What’s worse: Bachelor party hangover or hangover from ER bill?
Two days before his wedding, Cameron Fischer had one heck of a bachelor party, hitting a few bars in the Old Town section of Fort Collins with his friends into the wee hours. The next morning, the 30-year-old IT professional from nearby Loveland woke up with a killer hangover.
“I couldn’t keep anything down,” Fischer said. “I just felt miserable.”
He was in such bad shape that, with their wedding day fast approaching, Fischer’s fiancée urged him to leave their rehearsal dinner in Denver and head to an emergency room to be rehydrated. That resulted in an even bigger headache — a medical bill that was initially $12,460. That was more than twice the cost of their wedding.
Fischer’s case is a sobering illustration of America’s health care system. With few constraints on how emergency rooms set prices, hospital systems have jacked up rates and coded patient visits as being more complex than previously, which increases the payments they receive from insurance plans. The result: ER services have some of the fastest-growing prices in the health care system.
Many health economists think free-standing ER facilities, like the one Fischer visited — which are banned in many states but thriving in Colorado — are particularly culpable. While such ERs maintain they can’t survive on rates paid by Medicare and Medicaid, data suggests they are profit-seeking engines built primarily in high-income ZIP codes.
“It’s because they’ve figured out that they can get away with it,” said Vivian Ho, an economist with the Baker Institute at Rice University in Houston.
Fischer might have avoided the big bill had he sought treatment earlier in the day. But by 7 p.m. on a Saturday, urgent care facilities were closed. He checked Google Maps for the closest emergency room and — clutching a trash can — headed to HealthONE North Suburban Medical Center, a freestanding ER in Thornton.
The ER appeared to be devoid of patients, just a doctor and a couple of nurses on duty. Fischer told them what had happened, that he didn’t do drugs and doesn’t often drink. “I knew exactly why I was there,” he said. “It wasn’t that I had some unknown reason for my symptoms.”
A nurse started an IV, gave Fischer two bags of saline and a dose of Zofran, an anti-nausea medication. She drew blood, although Fischer said he wasn’t told what tests would be run on the blood sample. He was out of the ER within 45 minutes, feeling better.
Facility fees
A few weeks after Fischer’s April wedding, he received the medical bill. It included a $7,644 “facility fee” — an expense that hospital systems charge to cover their overhead costs of keeping an ER open 24 hours per day and ready for any emergency.
Facility fees are set on a scale from 1 to 5, depending on how severe the patient’s condition appears during the initial triage. The ER rated Fischer’s visit as a 4, one of moderately high complexity in terms of care needs.
“There are no limitations on the facility fees that they can charge,” said Adam Fox, director of strategic engagement for the Colorado Consumer Health Initiative, a nonprofit consumer advocacy group. “The facility fee for over $7,000 is simply obscene.”
The Health Care Cost Institute, an independent, nonprofit health research firm, recently analyzed millions of insurance bills to get a better sense of the facility fees ERs were charging. It found the charges nearly doubled from 2009 to 2016, outpacing overall health spending four times over. In Colorado, the average facility fee charged for a Level 4 visit grew from $1,064 to $2,336.
Insurance plans generally don’t pay the full charge but pay a negotiated rate for in-network hospitals. The Center for Improving Value in Health Care, which maintains a database of insurance payments in Colorado, found that insurance plans paid an average of $1,754 for a Level 4 facility fee in 2018.
Still, those prices pale in comparison with the fee charged to Fischer. “That seems like an outlier on the high end,” said John Hargraves, a senior researcher at the institute who led the ER study. “That’s more than triple what it was in 2016.”
Expensive saline
Fischer’s bill included $500 for a complete blood count, a test the online price comparison tool Healthcare Bluebook says could be had for less than $20 in a doctor’s office. He was charged more than $1,300 for a complete metabolic panel, a routine test that generally costs about $31.
The two liters of saline, which the ER billed at $700, are available at Walmart for $10.99 per liter.
The ER also charged Fischer $970 for a drug test, which he said he never consented to undergo. Medicare typically pays health care providers about $114 for the same test.
“When you look at the bill, obviously the prices are astronomical,” Fischer said. “But it was also the work that was performed without my authorization. That was pretty frustrating.”
HealthONE officials said the prices at its ERs are higher than at urgent care clinics or other outpatient settings because the ERs are staffed by board-certified emergency physicians and cannot turn away patients regardless of their ability to pay. So the patients who pay for care at their ERs subsidize those who show up and can’t pay.
“The move toward higherdeductible insurance plans has put a strain on many of our patients, but we understand their choice to pay a lower monthly premium, and we also understand their frustration with the larger out-of-pocket expenses they may experience as a result,” HealthONE North Suburban Medical Center spokeswoman Betty Rueda-Aguilar said in a written statement to Kaiser Health News. She added that Fischer presented with symptoms of alcohol poisoning and had to be treated accordingly. The company declined an interview.
The negotiated rates under Fischer’s health plan knocked his bill down to $4,694. The plan paid $2,102. That left Fischer with a bill of $2,592, which he said he can’t afford to pay.