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Modern Healthcare: ER spending rises with increasing prices, severity of visits

 By: Shelby Livingston

Even though emergency department use has stayed the same, ED spending per member nearly doubled from 2009 to 2016 as the severity of ED visits and the prices associated with those visits increased, new data from the Health Care Cost Institute shows.

The not-for-profit HCCI analyzed employer-sponsored insurance claims for the five procedure codes used to bill for ED visit facility fees over the seven-year period. Emergency department facility fees are coded on a scale of 1 to 5, with Level 1 codes reflecting low-acuity conditions, and Level 4 and 5 codes representing the most serious conditions, such as blunt trauma or severe infections.

Over the study period, the HCCI said average prices for each of the five codes increased, with the prices for codes used to designate the highest-severity visits rising faster than the lowest-severity codes. At the same time, the use of the two highest-severity codes increased.

Those two trends helped drive ED visit spending per person to an average $247 in 2016, up 98% over $125 in 2009, while overall ED use stayed the same. The average price of the facility fee claim was $894 in 2016, an increase of 98% over $452 in 2009. HCCI defines spending per person as total expenditures divided by the employer-sponsored insurance population studied. Spending is determined by prices and utilization.