HCCI: Spending on emergency care continues to grow even as use remains flat

Patients in a hospital waiting room
Spending on emergency care is on the rise, even though use isn't growing, according to a new report. (Getty/SuwanPhoto)

Spending on emergency care has nearly doubled even as utilization remained flat over the past several years, according to a new report. 

The Health Care Cost Institute analyzed claims data from commercially insured patients between 2009 and 2016 and found overall spending per visit increased by 98% in that time. The average ER spending per person in 2016 was $247, compared with $125 in 2009. 

But it wasn't ER use that was going up. The spending growth was instead driven by an increase in the severity of the visits—spending increased by 145% while use for the high-severity cases increased by 38%. Prices for those visits also increased by 77% between 2009 and 2016. 

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Spending per person on the high-severity ER visits grew from $31 to $77 between 2009 and 2016, according to HCCI, as the price for such visits increased from $627 to $1,108. In that same window, the number of visits coded at the highest severity increased from 50 claims per 1,000 members to 69 claims per 1,000 members.

"The population we're looking at is not getting sicker; there isn't an epidemic or a bunch of catastrophies," said John Hargraves, a senior researcher at HCCI and one of the blog's authors, in an interview with FierceHealthcare. "But the trend has been pretty stable."

Conversely, the number of visits coded at the lowest acuity decreased by 41% in the same window. Overall spending on low-acuity ER visits decreased by 5% between 2009 and 2016, even though the price for that level did increase by 47%. 

The HCCI teamed up with Vox last year for a report that suggested hospitals are more likely to code emergency department visits as severe. Spending on ER visits increased by $3 billion between 2009 and 2015, the institute found. 

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"It is having a dramatic effect on what people spend in a hospital setting," said Niall Brennan, HCCI's executive director. "And as we know, that has a trickle-down effect on premiums and benefits." 

The American College of Emergency Physicians pushed back on the findings. Its president, Paul Kivela, said HCCI's data are skewed because they are based on information from four major commercial payers, providing an incomplete picture. 

HCCI also analyzed the ER data on a state-by-state basis. Spending on emergency care increased in each state, according to the report, again driven by an increase in higher-coded visits. 

Spending grew the most in Mississippi, jumping 153% between 2009 and 2016. Overall, ER spending increased by more than 100% in 21 states. Price increases were also common, and highest in Nevada, which saw prices jump by 147%. Prices increased by more than 100% in 25 states.

Hargraves said it's crucial to study ER cost and spending data, as it's one of the areas of healthcare consumers can't really shop for, and it can be hard to anticipate what the ultimate cost of a visit will be when you arrive.

"The price and the charge you're going to experience isn't going to be known to you until well after you set foot in the ER," he said.