ER spending among the commercially insured continued to rise in 2016, driven by the price and use of high severity cases (2009-2016)
Health Care Cost Institute
HCCI recently expanded its reporting on emergency room (ER) spending trends to include the most recent data available (2016). We characterize trends in spending, price, and utilization for the five Current Procedural Terminology (CPT) codes designed to capture the level of severity and complexity of every ER visit. While average prices for all five ER CPT codes were higher in 2016 than in 2009, the average prices for higher severity codes rose at a faster rate than low severity codes. Combined with more use of the high severity codes (despite decreases in overall ER use), these price increases contributed to large spending hikes – per person spending for the two most severe codes grew by more than 100% over the seven years we studied. We also observed that, from 2009 to 2016:
- ER visit spending per person increased 98% while overall ER use remained the same.
- Overall ER spending growth was largely driven by higher severity visits, on which spending more than doubled.
- Per person spending on the highest severity ER visit rose 145%, with price increasing 77% and use increasing 38%.