By Ken Alltucker
June 4, 2019
Hospital emergency rooms are more likely to charge pricier levels of care than a decade ago, generating bigger bills that consumers increasingly must pay with their own money, according to a new report.
The nonprofit Health Care Cost Institute (HCCI) examined insurance claims for a decade’s worth of hospital emergency room bills, analyzing millions of insurance claims for people under the age of 65 who get health insurance through an employer.
HCCI found that hospital emergency rooms not only substantially increased prices for care from 2008 through 2017. The hospitals and doctors also billed for more complex care, which allows them to collect more lucrative fees from consumers, employers and private insurers.
The average emergency room visit cost $1,389 in 2017, up 176% over the decade. That is the cost of entry for emergency care; it does not include extra charges such as blood tests, IVs, drugs or other treatments.
“When you look at the last 10 years, it’s really astonishing how this average cost of admission to the ER has gone up,” says HCCI senior researcher John Hargraves, who presented his report this week at the AcademyHealth meeting in Washington, D.C.
Last month, President Trump called on Congress to curb surprise medical billing, which describes when a consumer gets an often-expensive bill from a hospital or doctor that is not part of their insurance network. Many states already have passed legislation to address these unexpected bills.
It comes down to the codes
But less attention has been paid on how ERs bill patients.
Every hospital emergency room visit is assessed on a scale of 1 to 5 – a figure intended to gauge medical complexity and the amount a consumer will be billed.
An insect bite might be assigned the lowest billing code, 99281. A heart attack, the highest code, 99285.
The difference in how an emergency room visit is coded might cost a consumer hundreds more for simply stepping in the building.
In 2008, 17% of hospital visits were charged the most expensive code. That surged to 27% of visits in 2017, the report said. The average price for the most expensive code more than doubled from $754 in 2008 to $1,895 in 2017.
Hospitals also increased billings for the second most expensive code, but they billed the three least expensive codes less often compared to a decade ago.
Are we sicker? Or just being billed like it?
Does that mean Americans became sicker over the past decade, requiring more intense and complex care at hospital emergency rooms? The report does not address that question.
Americans don’t go to the hospital ER more often than they did a decade ago, the report said. However, those visits cost more and are more likely billed with more expensive codes.
“We don’t see a big rise in overall ER rates,” Hargraves says. “Which is what you’d expect if there’s a large increase of people having heart attacks or other (more severe) things. I think that’s telling.”
The report combines the amount charged by hospitals and doctors, who often bill patients separately….