Inpatient ER cases may lead to unexpected medical bills

In 2014, 20% of inpatient stays resulting from an ER visit produced a surprise bill, according to a new report.

Visits to the emergency department that lead to an inpatient stay may also have another unexpected result for patients—surprise medical bills, according to a new study.

The study, published online by Health Affairs, examined data compiled between 2007 and 2014 in the Truven Health MarketScan Commercial Claims and Encounters Database, a national database of claims data that includes treatment descriptions for patients with employer-sponsored health plans. Using that information, the Federal Trade Commission–led research team found that in 2014 20% of inpatient stays resulting from an ER visit produced a surprise bill.

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About 14% of outpatient visits to the emergency department and 9% of elective admissions led to surprise medical bills for that same year, according to the study. The numbers represent a significant drop, though, from 2007; about 28% of inpatient visits to the ER led to a surprise bill in that year.

The data used in the study focus on nonelderly patients, but the researchers found that the likelihood of unexpected bills increased with age and the complexity of a patient’s diagnosis. The rates also varied significantly across states, with some states seeing rates of surprise bills for inpatient ER visits as high as 37%, and other states with rates fewer than 10%.

The researchers note, too, that patients with Affordable Care Act marketplace plans may also be more likely to receive unexpected medical bills, as those plans often have very narrow coverage networks. A patient may visit an in-network hospital but see an out-of-network specialist, for example, leading to unexpected costs. The study team called for additional research on surprise bills to further understand both causes and solutions.

Some health systems are reinventing their billing process to make costs clearer to patients; several across the country are testing new medical bills approved by the federal government because they are easier for patients to understand. More efficient and fair negotiations between payers and providers could also reduce the number of unexpected bills.