This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Discuss the reason that the US Congress passed the No Surprises Act
2. Describe the findings in the JAMA Internal Medicine article “Association of Surprise-Billing Legislation with Prices Paid to In-Network and Out-of-Network Anesthesiologists in California, Florida, and New York”
Estimated time to complete activity: 0.25 hours
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from 8/30/2021 through 8/30/2023, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the test and evaluation. Upon registering and successfully completing the test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.25 contact hours.Read Disclaimer & Fine Print
In December 2020, the US Congress passed the ‘No Surprises Act’, which is in effect as of January 2022. The purpose of this legislation is to protect patients from surprise medical bills that may occur when an individual unknowingly receives care from an out-of-network practitioner at an in-network health care facility. The law also establishes a method of determining payments made by a patient’s insurer to the out-of-network practitioner. Insurers and practitioners must first negotiate out-of-network rates. If negotiations fail, they may proceed to a federal independent dispute resolution (IDR) process in which each party submits a price, and an arbitrator decides using the insurer’s median in-network rate as a benchmark.
Before the No Surprises Act, 18 states had enacted their own surprise billing legislation.
Using anesthesia services, researchers (JAMA Internal Medicine) conducted a retrospective economic analysis of data from 2014 to 2017 from three states, California, Florida, and New York, comparing price changes before and after with 45 states that had not passed such ‘surprise bill’ legislation. Anesthesiology is one of the specialties with a great potential for surprise bills because patients typically do not choose an anesthesiologist for service.
Each of the three study states used a different payment standard or independent dispute resolution to determine the out-of-network rate paid to practitioners. The data set to examine the effect of the law had short before and after periods. Finally, not all commercial claims were examined, only claims from three of the largest US insurers.
The researchers learned that compared to prices in the control state, prices paid to in-network and out-of-network anesthesiologists in hospital outpatient departments and ambulatory surgery centers declined after surprise-billing legislation was enacted in the study states. California practitioners have argued that out-of-network prices were too low compared to in-network prices. Florida saw the largest out-of-network decline but that may have occurred because those prices were already substantially higher than those of in-network prices.
In summary, state surprise-billing legislation directly lowered anesthesia out-of-network prices and indirectly lowered in-network prices in outpatient departments and ambulatory surgery centers. These findings, however, cannot necessarily be extrapolated to other specialties. Data collection will need to continue to have more comprehensive information over a longer period of time.
Association of Surprise-Billing Legislation with Prices Paid to In-Network and Out-of-Network Anesthesiologists in California, Florida, and New York: An Economic Analysis (JAMA Internal Medicine)
Surprise Billing in Surgical Care Episodes – Overview, Ethical Concerns, and Policy Solutions in Light of COVID-19 (Annals of Surgery)
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presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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