Markups on emergency medicine and anesthesiology services — two specialties that are common in surprise medical billing — increased significantly from 2012 to 2016, according to a research letter published Nov. 11 in JAMA Internal Medicine.
The letter — written by Tim Xu, MD, of the Johns Hopkins University School of Medicine in Baltimore — highlighted findings from Dr. Xu's study of Medicare Part B claims from 2,042 U.S. hospitals.
The study found that markups increased 28 percent per year as a percentage of Medicare reimbursement for emergency medicine and 32 percent for anesthesiology from 2012 to 2016 — far exceeding economic inflation and internal medicine, which increased 7 percent per year. For the purposes of the study, markups were determined using the ratio of the charge relative to the Medicare reimbursed amount (i.e. if the hospital charged $450 to out-of-pocket patients for every $100 in Medicare reimbursement, the markup would be 350 percent).
Adjusted annual increases in charges for emergency medicine and anesthesiology were greatest among for-profit hospitals and hospitals in the Southeast, according to the study.
"In this analysis, emergency departments serving a higher percentage of uninsured patients [also] raised their charges more, a potential sign of cost shifting under financial stress," Dr. Xu concluded.
"Policymakers should consider how legislation limiting the degree of markup could give insurers unfair negotiating leverage over these hospitals."
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