LAUSR

In reply: June 2, 2017 We are responding to the May 23, 2017, letter from Dr. Ho et al related to the concerns expressed about the data used in the Annals article titled “Comparing Utilization and Costs of Care in Freestanding Emergency Departments, Hospital Emergency Departments, and Urgent Care Centers,” which was recently published in the online edition of Annals. We have reviewed Dr. Ho’s response to the objections we raised in the first letter and would like to respond to some of her points. In accordance with the main arguments in Dr. Ho’s response, we have broken down each with an appropriate response. 1. Assertion: The explanations of benefits (EOBs) used in the first response are from 2017 and are not relevant to the 2012 to 2015 data presented in the study, in addition to the fact that they come from only one provider in Texas. Response: The data concerns expressed are based on a comprehensive review of charge data from FAIR Health, which are submitted by participating payers according to actual claims. The EOBs provided were used only as examples of how far off the corrected data in Table E1 of the study were in both original and corrected form. As previously noted, the EOBs are an example of data we have from a Dallas, TX, suburb and were consistent with EOBs other providers have submitted to Blue Cross Blue Shield of Texas (BCBSTX) during the past few years. 2. Assertion: Dr. Kivela submitted misleading dollar amounts in Table 3 of his letter, claiming the amount covered by BCBSTX was in fact the allowed amount that Dr. Ho used to calculate the mean and median prices in the study. Common knowledge is that insurers pay a substantial discount off the charge submitted by any health care providers. Response: For the EOBs provided, BCBSTX paid the providers for the full charge they submitted as the “covered amount”; thus, the covered amount in this particular case supports the argument that BCBSTX is paying at a rate much higher than what the study’s data suggest. Furthermore, other Texas providers attested that $102 and $242 could not have been the allowed amounts providers were receiving because they could not have maintained a financially sustainable practice with payment rates so low. 3. Assertion: Comparing FAIR Health charges to the allowed amounts in the study is misleading because BCBSTX discounts their claims before sending actual