News: ED spending among the commercially insured on the rise due to price, high-severity coding, study finds

CDI Strategies - Volume 13, Issue 31

While the average price for the five ED current procedural terminology (CPT) codes were higher in 2016 than in 2009, the average price for higher severity codes rose at a faster rate than low severity codes, according to a study from the Health Care Cost Institute (HCCI). Additionally, the use of high severity codes increased over the study period (2009-2016), despite decreases in ED use. Both of these changes over time lead to a per person spending increase by more than 100% for the two most severe codes from 2009 to 2016, HCCI found.

More specifically, the study found that from 2009 to 2016:

  • ED visit spending per person increased 98% while overall use remained the same.
  • Overall ED spending growth was largely driven by higher severity visits, on which spending more than doubled.
  • Per person spending on the highest severity ED visit rose 145%, with price increasing 77% and use increasing 38%.

HCCI created an interactive tool for users to determine how costs changed over time by state. According to their analysis, ED spending increased in every state primarily because of higher costs and the increased use of higher severity procedure codes. Though 21 states saw spending increases of more than 100%, Mississippi had the highest overall ED spending increase, rising 153% from 2009-2016.

Editor’s note: To read HCCI’s findings, access the interactive tool, and download the complete data, click here. To read about another study about private insurer spending, click here.

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