Missouri senator: EmCare is ‘gaming the system’ by inflating ER bills

Marriott plans to save Starwood owners real monety
U.S. Senator Claire McCaskill, D-Mo., wants answers from Envision Healthcare and its subsidiary EmCare Holdings, Inc. following reports of skyrocketing costs at emergency rooms run by EmCare. (Getty/Zzvet)

One lawmaker wants to put an end to surprise medical bills and has called out EmCare for allegedly pressuring ER doctors to order expensive, unnecessary tests for patients.

U.S. Senator Claire McCaskill, D-Mo., wants answers from Envision Healthcare and its subsidiary EmCare Holdings Inc. following reports of skyrocketing costs at emergency rooms run by EmCare. A recent study found patients' bills jumped from less than $500 for a hospital's doctors to more than $1,600 from EmCare, one of the nation’s largest physician-staffing companies. EmCare manages more than 10 hospitals in Missouri

RELATED: Newport Hospital and Health Services executive: Outsourcing ER turned out to be an insurance 'fiasco'

Conference

13th Partnering with ACOS & IDNS Summit

This two-day summit taking place on June 10–11, 2019, offers a unique opportunity to have invaluable face-to-face time with key executives from various ACOs and IDNs from the entire nation – totaling over 3.5 million patients served in 2018. Exclusively at this summit, attendees are provided with inside information and data from case studies on how to structure an ACO/IDN pitch, allowing them to gain the tools to position their organization as a “strategic partner” to ACOs and IDNs, rather than a merely a “vendor.”

 “Emergency room visits can be far too expensive already—and if EmCare is gaming the system just to up their profits, that needs to be thoroughly investigated,” McCaskill said in an announcement. “I’m committed to protecting patients in Missouri and across the country by getting to the bottom of what’s going on with EmCare’s billing.”

In a letter (PDF) to Envision President and CEO Christopher A. Holden, McCaskill wrote that “EmCare staffing and management have led to a decline in healthcare quality and access for patients in communities around the country.”

She referenced a study of 16 hospitals that found that out-of-network billing rates increased by more than 70%—rates that were often passed onto patients. Another report found that similar services at a hospital tripled when EmCare took over the hospital’s staffing and billing.

RELATED: Price gouging in the ER: Patients often overcharged but markups highest for minorities, uninsured

“These [rising] costs have a significant adverse impact on the communities where EmCare operates and on the unsuspecting patients,” McCaskill wrote. She requested Envision provide information on bonuses physicians may receive related to their lab testing rates, how much Envision or EmCare has received from the federal government, and their percentage of out-of-network billing.

EmCare has disputed the results of the study, calling it “fundamentally flawed and dated.” The company said it helps hospitals treat patients with more severe illnesses, which accounts for the higher billing rates.

The high cost of emergency care, and healthcare in general, is a concern across the country. Most states don’t have protections in place to prevent balance billing. Patients in Texas may be at a particular high risk for surprise medical bills, especially if they need emergency care.

A study of more than 300 hospitals in Texas found that even if a hospital belongs to an insurer’s network, none of the emergency doctors on staff are in those networks. That means patients receive care from out-of-network physicians and will be hit with unexpected bills.

Suggested Articles

The FTC is suing Surescripts, accusing the health IT company of employing illegal restraints to maintain its monopolies over the e-prescribing market.

Group plans for small businesses may offer a lower-cost option in comparison to individual market coverage, according to a new report. 

Ohio’s attorney general is continuing his war on PBMs, this time by proposing a multi-step plan to improve transparency and lower drug costs.