Researchers led by Sean Doyle, PhD, from the Emory University School of Medicine in Atlanta found that in dollars, the 12% of overall costs borne by patients for secondary interpretations averaged $15.

Secondary interpretations are increasingly performed for patients with complex conditions, but liabilities for patients and paid out-of-pocket costs were not previously known. The team based their study on 7,740 secondary interpretations for adult patients performed over a two-year period in a health system that has 600,000 patient encounters annually across over 400 facilities.

Out-of-pocket costs are generally higher in the first quarter of the year (17%) when patient deductibles and out-of-pocket maximums are less likely to be reached compared to the fourth quarter of the year (9%), researchers found.

They also found that out-of-pocket costs borne by patients are higher in the outpatient setting (13%) compared to the emergency department or inpatient settings (1%-4%). Researchers said this is consistent with the greater likelihood of patients reaching deductible and out-of-pocket limits when hospitalized or in the emergency department compared to when they receive outpatient care.

Study authors said the unexpected bills highlight a need for enhanced physician-patient communication and shared decision-making regarding both the costs and benefits of secondary interpretations.