ER spending increased 85% from 2009-2015, driven by price increases for the most severe cases

Dec. 7, 2017

Medical bills from the Emergency Room (ER) are a mystery to many patients in the U.S. health system. From incredibly high, varying charges to surprise bills resulting from in/out of network confusion, many Americans have no idea what to expect when it comes to the cost of this necessary service.

Using The Health Cost Data Institute (HCCI’s) commercial claims dataset, five successive were examined.

Current Procedural Terminology (CPT) codes for an ER visit which are designed to capture the level of severity and complexity of the ER visit. Analyzed collectively, these codes were used to explore how spending, utilization, and prices for ER visits have changed from 2009 through 2015.

Spending per member on all ER visits increased 85% between 2009 and 2015, largely due to the more than 100% growth in spending on high severity cases.

ER spending growth was driven by price increases. High severity visits had the highest prices and the greatest price growth; the price for the most severe ER visit rose over $400, from $498 in 2009 to $900 in 2015.

While overall use of the ER remained constant, there was a significant shift in case mix from low to high severity visits—further magnifying the effects of high severity price increases on spending.

The average price of an ER visit increased in every state. Some states saw price increases well over 100%, while price growth was half the national rate in others.

HCCI has the study

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