Freestanding Emergency Rooms: Exorbitant Prices Surprise Billing Misleading Patients P R E S S K I T

Transcription

1 Freestanding mergency Rooms: xorbitant Prices Surprise Billing Misleading Patients P R S S K I T

2 O U R M I S S I O N Texans for Affordable Healthcare (TAHC) is a healthcare advocacy coalition representing Texas employers, patients, consumer advocates, health plans, providers and others, set to expose the non-transparent, anti-consumer tactics frequently used by freestanding emergency rooms to mislead patients and charge them exorbitant prices for medical care.

3 FOR IMMDIAT RLAS February 14, 2017 Contact: Jessica Sandlin PRSS RLAS: New Group Launches ffort to Tell the Truth About Freestanding Rs AUSTIN Texans for Affordable Healthcare (TAHC), a new statewide healthcare advocacy coalition, was formally launched today to expose the non-transparent, anti-consumer tactics frequently used by freestanding emergency rooms (FSRs) to mislead patients and charge them exorbitant prices for medical care. The group intends to advocate for legislative solutions to protect patients, as well as educate healthcare consumers, elected leaders and the media about the Texas-sized problems freestanding Rs have created for thousands of people across the state. FSRs are stand-alone, largely out-of-network facilities that typically operate independently from hospital systems and can charge patients up to ten times more than what an urgent care center would charge for the same services. FSRs largely choose to remain out-of-network for most health insurance plans, utilize confusing advertising to intentionally mislead patients into believing they accept those plans, and charge like a traditional hospital R, even though they mostly provide routine medical care. More than 200 of the nation s freestanding emergency rooms are located in Texas, making our state ground zero in the battle against surprise medical billing and skyrocketing emergency care costs, said Amanda Martin, governmental affairs manager of the Texas Association of Business. TAHC was formed to tell the truth about freestanding Rs, and we will be a voice for those who have fallen prey to their misleading, billing practices. Following routine medical visits, FSRs often leave consumers reeling from exorbitant, surprise medical bills. The top three reasons people visited freestanding Rs in Texas are fever, bronchitis and sore throat conditions that could be treated for substantially lower prices at an urgent care or traditional doctor s office. To protect Texans from the unexpected and exorbitant billing associated with freestanding emergency room visits, TAHC will work with lawmakers this session to: ducate Texans with accurate information and increase cost transparency and network status at freestanding Rs; xpand surprise billing protections for consumers to all freestanding Rs; and Hold bad actors accountable for exploiting patients through misleading advertising and exorbitant pricing. To learn more about Texans for Affordable Healthcare, visit This legislative advertising was paid for by the Texas Association of Health Plans, Jamie Dudensing, CO, and authorized by Texans for Affordable Healthcare, a coalition of businesses, patients, health plans, and Texas This legislative advertising was paid for by the Texas Association of Health Plans, Jamie Dudensing, CO, and authorized by Texans for Affordable leaders who want to share the truth about freestanding emergency rooms. Texas Association of Health Plans, 1001 Congress Ave. Suite 300, Austin, TX Healthcare, a coalition of businesses, patients, health plans, and Texas leaders who want to share the truth about freestanding emergency rooms. Texas Association of Health Plans, 1001 Congress Ave. Suite 300, Austin, TX w w w. T X A N S F O R A F F O R D A B L H A L T H C A R. c o m

