Measurement of QPA vs Mean Allowed Amounts

Within each CPT code, geographic region, and funding type stratum, we calculated the ratios of the mean in-network and mean out-of-network allowed amounts to the stratum’s QPA. To produce summary results, we computed volume-weighted means of these ratios across all emergency CPT codes within each geographic and funding market stratum. We weighted by the total volume (claim count) of each CPT code in the analytic sample. This sample yielded measures comparing mean in-network and out-of-network payments to the QPA for self-funded and fully insured plans in each geographic market. We presented ratios as percentages in the text to enhance interpretation of findings.

Aggregating across CPT codes increased the number of claims underlying the descriptive statistic for each geographic and funding market stratum, thus increasing the number of strata meeting the threshold of at least 500 claims to be included in the primary analyses (the threshold was set by the data provider under the data use agreement). As a sensitivity analysis, we replicated descriptive statistics disaggregating by CPT code.