Surprise billing after TJA may negatively impact patient satisfaction
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Key takeaways:
- Among patients who underwent total joint arthroplasty, 12% received at least one surprise bill after surgery.
- Overall, 49% of patients reported that surprise billing negatively affected their satisfaction.
Published results showed 12% of patients who underwent total joint arthroplasty received at least one surprise bill after surgery, which may negatively affect patient satisfaction.
Joseph A. S. McCahon, DO, an orthopedic surgery resident at Jefferson Health in New Jersey, and colleagues performed a retrospective study of data from 918 patients (mean age, 67 years) who underwent primary TJA between May 2020 and March 2022 and completed a questionnaire regarding surprise billing and patient satisfaction after surgery.
McCahon and colleagues found 12% of patients received at least one surprise bill after surgery, with 53% of these patients receiving more than one surprise bill. They found 45% of patients received a surprise bill of greater than $1,000. They noted 42% of patients did not pay their bill, which resulted in 30% of patients being sent to collections.
According to the study, the most common source of the bills was from the surgical facility (48%), anesthesia (36%), surgeon (23%) or insurance (10%). McCahon and colleagues noted 20% of patients could not identify from where the bill originated. Overall, 49% of patients reported that surprise billing negatively affected their satisfaction with surgery.
After multivariate logistic regression analysis, McCahon and colleagues found older patients and Black patients had the highest likelihood of receiving surprise bills. They also found surgeries that occurred after the No Surprises Act enforcement on Jan. 1, 2022, were associated with an increased likelihood of surprise bills.
“Although surgeons may be unable to limit the amount of bills patients receive postoperatively, increased communication and education regarding the perioperative billing process may prove to be beneficial for both patient satisfaction and the physician-patient relationship,” McCahon and colleagues wrote in the study.
Perspective
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Adam J. Bruggeman, MD, MHA, FAAOS, FAOA
A surgical team involves many professionals beyond the surgeon, and their network status can vary. As surgeons, we cannot control whether anesthesiologists or other parts of the care team are in-network, and the reasons for out-of-network status are complex.
What is crucial is that this legislation achieves its primary goal: protecting patients from being caught in the middle of billing disputes between health care providers and insurance companies. The data clearly show a decrease in surprise bills that patients are responsible for, which is precisely what Congress intended.
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