4 Telling the Truth about Freestanding Rs Independent Freestanding Rs: A Texas-Sized Problem Surprise Billing. xorbitant Prices. Misleading Patients. Buyer beware: Learn the truth about independent freestanding emergency rooms in Texas. There is nothing free about your neighborhood freestanding R. They look like urgent care centers and often set up shop in commercial shopping areas, but an independent freestanding R is neither an urgent care center nor a traditional hospital R. They re expensive. They mislead patients. They are likely not in your health plan network by choice. Independent freestanding Rs are a relatively new, lucrative business model that may only need to see 12 patients a day to turn a profit, and Texas is ground zero. More than 200 freestanding Rs call Texas home - that's more than half of the nation s total population of freestanding Rs. FICTION: Freestanding Rs accept your insurance. FACT: Accepting all insurance does not mean the freestanding R is in your health plan s network. NTS I T A AD P L S I M THY Freestanding Rs (FSRs) largely choose to remain out-of-network for most health insurance plans in Texas. FSRs use confusing advertising to intentionally mislead patients into believing they accept their insurance plans for full payment, but in reality, they choose not to be in network with most insurance plans in order to charge higher prices. This means insured patients will often get slapped with a bill that can be 10x what an urgent care center would charge for the same services - and it's not covered by your insurance. FICTION: Independent freestanding Rs are cheaper than urgent care centers or traditional hospital Rs. FACT: Freestanding Rs charge up to 10X more than urgent care centers and are often more expensive than Texas hospital-based Rs. R ' Y H T V I S N XP Charge like a traditional hospital R but provide mostly routine clinic care: The top three reasons people visited freestanding Rs in Texas are fever, bronchitis and sore throat conditions that could be treated for substantially lower prices at an urgent care or traditional doctor s office. The average cost to treat bronchitis at a Texas freestanding R is $2,944, compared to $136 at a traditional doctor s office or $167 at an urgent care center. Freestanding Rs bill you for more extras: Freestanding Rs in Texas have nearly 3x more costs associated with extras such as lab tests, x-rays and MRIs than traditional Rs, and 40x more than urgent care centers or physician office settings.

5 Telling the Truth about Freestanding Rs FICTION: Insured consumers are protected from surprise medical bills at freestanding Rs. FACT: Surprise billing protections for patients do not apply to FSRs in Texas. OUR Y N I NOT ORK R ' W Y T H N T LAN P H T HAL Texas has one of the highest rates of surprise medical billing in the nation. A surprise bill happens when a consumer receives out-of-network care unknowingly often in an emergency situation. The risk of surprise billing is even greater at FSRs nearly 70 percent of out-ofnetwork emergency claims for Texas R facilities occur at freestanding Rs. SOLUTIONS TO PROTCT TXANS Hold bad actors accountable for exploiting patients through misleading advertising and exorbitant pricing. ducate Texans with accurate information: Increase cost transparency and network status at freestanding Rs. SB 2240, HB 3099, HB 3276 & HB 3122 xpand surprise billing protections for consumers to all freestanding Rs. SB 507 & HB 1566 SB 2064, HB 3867 SB 1592

6 Telling the Truth about Freestanding Rs Independent Freestanding Rs: What the Media is xposing Austin American-Statesman: Commentary: Freestanding emergency rooms, medical costs threaten Texas San Antonio xpress-news: Freestanding Rs driving up medical costs Victoria Advocate: Freestanding emergency rooms threaten health of Texas business l Paso Times: Martin: Health costs threaten Texas Dallas Morning-News: Lawsuit claims freestanding emergency room operator scams patients Journal of Urgent Care Medicine: Dissecting the Cost of a Freestanding mergency Department Visit NBC DFW: Freestanding mergency Rooms Can Be Confusing, Costly Texas Tribune: Freestanding Rs Find A Home in Wealthy Areas Dallas Morning-News: How the spread of freestanding emergency rooms hurts patients D Healthcare Daily: Are Freestanding mergency Rooms Driving Up Costs? USA Today: Stand-alone emergency rooms popping up Ark-La-Tex.com: Freestanding mergency Rooms Bring Competition, Confusion to ast Texas Healthcare Cosmopolitan Magazine: Why Did It Take 9 Hours and 3 mergency Rooms For This Woman to Get a Rape Kit? Dallas Morning-News: Medical billing is a national problem that's even a bigger headache in Texas Dallas Morning-News: Dallas man stuck in battle over a $128,000 hospital bill

