“Our 1,000 simulated years found that, for large stroke centers, 87% of OON claims could not be batched with another claim given the 30-business day batching rules. For the 13.2% of claims that could be batched with another claim, in no instance did these batches have more than 2 claims,” said Dr. Grossberg. “While a batch of 2 global claims is financially viable for entering the IDR process, the reality is that a batch of 4 or more claims is required to make entering the IDR process financially viable for professional claims.”
The most crucial assumption in the study’s stimulation model was the OON rate. The study used an OON rate of 1.1% of commercial claims based on a recent study. To examine the sensitivity of the results to this OON rate, the authors evaluated the results assuming various OON rates from 2% to 10% of claims.
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“Even when we assumed a 10% OON rate, only 11.6% of claims could be batched with 4 or more claims for neurointerventionalists working in a large stroke center,” stated Joshua Hirsch, MD, Neiman Institute Affiliate Senior Research Fellow and Vice Chair Procedural Services, Massachusetts General Hospital. “This is the best-case scenario. For medium and small stroke centers, this percentage is only 3.8% and 0.7%, respectively. Likewise, assuming a 5% OON rate, these percentages are 2.0%, 0.9%, and 0% for large, medium, and small stroke centers, respectively.”
“The NSA process was designed to protect patients from unexpected bills following non-elective medical services. Rulemaking provided insurers with lopsided power resulting in potential diminution of in-network providers,” stated Dr. Hirsch. “Given the nature of many neuroendovascular cases, the field is at particular risk of under-reimbursement from commercial health insurance companies and is frequently without access to IDR in a cost-effective manner, as our study shows.”
About the Harvey L. Neiman Health Policy Institute
The Harvey L. Neiman Health Policy Institute is one of the nation’s leading medical imaging socioeconomic research organizations. The Neiman Institute studies the role and value of radiology and radiologists in evolving health care delivery and payment systems and the impact of medical imaging on the cost, quality, safety and efficiency of health care. Visit us at www.neimanhpi.org and follow us on Twitter, LinkedIn and Facebook.
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