scholarly journals Out-of-Pocket Spending for COVID-19 Hospitalizations in 2020

2021 ◽  
Author(s):  
Kao-Ping Chua ◽  
Rena M Conti ◽  
Nora V Becker
Keyword(s):  
Cost Sharing ◽  
Financial Burden ◽  
Ancillary Services ◽  
Medicare Advantage ◽  
Cross Sectional ◽  
Outcomes Measures ◽  
Ambulance Transport ◽  
Insured Patients ◽  
Sectional Analysis ◽  
Privately Insured

IMPORTANCE: Many insurers waived cost-sharing for COVID-19 hospitalizations during 2020. Nonetheless, patients may have been billed if their plans did not implement waivers or if waivers did not capture all hospitalization-related care, including clinician services. Assessing out-of-pocket spending for COVID-19 hospitalizations in 2020 could demonstrate the financial burden patients may face if insurers allow waivers to expire, as many chose to do during early 2021. OBJECTIVE: To estimate out-of-pocket spending for COVID-19 hospitalizations in 2020 DESIGN: Cross-sectional analysis SETTING: IQVIA PharMetrics Plus for Academics Database, a national claims database PARTICIPANTS: COVID-19 hospitalizations for privately insured and Medicare Advantage patients during March-September 2020 MAIN OUTCOMES/MEASURES: Mean total out-of-pocket spending, defined as the sum of out-of-pocket spending for facility services billed by hospitals (e.g., accommodation charges) and for professional/ancillary services billed by clinicians and ancillary providers (e.g., clinician inpatient evaluation and management, ambulance transport) RESULTS: Analyses included 4,075 hospitalizations. Of the 1,377 hospitalizations for privately insured patients and the 2,698 hospitalizations for Medicare Advantage patients, 981 (71.2%) and 1,324 (49.1%) had out-of-pocket spending for facility services, professional/ancillary services, or both. Among these hospitalizations, mean (SD) total out-of-pocket spending was $788 (1,411) and $277 (363). In contrast, 63 (4.6%) and 36 (1.3%) hospitalizations had out-of-pocket spending for facility services. Among these hospitalizations, mean total out-of-pocket spending was $3,840 (3,186) and $1,536 (1,402). Total out-of-pocket spending exceeded $4,000 for 2.5% of privately insured hospitalizations, compared with 0.2% of Medicare Advantage hospitalizations. CONCLUSIONS: Few COVID-19 hospitalizations in this study had out-of-pocket spending for facility services, suggesting most were covered by insurers with cost-sharing waivers. However, many hospitalizations had out-of-pocket spending for professional/ancillary services. Overall, 7 in 10 privately insured hospitalizations and half of Medicare Advantage hospitalizations had any out-of-pocket spending. Findings suggest insurer cost-sharing waivers may not cover all hospitalization-related care. Moreover, high cost-sharing for some hospitalizations suggests out-of-pocket burden could be substantial if waivers expire, particularly for privately insured patients. Rather than rely on voluntary insurer actions to mitigate this burden, federal policymakers should consider mandating insurers to waive cost-sharing for all COVID-19 hospitalization-related care throughout the pandemic.

scholarly journals Out-of-Pocket Spending for Health Care Within 90 Days of COVID-19 Hospitalization

2021 ◽  
Author(s):  
Kao-Ping Chua ◽  
Rena M Conti ◽  
Nora V Becker
Keyword(s):  
Health Care ◽  
Private Insurance ◽  
Health Care Needs ◽  
Medicare Advantage ◽  
Care Needs ◽  
Post Discharge ◽  
Cross Sectional ◽  
Discharge Care ◽  
Sectional Analysis ◽  
Privately Insured