7 Telling the Truth about Freestanding Rs The Real Pain of Visiting an Independent Freestanding R: There is nothing "free" about your neighborhood freestanding R. Freestanding Rs charge up to 10x more than urgent care centers for the same services. Freestanding R Urgent Care VS. $2,994 Bronchitis $167 $3,340 Fever $180 $2,562 Sore Throat $154 Upper $156 Respiratory $2,331 Infection $3,044 Cough (SOURC: Texas Association of Health Plans, $180

8 Legislative solutions to PROTCT TXANS from Freestanding Rs SB 2064 & HB 3867 Protecting Texans Against Price-Gouging in mergency Medical Situations Texas Senator Kelly Hancock and House Rep. John Smithee have introduced SB 2064 and HB 3867 to protect Texans from price-gouging for emergency care provided by freestanding emergency rooms and hospitalbased emergency rooms. Similar to current protections available in declared emergencies, Sen. Hancock and Rep. Smithee s bills grant the Texas Attorney General Consumer Protection Division discretion to act to protect Texans from financially devastating emergency care prices when they seek help in a personal medical emergency. SB 507 & HB 1566 xpanding Mediation Protection for Consumers to Freestanding Rs & all mergency Care Situations Sen. Hancock s SB 507 and Rep. Frullo s HB 1566 would expand mediation protections, already being successfully used on a limited basis by consumers in Texas, for insured consumers with PPO plans to all emergency providers, including all freestanding emergency rooms, and to all of out-of-network providers working at a network facility. Mediation is a process by which consumers can challenge surprise medical bills and leave the dispute to the insurer and provider. SB 1592 Holding Bad Actors Accountable Sen. Charles Schwertner s SB 1592 increases the maximum total penalty from $5K to $25K on freestanding Rs that violate their regulatory requirements. SB 2240, HB 3099, HB 3276 & HB 3122 Requiring Greater Transparency at Freestanding Rs SB 2240 by Sen. Larry Taylor; HB 3099 by Rep. Dennis Paul; HB 3276 by Rep. Tom Oliverson; and HB 3122 by Rep. Jessica Farrar, would require freestanding Rs and physicians to provide clear, upfront information to consumers about their network status; provide in advance the minimum and maximum charges they could be charged for their visit; specify whether or not Medicare/Medicaid/Tricare are in-network for their facilities; and provide consumers with the name of the nearest urgent care center along with its address, hours and phone number, among other requirements. This legislative advertising was paid for by the Texas Association of Health Plans, Jamie Dudensing, CO, and authorized by Texans for Affordable Healthcare, a coalition of businesses, patients, health plans, and Texas This legislative advertising was paid for by the Texas Association of Health Plans, Jamie Dudensing, CO, and authorized by Texans for Affordable leaders who want to share the truth about freestanding emergency rooms. Texas Association of Health Plans, 1001 Congress Ave. Suite 300, Austin, TX Healthcare, a coalition of businesses, patients, health plans, and Texas leaders who want to share the truth about freestanding emergency rooms. Texas Association of Health Plans, 1001 Congress Ave. Suite 300, Austin, TX w w w. T X A N S F O R A F F O R D A B L H A L T H C A R. c o m

