The Leapfrog Group’s 2022 survey reveals a widespread deficiency in medical billing quality across over 2,200 US hospitals. Analyzing legal actions, timeliness of billing statements, and patient access to billing representatives, the study unveils alarming gaps in standards. Only 38% of hospitals meet all three billing quality measures, indicating a significant industry-wide shortfall. While recent regulations aim to address these issues, the study emphasizes the need for further investigation into fair billing practices. Standardized measurement could enhance accountability and reduce barriers to care, highlighting the imperative for improved medical billing practices for the benefit of patients and the healthcare system.
The landscape of medical billing quality in US hospitals comes under scrutiny in a recent JAMA-published study analyzing the Leapfrog Group’s 2022 survey. With a focus on legal actions, timeliness, and patient access, the study assesses over 2,200 hospitals, revealing substantial shortcomings. The Leapfrog Group’s effort to introduce billing quality measures aims to benchmark and ensure accountability. However, findings indicate a concerning lack of adherence to these standards, emphasizing a pervasive underperformance. Amid calls for standardized measurement, the study questions whether proposed measures truly reflect reasonable and fair billing practices, urging further investigation into improving medical billing standards and practices.
Leapfrog Group’s New Billing Quality Measures:
The 2022 Leapfrog Group survey incorporated billing quality measures, encompassing legal actions taken by hospitals to collect medical debt, the timeliness of sending patients itemized billing statements, and patient access to qualified billing representatives. The study, analyzing over 2,200 hospitals, focused on hospital performance in these three key areas. Notably, the study excluded two measures intended for use by the Leapfrog Group but partially addressed in recent regulations.
Widespread Lack of Medical Billing Quality:
The study’s findings paint a concerning picture, with only 38 percent of hospitals meeting all three billing quality standards. Legal actions against patients for late or insufficient payments were reported by a third of hospitals (754), while nearly 45 percent (1,020 hospitals) did not routinely send itemized bills to patients within 30 days. Furthermore, 5.5 percent (125 hospitals) did not provide patients with access to billing representatives capable of investigating errors, offering price adjustments, and establishing payment plans.
Call for Further Investigation:
Authors of the study, hailing from the Leapfrog Group, Northwestern University, and Johns Hopkins, stress the need for further investigation into whether the proposed billing quality measures indicate “reasonable and fair billing practices.” Despite this call for additional scrutiny, the study unequivocally highlights a pervasive underperformance in medical billing quality across US hospitals.
Potential Impact of Standardized Measurement:
The authors suggest that standardized measurement and reporting of hospital billing practices could enhance accountability, reduce variation in billing practices, and alleviate barriers to accessing care in the US. This echoes the ongoing industry-wide plea for improved medical billing standards to address substantial gaps in quality and patient understanding.
Recent Regulatory Efforts:
Recent regulatory initiatives, such as the No Surprises Act, have aimed to bridge certain gaps in quality and medical billing. However, the study suggests that there is still room for improvement and that hospitals can play a more active role in enhancing their billing processes for the benefit of patients.
Proposed Medical Billing Quality Measures:
Dr. Martin A. Makary and Dr. Simon C. Mathews, authors of the study, proposed five medical billing quality measures in 2020. These measures include access to clear cost estimates, price transparency, and access to staff knowledgeable about billing. The authors argue that aggressive actions like suing patients over unpaid bills are contrary to a hospital’s core mission and should be considered a “never event.”
Addressing Healthcare Affordability:
The study underscores the broader issue of healthcare affordability for many US adults, prompting both government and industry leaders to address the challenges faced by patients and hospitals concerning patient financial responsibility. While recent regulations have made strides in this direction, the study suggests that there is still much work to be done to achieve comprehensive and equitable medical billing practices across the healthcare landscape.
Overall, the Leapfrog Group’s 2022 survey underscores a critical need for enhanced medical billing quality across US hospitals. With alarming gaps in legal actions, timeliness, and patient access, the study illuminates a systemic issue demanding urgent attention. While recent regulatory efforts, including the No Surprises Act, represent steps in the right direction, the study suggests that hospitals must play a more active role in improving billing processes for the benefit of patients. As the healthcare industry grapples with issues of affordability and access, collaborative efforts are crucial to establishing fair and transparent medical billing practices, ensuring equitable healthcare for all.
