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ER Spending Rise Driven by High-severity Cases

By John Commins  
   May 31, 2018

A review of emergency department claims for employer-sponsored plans from 2009 through 2016 found that the average prices for higher severity billing codes rose faster than lower severity codes.

Emergency department spending per employer-sponsored plan enrollee increased 99% from 2009 to 2016, even as overall ED use for that cohort flat-lined, the Health Care Cost Institute reports.

HCCI examined trends in spending, price and utilization for five Current Procedural Terminology codes used to record the complexity and severity of ED visits over the seven-year span.

The findings:

  • While average prices for all five ER CPT codes were higher in 2016 than in 2009, the average prices for higher severity codes rose at a faster rate than low severity codes.
  • Combined with more use of the high severity codes, these price increases contributed to large spending hikes – per person spending for the two most severe codes grew by more than 100% over seven years.
  • ED visit spending per person increased 99% while overall ED use remained the same.
  • Overall ED spending growth was largely driven by higher severity visits, on which spending more than doubled.
  • Per person spending on the highest severity ED visit rose 145%, with price increasing 77% and use increasing 38%.
  • The second-highest severity ED visit experienced the largest price increase of any severity level (94%) and an above average increase in utilization (16%), resulting in a 124% spending increase.

A state-by-state review of the data found that:

  • Mississippi had the highest overall ED spending increase, rising 153% from 2009 to 2016 – 21 states saw spending increases of over 100%.
  • Nevada had the highest overall ED price increase, rising 147% from 2009 to 2016 – 25 states saw price increases of 100% or more.
  • Between 2009 and 2016, ED use remained unchanged in 18 states, decreased in 22, and increased in 11.

John Commins is a senior editor at HealthLeaders.

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