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Variation in Charges for Emergency Department Visits Across California - 23/07/14

Doi : 10.1016/j.annemergmed.2014.03.006 
Renee Y. Hsia, MD, MSc a, , Yaa Akosa Antwi, PhD b
a Department of Emergency Medicine, University of California San Francisco, San Francisco, CA 
b Department of Economics, Indiana University–Purdue University Indianapolis, Indianapolis, IN 

Corresponding Author.

Abstract

Study objective

Previous studies have shown that charges for inpatient and clinic procedures vary substantially; however, there are scant data on variation in charges for emergency department (ED) visits. Outpatient ED visits are typically billed with current procedural terminology-coded levels to standardize the intensity of services received, providing an ideal element on which to evaluate charge variation. Thus, we seek to analyze the variation in charges for each level of ED visits and examine whether hospital- and market-level factors could help predict these charges.

Methods

Using 2011 charge data provided by every nonfederal California hospital to the Office of Statewide Health Planning and Development, we analyzed the variability in charges for each level of ED visits and used linear regression to assess whether hospital and market characteristics could explain the variation in charges.

Results

Charges for each ED visit level varied widely; for example, charges for a level 4 visit ranged from $275 to $6,662. Government hospitals charged significantly less than nonprofit hospitals, whereas hospitals that paid higher wages, served higher proportions of Medicare and Medicaid patients, and were located in areas with high costs of living charged more. Overall, our models explained only 30% to 41% of the between-hospital variation in charges for each level of ED visits.

Conclusion

Our findings of extensive charge variation in ED visits add to the literature in demonstrating the lack of systematic charge setting in the US health care system. These widely varying charges affect the hospital bills of millions of uninsured patients and insured patients seeking care out of network and continue to play a role in many aspects of health care financing.

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Plan


 Please see page 121 for the Editor’s Capsule Summary of this article.
 Supervising editor: Donald M. Yealy, MD
 Author contributions: RYH and YAA conceived of and designed the study, critically interpreted and revised the analysis, and revised the article for intellectually important content. YAA conducted the data analysis. RYH drafted the article and provided funding. RYH and YAA take responsibility for the paper as a whole.
 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). The authors have stated that no such relationships exist and provided the following details: This project was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through University of California San Francisco (UCSF)- Clinical and Translational Science Institute grant KL2 TR000143 (Dr. Hsia), the Robert Wood Johnson Foundation Physician Faculty Scholars Program (Dr. Hsia), and a UCSF Center for Healthcare Value grant.
 The article’s contents are solely the responsibility of the authors and do not necessarily represent the official views of any of the funding agencies. The funding sponsors played no part in the design and conduct of the study; collection, management, analysis and interpretation of the data; and preparation, review, or approval of the article.
 Dr. Callaham was recused from the decisionmaking for this article.
 A JDC5L2S survey is available with each research article published on the Web at www.annemergmed.com.
 A podcast for this article is available at www.annemergmed.com.


© 2014  American College of Emergency Physicians. Publié par Elsevier Masson SAS. Tous droits réservés.
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Vol 64 - N° 2

P. 120 - août 2014 Retour au numéro
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