INTRODUCTION: Millions of U.S. patients have been hospitalized for coronavirus disease 2019 (COVID-19). After discharge, these patients often have extensive health care needs, but out-of-pocket burden for this care is poorly described. Using national data, we assessed out-of-pocket spending during the 90 days after COVID-19 hospitalization among privately insured and Medicare Advantage patients. METHODS: In May 2021, we conducted a cross-sectional analysis of the IQVIA PharMetrics Plus for Academics Database, a national de-identified claims database. Among privately insured and Medicare Advantage patients hospitalized for COVID-19 between March-June 2020, we calculated mean out-of-pocket spending for care within 90 days of discharge. To contextualize results, we repeated analyses for patients hospitalized for bacterial pneumonia. RESULTS: Among 1,465 COVID-19 patients included, 516 (35.2%) and 949 (64.8%) were covered by private insurance and Medicare Advantage plans. Among these patients, mean (SD) post-discharge out-of-pocket spending was $534 (1,045) and $680 (1,360); spending exceeded $2,000 for 7.0% and 10.3%. Compared with patients with pneumonia, mean post-discharge out-of-pocket spending among COVID-19 patients was higher among the privately insured ($534 vs $445) and lower among Medicare Advantage patients ($680 vs $918). CONCLUSIONS: Out-of-pocket spending for immediate post-discharge care can be substantial for many patients hospitalized for COVID-19. Among Medicare Advantage patients, post-discharge out-of-pocket spending was higher after pneumonia hospitalizations, potentially because insurer cost-sharing waivers fully covered the costs of COVID-19-related readmissions during the study period. As many insurers allowed such waivers to expire in 2021, it is important to repeat analyses among patients more recently hospitalized for COVID-19.

scholarly journals Increasing Trends in the Use of Hospital Observation Services for Older Medicare Advantage and Privately Insured Patients

2017 ◽  
Vol 76 (2) ◽  
pp. 229-239 ◽  
Author(s):  
Keith D. Lind ◽  
Claire M. Noel-Miller ◽  
Lindsey R. Sangaralingham ◽  
Nilay D. Shah ◽  
Erik P. Hess ◽  
...  
Keyword(s):  
Data Warehouse ◽  
Older Patients ◽  
Claims Data ◽  
Veterans Affairs ◽  
Inpatient Stay ◽  
Medicare Advantage ◽  
Younger Patients ◽  
Insured Patients ◽  
Increasing Trends ◽  
Privately Insured

Policy and financial pressures have driven up use of observation stays for patients in traditional Medicare and the Veterans’ Affairs Healthcare System. Using claims data (2004-2014) from OptumLabs™ Data Warehouse, we examined whether people in private Medicare Advantage (MA) and commercial plans experienced similar changes. We found that use of observation increased rapidly for patients in MA plans—even though MA plans were not subject to the same pressures as government-run programs. In contrast, use of observation remained constant for people in commercial plans—except for enrollees 65 and older, for whom it increased somewhat. Privately insured patients returning to the hospital after an inpatient stay were increasingly likely to be placed under observation. Our results suggest that observation is rapidly replacing inpatient admissions and readmissions for many older patients in MA and commercial plans, while younger patients continue to be admitted as inpatients at relatively constant rates.

scholarly journals Patient out-of-pocket spending in cranial neurosurgery: single-institution analysis of 6569 consecutive cases and literature review

2018 ◽  
Vol 44 (5) ◽  
pp. E6 ◽  
Author(s):  
Seungwon Yoon ◽  
Michael A. Mooney ◽  
Michael A. Bohl ◽  
John P. Sheehy ◽  
Peter Nakaji ◽  
...  
Keyword(s):  
Health Insurance ◽  
Cost Sharing ◽  
Financial Burden ◽  
Vascular Lesions ◽  
Annual Growth Rate ◽  
Model Case ◽  
Patient Cost ◽  
Neurosurgical Patients ◽  
The Mean ◽  
Insured Patients

