ER Spending Spikes, Along with Prices and High Severity Visits

30 Jul ER Spending Spikes, Along with Prices and High Severity Visits

The emergency department is experiencing the same use but at a much higher cost these days. ER spending has nearly doubled between 2009 and 2016 as a result of more complicated and severe health issues being presented to the emergency department, according to a new data from the Health Care Cost Institute (https://www.healthcostinstitute.org) . Price increases for these services is the primary driver according to the HCCI report.

HCCI analyzed employer-sponsored insurance claims for five procedure codes used to bill for emergency department visits.  The procedure codes reflect five different levels of care with Level 1 codes indicating less severe health issues compared to Level 4 and 5 codes that represent more serious and complicated conditions, such as blunt trauma or severe infections.

Over the study period (2009 to 2016) the prices for these five codes increased, especially for the more serious health conditions at a faster rate. In addition, the use of the Level 4 and 5 codes increased in frequency. The emergency room spending per person consequently increased to an average of $247 in 2016, from $125 in 2009, for an overall 98 percent increase in spending.

The study showed that spending per person for the highest severity emergency department code more than doubled to $77 from $31 in 2009 due to price increases and frequency of use.  The price for the code spiked by 77 percent to $1,108 from $627 in 2009.

Conversely, price and uses of the lower severity emergency department codes plummeted. The use of the Level 1 lower-acuity procedure code fell by 41 percent between 2009 and 2016. The price for this code increased by 47 percent to $215 per claim. The overall spending for the lower severity health visits to the emergency room dropped by 5 percent during the seven-year period.

The HCCI reported that overall spending for emergency department visits increased in all states, even though emergency department use increased in only 11 states. Mississippi ranked the highest for increased spending on emergency department visits rising 153 percent to $300 per claim in 2016. Some health insurers are cracking down on the rising cost for emergency department visits and are examining the frequency of use of the highest-severity procedure codes.

SOURCE: https://www/modernhealthcare.com, “ER spending rises with increasing prices, severity of visits, by Shelby Livingston, May 30, 2018

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