Rather than $48.3 billion spent on emergency department care that year, Lee suggests the number is more in the range of $131 billion to $136 billion, and may account for 10% of total healthcare spending when factored as costs per patient visit, he says.
"Emergency medicine represents a larger percentage of overall costs than we think," Lee says. "But the flip side of that is that there's a lot of value in emergency care and what services are provided, and we need to do a better job in quantifying and demonstrating what that is."
The article raises questions about the accuracy of the American College of Emergency Physicians' long-standing "Emergency Care: Just 2% Campaign." Asked for a comment, ACEP spokeswoman Julie Lloyd said "We feel confident in our analysis from the Just 2% campaign." The Annals of Emergency Medicine is the official publication of ACEP.
Lee contends that the low figure of 2% is frequently used as a "public relations campaign" to convey the idea that emergency care is cost-effective, and not a major contributor to healthcare costs.
Often however, the very critical life-saving strategies that take place in the emergency room, and cost money, are not counted in this equation, such as imaging for a stroke patient who is administered clot busting drugs and admitted to a telemetry unit.
It is important to understand the true costs of what is provided in the ED because of what's at stake in payment reform. "Accountable care organizations and bundled payments may disrupt how emergency care is reimbursed," he wrote. "Cuts for indigent care at Disproportionate Share Hospitals are a threat to EDs due to federal mandates to provide medical screening for all patients."