OBJECTIVEWith drastic changes to the health insurance market, patient cost sharing has significantly increased in recent years. However, the patient financial burden, or out-of-pocket (OOP) costs, for surgical procedures is poorly understood. The goal of this study was to analyze patient OOP spending in cranial neurosurgery and identify drivers of OOP spending growth.METHODSFor 6569 consecutive patients who underwent cranial neurosurgery from 2013 to 2016 at the authors’ institution, the authors created univariate and multivariate mixed-effects models to investigate the effect of patient demographic and clinical factors on patient OOP spending. The authors examined OOP payments stratified into 10 subsets of case categories and created a generalized linear model to study the growth of OOP spending over time.RESULTSIn the multivariate model, case categories (craniotomy for pain, tumor, and vascular lesions), commercial insurance, and out-of-network plans were significant predictors of higher OOP payments for patients (all p < 0.05). Patient spending varied substantially across procedure types, with patients undergoing craniotomy for pain ($1151 ± $209) having the highest mean OOP payments. On average, commercially insured patients spent nearly twice as much in OOP payments as the overall population. From 2013 to 2016, the mean patient OOP spending increased 17%, from $598 to $698 per patient encounter. Commercially insured patients experienced more significant growth in OOP spending, with a cumulative rate of growth of 42% ($991 in 2013 to $1403 in 2016).CONCLUSIONSEven after controlling for inflation, case-mix differences, and partial fiscal periods, OOP spending for cranial neurosurgery patients significantly increased from 2013 to 2016. The mean OOP spending for commercially insured neurosurgical patients exceeded $1400 in 2016, with an average annual growth rate of 13%. As patient cost sharing in health insurance plans becomes more prevalent, patients and providers must consider the potential financial burden for patients receiving specialized neurosurgical care.

scholarly journals Publicly insured caesarean sections in private hospitals: a repeated cross-sectional analysis in Chile

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e024241 ◽  
Author(s):  
Florencia Borrescio-Higa ◽  
Nieves Valdés
Keyword(s):  
Public Insurance ◽  
Cross Sectional ◽  
Private Hospitals ◽  
The Public ◽  
Cross Sectional Analysis ◽  
Maternal Morbidity And Mortality ◽  
Hospital Births ◽  
Publicly Insured ◽  
Sectional Analysis ◽  
Privately Insured

ObjectiveTo measure the likelihood of delivery by caesarean section (C-section) for publicly insured births as compared with privately insured births, across all hospitals and within private hospitals.DesignRepeated cross-sectional analysis.SettingThe universe of hospital births in 15 regions of Chile.Participants2 405 082 singleton births between 2001 and 2014.Outcome measuresC-section rates by type of hospital and type of insurance; contribution to overall C-section rates of subgroups by type of insurance and type of hospital; adjusted OR of privately insured births delivered by C-section compared with publicly insured births, across all hospitals and within private hospitals; percentage of discharges related to maternal morbidity and mortality across groups; length of stay after delivery.ResultsAn increasing percentage of publicly insured births occur in private facilities each year. Approximately three out of four publicly insured births in private hospitals are delivered by C-section. The adjusted odd of C-section delivery in a private maternity unit is lower for those privately insured than for those with public insurance: OR 0.6, 95% CI 0.56 to 0.64. There is no evidence that these women would have been more likely to have a C-section out of medical necessity.ConclusionsWe find an association between high C-section rates and publicly insured women delivering at private institutions in Chile, and show that this group is driving the overall high and growing rates. There is a need for a more informed surveillance on the part of the public insurance system of its private providers’ C-section practices.

