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ED Cost of Care Greatly Underreported, Researcher Says

Cheryl Clark, for HealthLeaders Media, May 2, 2013

A widely accepted federal report which represents emergency department care costs as only 2% of the nation's total healthcare bill is seriously flawed, according to a Brown University researcher and ED physician at Rhode Island Hospital. The true cost is in the range of 6.2% to 10%, they say.

Michael Lee, MD, assistant professor of emergency medicine, reports in the Annals of Emergency Medicine that commonly cited data from the Medical Expenditure Panel Survey or MEPS, prepared by the federal Agency for Healthcare Research and Quality, greatly underreports key components of ED care, including costs for patients who ultimately are admitted to an inpatient bed.

His analysis suggests that patients who are admitted require ED services that cost between 26% and 48% more than patients who are treated in the ED and released.

Tests and imaging for those patients are not included in the agency's survey reports. Also, care provided to patients enrolled in Medicaid who are treated in the emergency department is underreported, he wrote. The cost of providing emergency services for patients who are insured also is missed because those services are often bundled.

Additionally, the MEPS greatly underestimates the number of ED visits in U.S. hospitals, Lee says. According to the National Hospital Ambulatory Medical Care Survey (NHAMCS), there were 129.8 million ED visits in 2010, but MEPS only counts 48.9 million.

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