Out-of-network hospital payment caps could save $124B a year, RAND finds

If out-of-network hospital payments were capped, up to $124 billion could be saved annually, according to new findings published by RAND Corp.

To come to this conclusion, RAND researchers studied four proposals that cap out-of-network hospital billing to:

  • 125 percent of Medicare payment rates 
  • 200 percent of Medicare payment rates
  • the average of payments made by private health plans in a state, and 
  • 80 percent of average billed charges in a state 

Under a strict proposal like limiting out-of-network payments to 125 percent of Medicare rates, the researchers found in-network negotiated hospital prices could be cut by 31-40 percent. This would save an estimated $108 billion to $124 billion each year, according to the study.

Erin Duffy, PhD, the study's lead author and an adjunct researcher at RAND, warned against cutting hospitals' revenue too much: "While cost containment can benefit patients who face rising health costs, such changes also would disrupt hospital revenues. A policy that reduces revenue so much that hospitals close or the quality of care is disrupted would not be in the best interests of patients."

More articles on healthcare finance:
North Carolina health system files for bankruptcy
Physician-owned hospital in Ohio closes
8 hospitals have closed so far this year — here's why

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