Investigation into emergency rooms shows that for-profit hospitals engage in billions in price-gouging

Vox undertook a deep investigation into emergency room pricing, finding that emergency rooms, being the most monopolistic aspect of hospital care (because you don't shop for an ER while you're having a heart attack in the back of an ambulance) are also the most abusive and price-gouging.

They found that hospitals systematically "code" ER visits are more serious than they really are, in order to levy eyepopping "emergency room facility fees" that are often not covered by health insurance (and thus not subject to countervailing pressure from insurers). These fees also take literal billions out of Medicare.

In addition to coding routine visits as more serious than they really are, ERs also routinely overtreat patients, subjecting them to needless and expensive tests for minor (but time-sensitive) ailments — David Overton visited Legacy Emergency Room & Urgent Care near Dallas when his chronic strep throat flared up over a holiday weekend when urgent care facilities were shut, and rather than just giving him oral antibiotics, they gave him a CT scan, pushed IV antibiotics, and wrote him a scrip. The cost of this (which Overton is personally liable for) is $1,900.

For-profit healthcare is a disaster at every level, from insurers to hospitals to doctors' practices to the pharmaceutical industry. That's why the Americans spend more per-capita to receive worse care that produces worse outcomes than anyone else in the developed world, where socialized and regulated medicine are the norm.

"Hospitals can make a lot of money charging for all the extras — CT scans, MRIs, laboratory fees, even starting an IV," Derlet, the emergency physician, says.

In 2009, 50 percent of all emergency room facility fee charges were for level 4 and 5 codes. In 2015, that number rose to 59 percent.

How to interpret that trend isn't fully clear. Some say it could signal hospitals charging higher rates for similar care. But the current data makes it impossible to rule out the fact that emergency room visits may just be getting more serious.

"At face value, it might suggest that patients are showing up at the ER sicker or with more serious injuries," says Jonathan Mathieu, chief economist at the Center for Improving Health Care Value in Colorado. His group has documented similar, state-level trends to what the HCCI national data set shows. "This feels a little shaky, for a lack of a more elegant term, because it is the same trend year over year over year."

Emergency rooms are monopolies. Patients pay the price. [Sarah Kliff/Vox]

(via Naked Capitalism)