No Surprises Act Could Lead to Uptick in Emergency Department Visits

Research shows patients are more willing to utilize emergency services when unexpected bills are not a concern.

The No Surprises Act may have the unintended effect of causing millions more emergency department (ED) visits, according to a study from the Agency for Healthcare Research and Quality.

Since going into effect on January 1, 2022, the federal ban protects patients from surprise bills for emergency services at out-of-network facilities or for out-of-network providers at in-network facilities.

The study, published in The American Journal of Medical Care, compares ED visits in 15 states with balance billing bans between 2007 and 2018 to ED visits in 16 states without bans to examine the ripple effects of a significant reduction in out-of-pocket payments under the No Surprises Act.

Researchers found that the bans in the 15 states reduced spending per visit by 14%, but also resulted in an increase of 3% in ED visits, which offset the cost savings. The extra visits, however, were considered 9% less urgent than prior to the bans, based on the emergency service index.

From the findings, the authors calculate that the No Surprises Act will lead to 3.5 million more ED visits per year, with the $4.2 billion in extra spending largely wiping away $5.1 billion in savings.

"With such a large reduction in expected out-of-pocket cost of an ED visit, one would expect a possible increase in ED visits after a surprise bill ban, especially with all the media coverage that often surrounds the passage of the ban," the authors state. "Because individuals will no longer have the fear of a possible catastrophic surprise ED bill not covered by their insurer, they may be more inclined to go to the ED in marginal, less severe cases."

The study notes that many of the extra ED visits observed were for the diagnosis categories of "sprains and strains" and "superficial injuries; contusions," showing that the increase in quantity of visits is for less urgent cases.

While the protections afforded by the No Surprises Act is certainly beneficial for patients, it may put pressure on hospitals and health insurers to deal with the increased ED visits and the costs that come from that.

"Because this may also occur more broadly for the 2022 NSA, insurers and primary care physicians may want to renew efforts to prevent costly, avoidable ED visits," the authors conclude.