDR系统处理的空中救护车案件的参与方和结果.
- 提供关于IDR程序在空中救护车运输纠纷中的有效性和财务影响的见解.
主要方法:
- 一项横截面研究分析了2023年通过NSA IDR系统仲裁的5678起空中救护车支付纠纷,使用来自医疗保险和医疗补助服务中心的数据.
- 评估固定翼和旋转航空运输纠纷,检查披露的当事人,与合格支付金额 (QPA) 相比的结果,以及与医疗保险费率相比的货币措施.
- 数据分析包括所有权状况 (例如,私募股权) 和占优势方的决定,由于数据限制,对某些案例的子集评估了财务指标.
主要成果:
- 在5678起IDR案件中,空中救护车组织占优势86.4%,平均支付大大超过了保险公司提供的合格支付金额 (QPA).
- 很大一部分 (61.3%) 的纠纷涉及私募股权所有的组织,这些案件显示相对于QPAs,报价更高.
- 对财务措施的分析显示,获胜的报价大大高于QPA,并且明显超过医疗保险的城市允许金额,尽管数据限制影响了全面的财务评估.
结论:
- 该研究表明,空中救护车组织主要赢得NSA IDR案件,导致保险公司更高的报销率.
- 目前的NSA框架不要求根据IDR结果对患者的成本共享进行调整,数据限制阻碍了全面的财务影响评估.
- 对空中救护车IDR病例的持续监测对于充分评估"无惊喜法"在控制医疗保健成本方面的长期影响和有效性至关重要.
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