ED costs may be triple current estimates

The true cost of emergency department (ED) services may be as much as three times the amount of longstanding federal estimates.

The Agency for Healthcare Research and Quality's medical expenditure panel survey has estimated ED costs as 1.9 percent of healthcare spending. But researchers found that figure undercounts the number of ED visits and the number of ED patients who are admitted to hospitals. Adjusting for those discrepancies using data from a variety of other published sources, the authors estimated that ED costs are between 4.9 percent to 5.8 percent of total healthcare spending.

The authors, however, went beyond national data sets, including the National Emergency Department Sample, to review ED spending data from a different source: a major national private insurer. The data included charges from doctors and hospitals for imaging testing, and other procedures. There were accounting differences between admitted and discharged patients and a need to account fully for spending from Medicare and Medicaid. The authors’ estimate based on these data is ED spending that is 6.2 to 10 percent of total healthcare spending.

"The ER has become increasingly important as a place where people go for acute unscheduled care, however there has been little rigorous analysis of its cost structure," Michael Lee, MD, assistant professor of emergency medicine in the Warren Alpert Medical School of Brown University and lead author of the study published in Annals of Emergency Medicine, said in a press release.

"The real cost of providing emergency care has to do with accurately measuring the resources that are used, and time is an important variable to take into account," Lee said in a statement. However, he also acknowledged that ED cost estimates widely vary. Marginal costs of the same services have ranged from $150 to $638 based on studies conducted by insurers.