Anesthesia makes up 16% of out-of-network claims for in-network admissions — 33 statistics

Anesthesiology accounts for the largest portion of all out-of-network claims associated with an in-network admission, according to a report from the Health Care Cost Institute.

The report examined nearly 620,000 in-network inpatient admissions and all associated professional claims across 37 states and Washington, D.C., in 2016. It identified all out-of-network professional claims associated with an in-network admission and how they were distributed across medical specialties.

More than 16 percent of all out-of-network claims in the sample were for services performed by an anesthesiologist.

The share of out-of-network professional claims each specialty comprised:

1. Anesthesiology: 16.5 percent
2. Other physician: 14 percent
3. Primary care: 13 percent
4. Emergency medicine: 11 percent
5. Non-physician: 9 percent
6. Specialty unavailable: 8 percent
7. Radiology: 8 percent
8. Other medical: 6 percent
9. Independent lab: 5 percent
10. OB-GYN: 2 percent

The report also gave a breakdown of how often a claim for each specialty was out-of-network when linked to an in-network admission. Nearly 8 percent of in-network admissions with anesthesiology claims were billed as out-of-network.

Specialties that billed out-of-network at in-network facilities most often:

11. Independent lab: 22.1 percent
12. Emergency medicine: 12 percent
13. Specialty unavailable: 11.5 percent
14. Other physician: 9.4 percent
15. Anesthesiology: 7.9 percent
16. Non-physician: 7.6 percent
17. Miscellaneous: 7.6 percent
18. Other medical: 6.9 percent
19. ENT: 6.4 percent
20. Mental health/substance use: 6.3 percent
21. Primary care: 6 percent
22. Radiology: 4.8 percent
23. General surgery: 4.4 percent
24. Neurology: 3.9 percent
25. Physical/occupational therapy: 3.6 percent
26. Other surgical: 2.6 percent
27. Cardiovascular: 2.5 percent
28. Facility: 2 percent
29. Orthopedic surgery: 1.9 percent
30. Gastroenterology: 1.5 percent
31. Urology: 1.2 percent
32. OB-GYN: 1.1 percent
33. Oncology/hematology: 0.8 percent

More articles on anesthesia:
CalvertHealth clinicians join North American Partners in Anesthesia — 3 insights
A timeline of CRH Medical's $27.5M anesthesia acquisitions in 2018
The trends to know about pain management in ASCs: 4 Qs with Dr. Eric Grahling

© Copyright ASC COMMUNICATIONS 2019. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.

 

Top 40 Articles from the Past 6 Months