9 Frequently Asked Questions What are freestanding emergency rooms? Independent freestanding emergency rooms (FSRs) are walk-in medical facilities that are structurally separate and distinct from hospitals, but still receive patients for emergency care. There are two types of FSRs: 1) hospital-owned FSRs and 2) independent FSRs that are not affiliated with a hospital system. Independent FSRs are chronically out of network. They often set up in commercial shopping areas of suburban communities and look and feel much like a traditional urgent care facility, although they are much more expensive. What makes freestanding emergency rooms so expensive? Independent freestanding Rs charge consumers expensive "hospital-based" facility fees even though they are not a hospital. Consumers often seek care from freestanding Rs for common conditions like a cold or cough, believing that these facilities will charge the same as look-alike urgent care centers. However, freestanding Rs levy facility fees like traditional hospital-based Rs on top of charges for the physician s services, who are almost always out of network. As a result, consumers who visit freestanding Rs are often charged up to 10 times what they would have been charged at an urgent care facility. (1) Do freestanding Rs offer the same services as traditional hospital Rs? While freestanding Rs are equipped to handle emergency care, they are not always equipped to treat the full range of illnesses and emergencies that traditional hospital Rs treat, which can result in patients being transferred to hospital Rs and billed twice for an emergency. Independent FSRs also find more services to charge for than traditional hospital Rs. Independent Freestanding Rs in Texas have nearly 3x more ancillary costs (Lab & Path, Radiology) for the same diagnoses codes than hospital-based Rs and more than 40x more than urgent care centers. Independent FSRs, not affiliated with a hospital system, are also chronically out-of-network, which means patients will have to pay higher prices that can be 2x more than hospital emergency rooms.(2) (1) Utilization Spot Analysis: Free Standing mergency Departments, Center for Improving Value in Health Care, July 2017 (2) Major TX Insurer Health Claim Data.. (3) Where Do Freestanding mergency Departments Choose to Locate? A National Inventory and Geographic Analysis in Three States, Annals of mergency Medicine 2016 (4) Source: Freestanding Rs Find A Home In Wealthy Areas, Texas Tribune, August 2015 This legislative advertising was paid for by the Texas Association of Health Plans, Jamie Dudensing, CO, and authorized by Texans for Affordable Healthcare, a coalition of businesses, patients, health plans, and Texas leaders who want to share the truth about freestanding emergency rooms. Texas Association of Health Plans, 1001 Congress Ave. Suite 300, Austin, TX L A R N M O R W W W. T X A N S F O R A F F O R D A B L H A L T H C A R. C O M

10 Are freestanding Rs improving access to healthcare for Texans? (cont...) Frequently Asked Questions No, they're not. Freestanding Rs in Texas typically do not set up shop in areas where there is reduced access to care. Instead, they are highly concentrated in areas where there are already a greater number of hospital-based Rs and physician offices. (3) Additionally, they rarely serve uninsured and low-income populations that all traditional Rs are required to serve. A Texas Tribune study found that Texans in the neighborhoods where freestanding Rs have opened earn 49 percent more income than the state average. (4) Are freestanding Rs unique to Texas? FSRs are not unique to Texas, although we do have more than any other state. Texas is home to more than 200 FSRs - that's more than half of the nation's total population of these facilities. With more FSRs sprouting up across the state, now more than ever we must take action to rein in their unfair and misleading billing practices. What is Texans for Affordable Healthcare doing to rein in freestanding Rs? Texans for Affordable Healthcare is advocating for private-market legislative solutions to protect Texans, which include increasing cost transparency and network status at freestanding Rs, expanding surprise billing protections for consumers to all freestanding Rs, and holding bad actors accountable for exploiting patients through misleading advertising and exorbitant pricing. What can patients do to avoid falling prey to freestanding Rs deceptive advertising and billing practices? First and foremost, healthcare consumers must educate themselves to recognize the differences between an urgent care facility and a freestanding R and avoid visiting the latter whenever possible. Understanding the differences between the two could save a Texas consumer thousands of dollars. Second, Texans should save emergency room visits for when they truly need them up to 65 percent of R visits are treatable by an urgent care center. Finally, patients should specifically ask whether or not the R facility they are visiting is in-network for their health insurer. But be warned - FSRs will tell you they accept all insurance. This is not the same as being in your insurance network. Know the difference and don t be misled. Patients are not protected from high prices, over-billing, overcharging, and surprise billing at out-of-network freestanding Rs. L A R N M O R W W W. T X A N S F O R A F F O R D A B L H A L T H C A R. C O M

11 C O N T A C T U S Jessica Sandlin press@texansforaffordablehealthcare.com This legislative advertising was paid for by the Texas Association of Health Plans, Jamie Dudensing, CO, and authorized by Texans for Affordable Healthcare, a coalition of businesses, patients, health plans, and Texas leaders who want to share the truth about freestanding emergency rooms. Texas Association of Health Plans, 1001 Congress Ave. Suite 300, Austin, TX 78701