Emergency Room Bills - A Major Contributor to Rising Healthcare Costs

Emergency Room Bills - A Major Contributor to Rising Healthcare Costs Huge ED bills increase healthcare costs. Healthcare costs must be controlled in all settings and processes, even when using medical transcription service.

Medical Transcription Services United States

In the United States, ED (emergency department) use has been growing steadily for years, even faster than the U.S population growth. ED physicians are overstressed and overworked, as any agency providing medical transcription service to emergency room doctors will know. Most states in America require healthcare plans to direct their members to go to the nearest hospital in an emergency and assure them that the insurance will cover the visit even if their plan doesn’t have a contract with that hospital and the emergency care they receive will be out of network. Researchers in the field point out that aging demographics is one of the main reasons for increasing ED use, with old people who have complex health conditions requiring urgent care. Other reasons include lack of timely access to care in a physician’s office or other non-ED urgent care setting.

Being the front door and conduit of hospital admissions, the ED is a place that evaluates complex patients with potentially serious problems. The rule regarding providing emergency healthcare to patients gives hospitals the opportunity to charge higher prices. Researchers at the University of Maryland School of Medicine who examined data from several national healthcare databases covering all 50 U.S states and the District of Columbia between 1996 and 2010 found that half of all hospital-associated medical care provided was provided in emergency departments. The reasons for this, according to the researchers are: access to healthcare, consumer-driven needs, appreciation for the comprehensive care delivered by EDs, and the ability of EDs to fill a critical gap with regard to care delivered to vulnerable populations. Hospitals are given great pricing power when they are negotiating with healthcare plan providers. Hospitals can cancel their contract if they do not get the high prices they demand from health plans.

They have nothing to lose because they will still get paid for treating ED patients under those plans and may even be paid more because those patients are out of network.

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Data from California states that hospitals are exploiting the situation. In California, for instance, the total billed charges by hospitals increased drastically by $263 billion to $386 billion during the period 2002 to 2016.

But the number of patients admitted did not increase during this period. The billed charges on health plans per day increased from $6,900 to $19,500.

This price trend gave California hospitals the leverage to demand and receive much higher prices for in-network patients as well. The average price health plans paid to hospitals for all care also grew, by almost 200% to $7,200 per day from $2,500. Sadly, patients are not often aware of this fight between hospitals and insurance companies. However, when hospitals charge insurers higher prices, patients are also affected in the form of higher premiums. In some cases, patients may have to pay huge out-of-network ER charges directly to hospitals in the form of balance billing.

This predicament can be effectively addressed only if states change their regulations to place caps on hospital prices for out-of-network emergency care. This will help prevent hospitals from exploiting their ER advantage. It would also lead to immediate price reductions and savings for consumers.

Healthcare associated costs must be controlled using effective measures in all settings and processes. For instance, hospitals and physicians can save costs by outsourcing medical transcription instead of having an in-house team do it, the latter being a more expensive option. Insurers and policymakers are concerned about the increased emergency department use that has much higher treatment costs compared with other care settings.

Observers in the field say that improving access to primary care could reduce ED utilization and also offer benefits in the form of greater preventive care and disease management.

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