Appropriateness of Otic Quinolone Use among Privately Insured US Patients

2019 ◽  
Vol 162 (1) ◽  
pp. 102-107
Author(s):  
Phuong T. Tran ◽  
Almut G. Winterstein ◽  
Xi Wang ◽  
Kiyon Rhew ◽  
Patrick J. Antonelli
Keyword(s):  
Time Windows ◽  
The United States ◽  
National Sample ◽  
Cross Sectional Study ◽  
Sensitivity Analyses ◽  
Sectional Study ◽  
Cross Sectional ◽  
Insured Patients ◽  
Ear Drops ◽  
Privately Insured

Objective Considering emerging safety concerns involving otic quinolones, we assessed the extent of otic quinolone use for questionable indications. Study Design Descriptive cross-sectional study of a national sample of privately insured patients. Setting Outpatient encounters in the United States. Subjects and Methods Children and adults with outpatient pharmacy-dispensing claims for new prescriptions of otic or ophthalmic quinolones in 2017 were identified within the IBM MarketScan Commercial Claims & Encounters and the Medicare Supplemental Database. Each dispensing ≥30 days apart constituted a unique episode. Only claims with supporting ear-related diagnoses on outpatient encounters ±3 days of dispensing were considered. Ophthalmic drops were excluded if eye-related diagnoses were found ±30 days. Prescribing was classified as appropriate, questionable, or undetermined. Results We found 214,897 episodes in 200,270 patients. Adults were twice as likely as children to have otic treatment with questionable indications (6.2% vs 3.0%). Sensitivity analyses with broader time windows to ascertain diagnoses showed similar proportions of questionable use. Otalgia and cerumen impaction constituted 90% of questionable indications. Family physicians (6.8%) and internists (8.0%) had higher percentages of questionable use than other specialties. Conclusion Based on the demonstrated risks of quinolone ear drops, opportunities exist to decrease otic quinolone use, especially in adults.

scholarly journals Increasing Out-of-Pocket Costs for Neurologic Care for Privately-Insured Patients

Neurology ◽  
2020 ◽  
pp. 10.1212/WNL.0000000000011278
Author(s):  
Chloe E. Hill ◽  
Evan L. Reynolds ◽  
James F. Burke ◽  
Mousumi Banerjee ◽  
Kevin A. Kerber ◽  
...  
Keyword(s):  
Cost Sharing ◽  
Diagnostic Testing ◽  
Service Cost ◽  
Number Of Patients ◽  
The Mean ◽  
Insured Patients ◽  
High Deductible Health Plan ◽  
The Cost ◽  
Out Of Pocket Costs ◽  
Privately Insured

Objective:To measure the out-of-pocket costs of evaluation and management (E/M) services and common diagnostic testing for neurology patients.Methods:Utilizing a large, privately-insured healthcare claims database, we identified patients with a neurologic visit or diagnostic test from 2001-2016 and assessed inflation-adjusted out-of-pocket costs for E/M visits, neuroimaging, and neurophysiologic testing. For each diagnostic service each year, we estimated the proportion of patients with out-of-pocket costs, the mean out-of-pocket cost, and the proportion of the total service cost paid out-of-pocket. We modeled out-of-pocket cost as a function of patient and insurance factors.Results:We identified 3,724,342 patients. The most frequent neurologic services were E/M visits (78.5%), electromyogram/nerve conduction studies (EMG/NCS) (7.7%), MRIs (5.3%), and electroencephalograms (EEGs) (4.5%). Annually, 86.5-95.2% of patients paid out-of-pocket costs for E/M visits and 23.1-69.5% for diagnostic tests. For patients paying any out-of-pocket cost, the mean out-of-pocket cost increased over time, most substantially for EEG, MRI, and E/M. Out-of-pocket costs varied considerably; for an MRI in 2016, the 50th percentile paid $103.1 and the 95th percentile paid $875.4. The proportion of total service cost paid out-of-pocket increased. High deductible health plan (HDHP) enrollment was associated with higher out-of-pocket costs for MRI, EMG/NCS, and EEG.Conclusions:An increasing number of patients pay out-of-pocket for neurologic diagnostic services. These costs are rising and vary greatly across patients and tests. The cost sharing burden is particularly high for the growing population with HDHPs. In this setting, neurologic evaluation might result in financial hardship for patients.

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