G2TT
来源类型Research Reports
规范类型报告
DOIhttps://doi.org/10.7249/RR1809
ISBN9780833097088
来源IDRR-1809-CPH
Evaluating the Impact of Policies to Regulate Involuntary Out-of-Network Charges on New Jersey Hospitals
Soeren Mattke; Chapin White; Mark Alan Hanson; Virginia Kotzias
发表日期2016
出版年2016
页码12
语种英语
结论

Effects of Caps on Payment for Involuntary Out-of-Network Services

  • Among hospitals in New Jersey, revenues from involuntary out-of-network services accounted for less than 20 percent of commercial revenues but almost 40 percent of profits.
  • The authors' estimates suggest that implementing New Jersey Bill A1952, which proposes a limit of between 90 and 200 percent of Medicare rates for involuntary out-of-network hospital care, would have reduced payments for hospital care by commercial plans by between 6 and 10 percent during 2010 through 2014. Assuming no change in operating expenses and no recoupment of lost out-of-network revenues, the cap would have led to an operating loss at between 48 and 70 percent of hospitals.
  • The authors also estimated that a 1-percent reduction of out-of-network rates because of the caps would reduce negotiated in-network rates by half a percent, as it would weaken hospitals' bargaining position.

All-Payer Blended Rates

  • An alternative payment model to reduce high charges for involuntary out-of-network services could be the approach used in Maryland, under which a uniform rate is set for all payers, with a 6-percent discount to public payers. A 14-percent discount for public payers relative to commercial payers would make this model budget-neutral for public payers and hold hospital margins constant but would increase payments by commercial insurers by about 10 percent.
主题Health Care Payment Approaches ; Health Legislation ; Hospitals ; Medicare ; New Jersey
URLhttps://www.rand.org/pubs/research_reports/RR1809.html
来源智库RAND Corporation (United States)
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条目标识符http://119.78.100.153/handle/2XGU8XDN/108280
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Soeren Mattke,Chapin White,Mark Alan Hanson,et al. Evaluating the Impact of Policies to Regulate Involuntary Out-of-Network Charges on New Jersey Hospitals. 2016.
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