- The cost of emergency department visits in Colorado vary enormously depending on facility and condition severity, according to new data from the state's all-payer claims database analyzed by the Center for Improving Value in Health Care.
- Colorado's EDs were paid an average of $3,115 for the most severe life-threatening cases in 2018. The largest single charge was $47,779, and the smallest was $190.
- But Denver-based CIVHC, which administers the database, only looked at reimbursement from commercial payers to the facility directly, meaning the entire cost of care for a Colorado patient — including common add-ons like lab tests, imaging services, surgical procedures or other physician fees — is likely much higher.
Colorado's data provides the U.S. an unusual glimpse into healthcare prices, albeit in one state and one type of provider setting.
Though national ER use remained largely unchanged over the past decade according to the Health Care Cost Institute, ER clinicians are using high severity codes more frequently. Previous research from the CIVHC found that trend held true in Colorado as well, with a decrease in coding for all other lower-tier severity levels across commercial payers between 2009 and 2016.
Last year, the median statewide facility payment for a low severity visit was approximately $290 and high severity level claims were paid at almost $3,000.
As ER costs continue to rise, some payers are taking controversial steps to try and blunt the trend. Anthem faced lawsuits and backlash from a slew of providers in Connecticut, Georgia and Missouri around its cost-cutting policies, including paying patients directly for emergency care and having them reimburse their providers, and no longer reimbursing for non-emergency services given in the ER.
If widely adopted, that latter policy from the Indianapolis-based payer could deny payment for as many as one in six ER visits, according to a study in JAMA.
Provider critics, wary of insurer policies that could further endanger their bottom lines, argue such measures could prevent patients from seeking care in the first place.
Over a dozen individual states along with Washington, D.C. have put forward proposals to try and mitigate the practice. The Trump administration backs legislation to ban surprise billing, which lawmakers are set to debate after the summer recess. Often, patients hit with surprise medical bills for care not covered by their insurer get them after receiving care in the ER.
Big hurdles remain to appease both the payer and provider lobbies, which stand diametrically opposed on the way forward to fix the problem.