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When asked to estimate the costs of emergency-room visits, even the people who work there were wrong most of the time. 

May 30, 2017

One of the most frustrating things about the U.S. healthcare system is how difficult it can be (if not impossible) to find out how much hospital procedures cost ahead of time. And prices in the emergency room, which patients often have no control over, can be shockingly high.

It turns out that patients aren’t the only ones surprised by the going rate for ER visits. According to a new study in the Journal of the American Osteopathic Association, even emergency-medicine doctors are bad at estimating the price tag for conditions routinely seen in their department. In a survey of 411 physicians, nurse practitioners, and physician assistants, only 38% of their responses correctly reflected the costs for common ER scenarios.

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That’s bad news, say the study authors, since their lack of knowledge could lead to unnecessarily expensive hospital bills and serious financial strain on patients.

For the study, ER professionals from across the country were asked to identify the cost of care for three common scenarios: A 35-year-old woman with abdominal pain, a 57-year-old man with breathing trouble, and a 7-year-old boy with a sore throat. Each imaginary patient came with a medical history and physical exam findings, and a list of which diagnostic tests, treatments, and other interventions would be involved in their care.

Despite these being fairly common issues in the ER, most study participants could not give accurate cost estimates. Only 43% guessed correctly for the woman, 40% for the child, and 32% for the man. (Think you could do better? You can see all the details and make your own guesses here. Spoiler alert: The answers are below.)

Lead author Kevin Hoffman, DO, an emergency-medicine resident at Lakeland Health in St. Joseph, Michigan, undertook the study because he says costs are rarely discussed among doctors. “Early in my residency, I realized I had no idea how much money I was spending with all the tests and medications I ordered,” he said in a press release.

 

Not only are emergency doctors not educated about hospital costs, the authors wrote in their paper, but they’re also unlikely to see patients for follow-up appointments or establish long-term relationships with them the way primary-care physicians can. This limits the opportunities for patient feedback about money, they point out.

But in order to take a whole-person approach to care, doctors need to better understand the financial burden that might be placed on patients, Dr. Hoffman argues. The costs of care should be more transparent, he says, so that doctors and patients can both make informed decisions.

To make things more transparent, Dr. Hoffman suggests, the prices of tests and medications could be added to hospitals’ order entry systems. This clarity can help keep costs under control, he adds, and prevent billing mistakes and price gouging.

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Billing errors and price gouging are more common than most of us realize. A separate study published today in JAMA Internal Medicine found that adult patients are charged 340% more, on average, than what Medicare pays for routine ER services. The largest hospital markups were more likely to hit minorities and uninsured patients.

Of course, physicians shouldn’t let expensive treatments stop them from performing crucial procedures or prescribing life-saving medicine. But sometimes, Dr. Hoffman says, the priciest option isn’t the best. Medications in pill form are less expensive than those given via IV, for example, and they can sometimes be just as effective.

Obviously, emergency care can bankrupt people who don't have insurance. But even for patients with good coverage, adding unnecessary expenses to hospital bills can drive up premiums and costs as a whole. Because of that, Dr. Hoffman says, doctors should be trained to “make a connection between the treatment they’re providing and the bill that’s going to hit the patient—or in many cases, the taxpayers.”

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In the survey, health-care professionals working in larger institutions were more likely to choose higher estimates for the three scenarios. Geographic location had no bearing on accuracy of responses, and neither did level of training—even though people with more experience believed they had a better understanding of costs.

So how much it would actually cost to diagnose and treat those imaginary patients, as determined by the Lakeland Health billing department? The total came to $4,713 for the woman with abdominal pain, who was discharged (with no cause identified) after receiving diagnostic tests and IV medicine; $2,423 for the man with breathing trouble, who was admitted to the hospital after receiving diagnostic tests and IV medicine; and $596 for the boy, who was prescribed antibiotics for strep throat and sent home.