How much will I be charged? Study examines patient bills for top 10 visits to the emergency room

February 27, 2013

It's a basic, reasonable question: How much will this cost me? For patients in the emergency room, the answer all too often is a mystery.

departments play a critical role in , yet consumers typically know little about how medical are determined and often underestimate their financial responsibility—then are shocked when the hospital bill arrives.

A new study led by UC San Francisco highlights the problem by identifying giant price swings in patient charges for the 10 most common outpatient conditions in emergency rooms across the country.

Out-of-pocket patient charges ranged from $4 to $24,110 for sprains and strains; from $15 to $17,797 for headache treatment; from $128 to $39,408 for kidney stone treatment; from $29 to $29,551 for ; and from $50 to $73,002 for .

The study, representing an estimated 76 million emergency department visits between 2006 and 2008, is the first to demonstrate a large, nationwide variability in charges for common emergency department outpatient conditions, according to the researchers. The analysis uses data from the 2006-2008 Medical Expenditures Panel Survey from the Agency for Healthcare Research and Quality.

The study will be published online Feb. 27, 2013 in .

Amid escalating and a growing burden of among many Americans, cost controls and transparency in the nation's emergency rooms are increasingly important, the authors said, particularly for medical conditions that are less time-sensitive.

"Our study shows unpredictable and wide differences in health care costs for patients,'' said senior author Renee Y. Hsia, MD, an assistant professor at UCSF. She is also an attending physician in the emergency department at San Francisco General Hospital & Trauma Center.

"Patients actually have very little knowledge about the costs of their health care, including emergency visits that may or may not be partially covered by insurance,'' she said. "Much of this information is far too difficult to obtain.''

The cost of health care has increasingly been at the forefront of economic, political and medical debate. But especially when it comes to emergency rooms (ERs), visited by an estimated one in five Americans annually, patients as well as their physicians are often in the dark about billable charges.

For consumers with health insurance, escalating ER charges are resulting in larger deductibles and co-payments. And for the ranks of uninsured patients, who disproportionately rely on the for non-emergency care, higher ER charges result in a larger proportion of self-pay responsibility.

The study focused on adults 18 to 64 years old, the demographic at the highest risk of facing the largest out-of-pocket charges. It excluded people 65 or older because most such patients are covered by Medicare. And it excluded visits resulting in hospital admission.

Altogether, the researchers looked at the total charges – medical care, tests and treatment – for 8,303 patients, nearly half of them privately insured. The charges do not represent the amount patients or insurers reimburse providers, but rather the total charge that patients or their insurance providers are billed. Because of the complex survey design, the number of patients analyzed in the sample was weighted to provide the total estimated number of ER visits during the study timeframe.

The most common outpatient conditions were sprains and strains, "other injuries,'' and "open wounds of extremities.'' Many patients suffered from hypertension, asthma or high cholesterol.

Among key findings:

  • The median charge for total outpatient conditions was $1,233.
  • Upper respiratory infections had the lowest median charge: $740.
  • A kidney stone condition had the highest median price: $3437.
  • Uninsured patients were charged the lowest median price ($1,178) followed by those with private insurance ($1,245) and Medicaid ($1,305).
"While most patients with time-sensitive conditions such as acute myocardial infarction, stroke, or sepsis may not be in a position to make decisions about their care based on costs or charges, there are many situations in which could reasonably inquire about the potential financial implications of their medical care before making treatment decisions,'' the authors wrote.

While the study was not designed to evaluate specific reasons behind the cost variations, the authors noted previous research attributing cost differences to factors such as geographic location and provider reimbursement variations.

More transparency in hospital charges is needed, the authors said, and consumers should be better informed about the costs of their medical care.

Explore further: Medical bills: Sticker shock and confused consumers

Related Stories

Medical bills: Sticker shock and confused consumers

April 25, 2012
You're enjoying a quiet weekend at home when suddenly you double over in pain. You need emergency appendectomy surgery. How much should it cost? And how much price shopping are you able to do?

Gout is primary indication in about 0.2 percent of ER visits

September 18, 2012
(HealthDay)—Gout is the primary indication in about 0.2 percent of emergency department visits annually, according to a study published online Sept. 4 in Arthritis Care & Research.

People surprised by costs of out-of-network care, more patient educated needed

October 26, 2012
Forty percent of people who received health care outside of their insurance network did so out of necessity, finds a new study in Health Services Research. About half of those patients did not know how much they would have ...

Medicaid patients go to ERs more often: study

March 19, 2012
(HealthDay) -- Medicaid patients have more difficulty getting primary care and visit hospital emergency departments more often than those with private insurance, a new study finds.

Pediatric emergency department visits for psychiatric care on the rise

October 14, 2011
Pediatric patients, primarily those who are underinsured (either without insurance or receiving Medicaid), are increasingly receiving psychiatric care in hospital emergency departments (EDs), according to an abstract presented ...

Market factors affect closures of emergency departments nationwide

June 10, 2011
Despite a rise in the number of emergency room patients, the number of hospital-based emergency departments in the U.S. is in decline, according to a study led by Renee Hsia, MD, MSc, an emergency physician at San Francisco ...

Recommended for you

Americans misinformed about smoking

August 22, 2017
After voluminous research studies, numerous lawsuits and millions of deaths linked to cigarettes, it might seem likely that Americans now properly understand the risks of smoking.

Women who sexually abuse children are just as harmful to their victims as male abusers

August 21, 2017
"That she might seduce a helpless child into sexplay is unthinkable, and even if she did so, what harm can be done without a penis?"

To reduce postoperative pain, consider sleep—and caffeine

August 18, 2017
Sleep is essential for good mental and physical health, and chronic insufficient sleep increases the risk for several chronic health problems.

Despite benefits, half of parents against later school start times

August 18, 2017
Leading pediatrics and sleep associations agree: Teens shouldn't start school so early.

Doctors exploring how to prescribe income security

August 18, 2017
Physicians at St. Michael's Hospital are studying how full-time income support workers hired by health-care clinics can help vulnerable patients or those living in poverty improve their finances and their health.

In a nutshell: Walnuts activate brain region involved in appetite control

August 17, 2017
Packed with nutrients linked to better health, walnuts are also thought to discourage overeating by promoting feelings of fullness. Now, in a new brain imaging study, researchers at Beth Israel Deaconess Medical Center (BIDMC) ...

1 comment

Adjust slider to filter visible comments by rank

Display comments: newest first

Roland
not rated yet Feb 28, 2013
This is insane. What happened to "first do no harm"? The medical system has become a wrecking crew. They destroy lives financially and emotionally, and they don't care.

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.