Is your visit to the "ER" driving up health care costs?

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In Houston, your closest Emergency Room is pretty darn close.

It's part of a hot national trend of building freestanding ERs. They are more convenient and usually speedier than the traditional ER that is attached to a hospital. They also cost more.

Houston already has a bunch, according to a recent piece in Kaiser Heath News (KHN).

Nowhere is the trend hotter than in the Houston metropolitan area, with 41 freestanding ERs and 10 more under development. Counting the freestanding ERs and traditional hospital-based ERs, greater Houston has 150 emergency rooms — twice the number as Greater Miami — even though its population is only slightly bigger, according to a KHN analysis.

These facilities are often co-owned by physicians and are "often located near high-end shopping centers, … target consumers with private insurance [and] bill like regular emergency rooms." 

The KHN piece analyzes the costs to the health care system associated with these new facilities. They can "charge insurers double or triple the amount per patient as an urgent care center or doctor's office." Some patients are using them for routine care that would cost less in their physician's office.

Why?

Insurers have little power to stop patients from using the facilities because by state law, they must pay for ER coverage anytime a patient perceives they have an emergency, regardless of whether that turns out to be the case. For that reason, the freestanding ERs have no need to contract with insurers and offer discounts.
The main reason they are more costly than urgent care is that they charge a "facility fee" on top of a fee for the physician's time—just like traditional ERs. The facility fee was originally intended as a way to help hospitals recoup overhead costs including 24-hour staffing, administration and equipment. 

Price and cost are considerations every health care consumer will sooner or later need to address. 

If the Affordable Care Act is going to make care, well, "affordable," health systems and physicians will need to be more assertive in educating patients about using the right facility at the right time to receive the right care.

That way, everyone can win.

Original source: Columbia Journalism Review

 

Price: Health care's next frontier

First it was quality. Then patient satisfaction. Say hello to health care's new competitive pressure: 

Price.

The Surgery Center of Oklahoma has gone all in on the price front. 

Need an Achilles repair? $5,730.

How about a cochlear Implant? $8,800.

A breast lymph node image will set you back $815.

This is "all inclusive" pricing — one charge for the surgery, the facility fee, the surgeon’s fee and anesthesiologist’s fee. 

One charge. One bill. Simple for the patient.

Have insurance? Read this disclaimer: 

NOTE: If you are scheduled for surgery at our facility and we are filing insurance for you, the prices listed on this website do not apply to you.   

NOTE: If you are scheduled for surgery at our facility and we are filing insurance for you, the prices listed on this website do not apply to you.

 

That's because your insurance provider (whether it be a government-supported program like Medicare or Medicaid or private insurance) negotiates its own rates. They may be higher or lower. And you may never know (but you should!).

The message here? Price is important. More patients are responsible for covering more of the cost of their procedures. That means they will care more and more about price.

So in addition to posting information about quality scores and patient satisfaction scores, hospitals and doctors will now need to consider posting pricing.

Source: 37Signals