Study: No Surprises Act could lead to increase in emergency department visits

Editor's note: The following is an edited excerpt from our sister publication, HealthLeaders.

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