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.
Hospital industry officials point to their own studies to explain the increased use of more expensive codes at emergency rooms.
An American Hospital Association report found the average number of emergency room visits per 1,000 patients increased nearly 12% between 2006 and 2010. The report also found those adults had a rising level of illness. The report examined hospital use by older adults eligible for Medicare; HCCI reported on hospital claims of people under the age of 65.
“Hospital emergency departments treat many of our nation’s sickest and most complex patients,” says Ashley Thompson, senior vice president of policy at the American Hospital Association. “As hospitals serve as the front-door for dealing with issues ranging from violence, mental health conditions and the opioid epidemic, the number and complexity of ED visits overall continues to increase.”
The decade-long change in billing practices comes as hospitals have shifted to electronic health records systems. These computerized systems might prompt hospital staff to better document care, which might support the use of more expensive codes, Hargraves said.
Others aren't so sure.
Jeffrey Newman is a Boston attorney who has represented whistleblowers under the federal False Claims Act. The federal law allows individuals to bring lawsuits on behalf of the government and collect a portion of any settlement. The law is often used by ex-employees of hospitals, medical practices, drug companies or medical-device makers when they suspect a former employer is improperly billing federal health programs such as Medicare or Medicaid.
In March, a nurse practitioner represented by Newman settled a False Claims Act case for $2.1 million against CareWell Urgent Care Centers.
The settlement said that CareWell managers directed doctors and other medical providers ask patients about 13 body parts or systems and examine at least 9 areas, even if the patient's symptoms that did not require such extra attention.
If the doctors did not ask the questions, the urgent care center's medical records system registered a "no" answer. The robust queries were meant to ensure the urgent care center could bill at a higher level reimbursement code, the settlement said.
Newman said he believes there are not enough checks and balances to guarantee medical services are properly coded.
"They can find reasons to say they were doing more complex things," Newman says. "They often see this as an easy mark to pump the services and say, 'We're being better doctors,' when it contravenes the rules."
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This article originally appeared on USA TODAY: 'Really astonishing': Average cost of hospital ER visit surges 176% in a decade, report says