Comparing Utilization and Costs of Care in FSED, HED, and UC

Results

Main Results

 

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Figure 1

Visits by Blue Cross Blue Shield customers in Texas by provider type and year.

The plotted values reflect increases of 10%, 24%, and 236% in visits between 2012 and 2015 respectively, for hospital-based emergency departments, urgent care centers and freestanding emergency departments.

Figure 2 graphs the average price paid for care by facility type and year. Between 2012 and 2015, the average price per visit at freestanding EDs increased 54%, from $1,431 to $2,199. During this same period, the average price per visit at hospital-based EDs increased 23%, from $1,842 to $2,259. Prices at urgent care centers were substantially lower and increased only 2% (from $164 to $168) between 2012 and 2015. As prices increased, the amount patients were liable for out of pocket also increased. Freestanding ED patients were liable for 32% out of pocket in 2012 ($462/$1,431) but 35% ($763/$2,199) in 2015. Patients treated in hospital-based EDs were liable for 29% out of pocket in 2012 ($541/$1,842) but 33% ($749/$2,259) in 2015. Even urgent care center patients were liable for more out of pocket over time: 36% in 2012 ($58/$164) versus 38% in 2015 ($63/$168). Median prices by provider type and year are reported in Table E1 (available online at http://www.annemergmed.com). The median prices are lower than mean prices for freestanding and hospital-based EDs, suggesting that payments to these providers are skewed to the right. Changes in mean prices paid out of pocket for freestanding ED patients are greater than the change in median prices, indicating that freestanding ED patients with the highest out-of-pocket costs fared the worst over time.

 

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Figure 2

Mean total price per visit and mean amounts paid by insurance versus out of pocket by provider type and year.*

*Number of visits in 2012 versus 2015 equals 54,696 versus 183,971 for freestanding EDs, 954,548 versus 1,046,545 for hospital-based EDs, and 748,213 versus 926,933 for urgent care centers.

At urgent care centers, the insurer-paid amount was $106 in 2012 and $104 in 2015. The amount paid out of pocket was $58 in 2012 and $63 in 2015.

Source: Comparing Utilization and Costs of Care in Freestanding Emergency Departments, Hospital Emergency Departments, and Urgent Care Centers – Annals of Emergency Medicine

Posted in ER Billing, Freestanding ER, Industry Updates, TX Hospitals