ERs nearly doubled facility fees as visits decreased

Facility fees are charged for nearly every visit to an emergency room (ER), with departments arguing they’re necessary to keep their doors open. Between 2009 and 2015, ERs across the country increasingly used higher intensity codes for ER visits, leading to an 89 percent increase in facility fees.

The analysis from the Health Care Cost Institute (HCCI) and Vox—part of an investigation into hospital prices which has led to warnings from the American Hospital Association (AHA)—covered 70 million insurance bills for ER visits and focused on what health plans paid facilities for these fees, rather than the hospitals’ list price.

Overall, spending on ER fees rose from $4.3 billion to $7.3 billion between 2009 and 2015, even though the number of ER visits declined from 10.5 million to 9.4 million over the same time frame.

“If you have a monopoly—and when it comes to the ER, it’s a monopoly—you can set any price you want,” said Robert Derlet, MD, a professor emeritus in emergency medicine at the University of California Davis. “What is going to deter me from increasing my price? Who can stop me? If I’m the financial officer for the hospital, I might even get a bonus for doing this.”

The AHA justified the increases by claiming ER visits are actually on the rise and the patients being treated represent more complex cases.

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