HHS is trying to establish a No Surprises Act data baseline.
The Department of Health and Human Services' (HHS) Office of the Assistant Secretary for Planning and Evaluation recently released the first annual report on the impact of the No Surprises Act.
Since it’s the first annual report, it merely identifies the factors the agency intends to evaluate for future reports, and gives an analysis of the state of these factors prior to implementation of the law for the purpose of creating a baseline for future reports.
According to the report, there was a downward trend in out-of-network claims prior to the No Surprises Act implementation. The prevalence of claims that were out-of-network decreased from 6.0 percent to 4.7 percent from 2012 to 2020. In addition, the share of total payments that were out-of-network declined over this period from 9.2 percent in 2012 to 6.8 percent in 2020, the report said.
The report also says that during that time, out-of-network billing was highly concentrated among a small percentage of physicians from certain specialties.
Numerous gaps remain in the understanding of the effects of state surprise billing laws, the report says. “Evaluations of state surprise billing laws have yielded varying results. Some of this variation likely stems from variation in how states determine out-of-network prices in surprise billing scenarios as well as other differences in state regulation, state health care markets, and other state level variation,” the report says.
In future reports, the agency intends to analyze various factors including:
- The impact of market consolidation and concentration on prices, quality, and spending
- The implementation and impacts of state surprise billing laws already in effect
- Trends in market consolidation and concentration
- Trends in out-of-network billing
HHS notes that the data necessary to evaluate the impact of the act on these market factors should become available in 2023 and will be used for the next report in January 2024.
Amanda Norris is the Associate Content Manager of Finance, Payer, Revenue Cycle, and Strategy for HealthLeaders.