• Best in the world, my a$$! – Emergency Departments and Networks – ctd.

    A number of people, especially ER docs, have taken exception to this:

    How common is this, you might ask?

    When emergency medicine emerged as a specialty in the 1980s, almost all E.R. doctors were hospital employees who typically did not bill separately for their services. Today, 65 percent of hospitals contract out that function. And some emergency medicine staffing groups — many serve a large number of hospitals, either nationally or locally — opt out of all insurance plans.

    That’s right, two-thirds of hospitals have out-of-network doctors working in their in-network emergency rooms.

    The gist of their complaints seems to be that while 65% of hospitals are subcontracting to physician groups rather than employing them that’s not proof that they refuse to accept insurance. They further allege that they believe that the vast majority of those subcontracted groups are “in network”. Therefore, they claim that the likelihood of going to an in-network ED and encountering an out-of-network physician is very small.

    In not one of these emails or tweets is there a bit of data, other than an absolute confidence that they are correct. I, on the other hand, am not so sure of any position. The only data I have seen are things like this (emphasis mine):

    When legislators in Texas demanded some data from insurers last year, they learned that up to half of the hospitals that participated with UnitedHealthcare, Humana and Blue Cross-Blue Shield — Texas’s three biggest insurers — had no in-network emergency room doctors. Out-of-network payments to emergency room physicians accounted for 40 to 70 percent of the money spent on emergency care at in-network hospitals, researchers with the Center for Public Policy Priorities in Austin found.

    It’s very common and there’s little consumers can do to prevent it and protect themselves — it’s a roll of the dice,” said Stacey Pogue, a senior policy analyst with the nonpartisan center and an author of the study.

    While patients have complained of surprise out-of-network charges in hospitals from some other specialists — particularly anesthesiologists, radiologists and pathologists — the situation with emergency room doctors is even more troubling, patient advocates say. For one thing, patients cannot be expected to review provider networks in a crisis, and the information to do so is usually not readily available anyway. Moreover, the Texas study found that out-of-network fees paid to emergency room physicians eclipsed the amount of money paid to those other specialists.

    So maybe Texas is an outlier. Maybe all of those indignant ED docs are right. But I’d like to see some evidence to support their surety. If someone shows it to me, I promise to highlight it here on the blog. Until then, I continue to ARGH.

    @aaronecarroll

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