ACEP challenges report on ER billing fees

ACEP says that an analysis of ER fees uses incomplete data from private payers.

The American College of Emergency Physicians (ACEP) is challenging a recent report that says spending on hospital emergency room fees is on the rise. 

Vox and the Health Care Cost Institute analyzed more than 70 million bills for ER visits that were recorded between 2009 and 2015 and found that spending on the fees increased by $3 billion in that span. 

However, ACEP President Paul Kivela, M.D., said in a statement that the institute's data is limited, as it receives millions in funding from four major commercial payers, and bases its data on those sources.

Kivela said that as just 34% of ER visits are paid by commercial payers, that data set paints an incomplete picture of emergency care.  

"Basing an analysis such as Vox’s on data only from employer-sponsored health plans leaves out a major portion of the picture and skews the article’s findings," Kivela said. 

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Kivela noted that the HCCI indicated that ER visits dropped by 2% between 2009 and 2015, while CDC data suggested that the number of visits instead increased by nearly 4% between 2009 and 2014.  

He did say, however, that the article was correct in its assertion that hospital facility fees are often the highest part of a patient's ER bill. Emergency physicians bill separately, Kivela said, and generally account for a quarter or less of a patient's bill. 

Price-gouging in the ER is a problem across the country, particularly for minorities and the uninsured. A recent study, which was based on 2013 data, found that ERs charge on average between 1 and 12.6 times what Medicare pays for emergency care. The markups create total bills that were 340% more than what Medicare would cover; ERs were charging $4 billion versus $898 million in Medicare allowable amounts.  

In the Vox piece, an emergency care researcher called emergency rooms monopolies, which gives them free rein to set their own prices. Kivela disputed that assertion as well. 

“Hospital emergency departments are legally required to be open 24 hours a day, seven days a week, which is not one of the characteristics of a ‘monopoly,'" as the article claimed them to be," he said. "Unlike urgent care centers and physician offices, they never turn anyone away. This has resulted in significant amount of uncompensated care over the years."