Facility fees for emergency room visits nearly doubled between 2009 and 2015 even as the actual number of visits slightly decreased, according to a new analysis of available data.
The news website Vox and the public-interest nonprofit Health Care Cost Institute (HCCI) examined 70 million insurance bills for ER visits over the six-year period. They focused on the fee that health insurance companies paid for the visit, not for any health care associated with it. In that period, while the number of visits decreased by 2 percent, the overall cost of fees increased by 89 percent, the analysis found.
A factor in setting rates is the coding (on a scale of 1 to 5) for the billing, depending on the complexity of the patient’s case. The HCCI-Vox analysis determined that many hospitals have become more apt to use “higher-intensity codes and that the price of these codes has increased sharply since 2009.”
In an effort to lower Medicare costs associated with the fees, the Obama administration in 2013 proposed eliminating facility-fee levels and replacing them with a flat fee.
“A single code and payment for clinic visits is more administratively simple for hospitals and better reflects hospital resources involved in supporting an outpatient visit,” Medicare officials stated.
“But that rule never saw the light of day,” Vox reported, “after intense pushback from hospitals and doctor groups, the issue was dropped and the fee levels remain today.”