A Policy Analysis of Balance Billing Legislation in Washington State

Abstract

Purpose: To understanding the attitudes and perceptions of Washington state hospital stakeholders toward government policy strategies intended to minimize surprise medical bills. Setting: Washington state. Approach: Qualitative methods were utilized in order to generate a detailed and nuanced understanding of attitudes and perceptions. Methods: Hospitals in Washington State were contacted via cold calling with a request for a telephone interview with an individual working in leadership or administration with experience in hospital billing, finance, or contracting. Data Collection: Semi-structured telephone interviews were conducted that explored issues relevant to hospitals with regards to implementing policies designed to limit surprise medical bills. Interviews were audio-recorded and transcribed for analysis. Analysis: Data analysis was conducted on a continuous basis. An inductive approach was used to generate codes that represent recurring themes and concepts across participant responses. Results: three broad themes were identified that illustrate attitudes toward policy strategies intended to minimize balance bills: 1) a concern for the unintended consequences that may arise after implementation, 2) identification of significant barriers to successful implementation, and 3) identification of the negative impact of balance billing on consumers and hospital reputation as a motivating factor in exploring implementation. Discussion: This data suggests that there is firm support for comprehensive legislation protecting consumers from surprise medical bills. It will be important to evaluate whether new regulations may lead to additional administrative burden for hospitals or create financial uncertainty that may have an adverse impact on future organizational decisions in the public interest. Future qualitative research to elicit the perceptions of provider and health insurance stakeholders who may be affected by balance billing legislation will further contribute understanding the effects of billing policy changes.