Emergency rooms are monopolies. Patients pay the price.

Sarah Kliff · Monday, December 04, 2017, 8:32 am

New data shows how how emergency rooms take advantage of their market share, at the expense of their patients

Around 1 am on August 20, Ismael Saifan woke up with a terrible pain in his lower back, likely the result of moving furniture earlier that day.

“It was a very sharp muscle pain,” Saifan, a 39-year-old engineer, remembers. “I couldn’t move or sleep in any position. I was trying laying down, sitting down, nothing worked.”

Saifan went online to figure out where he could see a doctor. The only place open at that hour was Overland Park Regional Medical Center in his hometown of Overland Park, Kansas.

The doctor checked his blood pressure, asked about the pain, and gave him a muscle relaxant. The visit was quick and easy, lasting about 20 minutes.

But Saifan was shocked when he received bills totaling $2,429.84.

The bill included a $3.50 charge for the muscle relaxant. The rest — $2,426.34 — were “facility fees” charged by the hospital and doctor for walking into the emergency room and seeking care.

Because Saifan’s health spending is still within his plan’s deductible, he is responsible for the entire amount.

“I called the insurance company to make sure the bill was real,” Saifan says. “They said it was a reasonable price, and gave me a breakdown.”

Spending on emergency room fees has increased by $3 billion — even though the number of fees is declining slightly

There are 141 million visits to the emergency room each year, and nearly all of them (including Saifan’s) have a charge for something called a facility fee. This is the price of walking through the door and seeking service. It does not include any care provided.

Emergency rooms argue that these fees are necessary to keep their doors open, so they can be ready 24/7 to treat anything from a sore back to a gunshot wound. But there is also wide variation in how much hospitals charge for these fees, raising questions about how they are set and how closely they are tethered to overhead costs.

Most hospitals do not make these fees public. Patients typically learn what their emergency room facility fee is when they receive a bill weeks later. The fees can be hundreds or thousands of dollars. That’s why Vox has launched a year-long investigation into emergency room facility fees, to better understand how much they cost and how they affect patients.

Saifan’s bill was so expensive, it turns out, because the hospital used the facility fee typically reserved for complex, intensive emergency room visits.

Read more
https://www.vox.com/health-care/2017/12/4/16679686/emergency-room-facility-fee-monopolies