WASHINGTON, D.C.—A recent article in Vox about hospital billing practices makes a number of assertions that rely heavily on data from the Health Care Cost Institute or HCCI, which receives millions of dollars from four of the largest health insurance companies. According to a statement from Paul Kivela, MD, FACEP, president of the American College of Emergency Physicians:
“Unfortunately, Vox’s data source is not independent, because the data used for the article come directly from a limited subset of claims from four major commercial insurers, which have a long history of denying emergency department claims. For example, the state of New York successfully sued United Health Care, one of the main contributors to HCCI, for fraudulently calculating and significantly underpaying doctors for out-of-network medical services using its Ingenix database. In 2014, only 34 percent of emergency department visits were under private payer coverage (of which employer-sponsored coverage is an even smaller subset). Basing an analysis such as Vox’s on data only from employer-sponsored health plans leaves out a major portion of the picture and skews the article’s findings. For example, Vox says it found that emergency department visits have dropped by 2 percent between 2009 and 2015—yet CDC data show that visits have actually increased overall by 3.9 percent from 2009 to 2014. Such a disparity calls into question the rest of the findings presented in the piece.
“Hospital emergency departments are legally required to be open 24 hours a day, seven days a week, which is not one of the characteristics of a ‘monopoly,” as the article claimed them to be. Unlike urgent care centers and physician office, they never turn anyone away. This has resulted in significant amount of uncompensated care over the years.
“The article correctly identifies hospital facility fees as one of the most expensive part of an emergency department bill. Doctors bill separately and are typically about one-fourth of a total emergency department bill.
“Emergency physicians are calling for transparency by insurance companies and use of independent databases, such as Fair Health to calculate physician payments.”